Asthma Drug Summary

Last updated: 05 August 2025

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Anticholinergics (Inhaled)

Content on this page:

Anticholinergics (Inhaled)

Anticholinergics (Inhaled)


Drug  Available Strength
 Dosage Remarks
Short-Acting Adverse Reactions
  • Respiratory effects (upper respiratory tract infection [URTI], bronchitis, sinusitis); CV effects (chest pain, palpitation); CNS effects (headache, dizziness); GI effects (dry mouth, bad taste, dyspepsia, nausea); Hypersensitivity effects (urticaria, angioedema, rash, bronchospasm)
Special Instructions
  • Avoid contact of eyes with inhalation solution
  • Use with caution in patients with prostatic hyperplasia, patients predisposed to narrow-angle glaucoma, bladder neck obstruction, myasthenia gravis
  • Check patient’s inhaler technique for optimum delivery of drug
  • Not used as first-line treatment
    • Should be added to beta2-agonist therapy
Ipratropium bromide

 20 mcg/puff MDI  2 puffs 6 hourly
Max dose: 12 puffs/day   
250 mcg/mL, 250, 500 mcg/2 mL inhalation solution
 100-500 mcg via nebulizer up to 8 hourly as required
0.025% inhalation solution  0.4-2 mL (100-500 mcg) via nebulizer 6-8 hourly
 Long-Acting
Tiotropium bromide
 2.5 mcg/puff  2 puffs 24 hourly
18 mcg inhalation powder cap
 Inhale 1 cap 24 hourly

Antihistamines & Antiallergics


Drug Dosage Remarks
Allergen Extract
House dust mite allergen extract (D pteronyssinus and D farinae) 1 oral lyophilisate tab (12 SQ-HDM) sublingually 24 hourly Adverse Reactions
  • Nasopharyngeal effects (throat irritation, oromucosal erythema, lip/mouth edema, rhinitis); Respiratory effects (bronchitis, asthma, dyspnea); Other effects (GI upset, chest discomfort, pruritus, urticaria)
Special Instructions
  • Take 5 minutes before meals and beverage; maintain sublingually for approximately 1 minute before swallowing
  • Avoid abrupt discontinuation of asthma controller medication
  • Avoid in patients with severe asthma exacerbation within the last 3 months, asthma with acute respiratory tract infection until resolved; active or poorly controlled autoimmune diseases, immunodeficiencies, malignant neoplastic diseases, acute severe oral inflammation or wounds
  • Use with caution in patients with previous systemic allergic reaction to SC HDM immunotherapy, cardiac disease, severe or persisting gastroesophageal symptoms, autoimmune diseases in remission, fish allergy
  • Postpone therapy in patients with severe oral inflammation, oral wounds, oral surgery, dental extraction, or following tooth loss and temporarily interrupt ongoing treatment
Mast Cell Stabilizer
 
Ketotifen 1-2 mg PO 12 hourly or
0.5-1 mg PO at night for the first week of treatment to minimize drowsiness		 Adverse Reactions
  • CNS effects (drowsiness, dizziness, CNS stimulation); GI effects (dry mouth, increased appetite, weight gain)
Special Instructions
  • Should not be used for acute asthma attacks
  • Use with caution in patients who requires mental alertness (eg driving, machine operation)

Beta2 Adrenoceptor Agonists (Bronchodilators) (Inhaled)*


Drug  Available Strength
 Dosage1 Remarks
Short-Acting Adverse Reactions
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
Special Instructions
  • Use with caution in patients with hyperthyroidism, diabetes mellitus (DM), myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
  • Spacer device or valved holding chamber is advised when using MDI
Fenoterol

 100 mcg/puff MDI 1-2 puffs 6-8 hourly as required
Max dose: 8 puffs/day   
1 mg/mL (0.1% inhalation solution)
 0.5 mL (10 drops) via nebulizer up to 6 hourly
Procaterol
 10 mcg/puff swinghaler
 2 puffs up to 6 hourly as required
Max dose: 8 puffs/day 
30 mcg/0.3 mL,
50 mcg/0.5 mL
 30-50 mcg via nebulizer 
Salbutamol (Albuterol)  100, 200 mcg/dose easi-breathe MDI  100-400 mcg inhaled PO 6-12 hourly as required
Max dose: 2.4 mg/day
100 mcg/puff MDI/CFC-free 
200 mcg/dose easyhaler DPI
200 mcg/cap rotahaler DPI 
200, 400 mcg/cap DPI
200 mcg/dose diskhaler DPI
1 mg, 2 mg/mL, 2.5 mg/2.5 mL inhalation solution
 2.5-5 mg via nebulizer 6-8 hourly as required
Max dose: 40 mg/day 
5 mg/mL inhalation solution
 0.5-1 mL (2.5-5 mg) via nebulizer 6-8 hourly
Max single dose: 5 mg (1 mL)
Terbutaline
 250 mcg/puff MDI  250-500 mcg 6-8 hourly as required
Max dose: 2 mg/day 
500 mcg/dose turbuhaler DPI
 200-800 mcg inhaled PO 6-12 hourly as required
For severe exacerbations: 1,600 mcg/day
Max dose: 12 inhalations/day 
2.5 mg/mL  2.5-10 mg via nebulizer up to 6 hourly as required
 Long-Acting
Formoterol
 12 mcg/cap DPI   1-2 caps inhaled PO 12 hourly
Salmeterol
 25 mcg/puff MDI 2-4 puffs 12 hourly
50 mcg/dose accuhaler DPI, diskhaler DPI
 1-2 doses inhaled PO 12 hourly
*Should be used as an adjunct to inhaled corticosteroids in the management of asthma.
1Please note: Doses for acute exacerbations can be higher than the recommended maintenance doses listed here.

Beta2 Adrenoceptor Agonists (Bronchodilators) (Oral)*


Drug Dosage Remarks
Short-Acting Adverse Reactions
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
  • Orciprenaline is less selective for beta2-receptors and therefore, side effects may be more common
Special Instructions
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
Clenbuterol 20-40 mcg PO 12 hourly
Max dose: 80 mcg/day
Fenoterol 2.5-5 mg PO 8-12 hourly
Hexoprenaline 0.5-1 mg PO 8-12 hourly
Max dose: 3 mg/day
Orciprenaline (Metaproterenol)  10-20 mg PO 6 hourly 
Procaterol  50 mcg PO 12-24 hourly
Salbutamol (Albuterol)
 2-4 mg PO 6-8 hourly
Max dose: 32 mg/day 
Terbutaline
 2.5-5 mg PO 8-12 hourly 
Trimetoquinol
 2-4 mg PO 8-12 hourly
Long-Acting
Bambuterol 10 mg PO 24 hourly
May be increased to 20 mg PO 24 hourly after 1-2 weeks
Max dose: 10 mg
Salbutamol (Albuterol) 2-4 mg PO 6-8 hourly
May increase dose up to 8 mg
Max dose: 32 mg/day
Extended-release: 4-8 mg PO 12 hourly
Terbutaline
 2.5-5 mg PO 8-12 hourly
*Oral bronchodilator combinations are available. Please see the latest MIMS for specific formulations and prescribing information.

Beta2 Adrenoceptor Agonists (Bronchodilators) (Topical)


Drug Dosage Remarks
Tulobuterol 2 mg transdermal patch 24 hourly
 Adverse Reactions
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
Special Instructions
  • Contraindicated in patients with pheochromocytoma
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma

Bronchodilators (Parenteral)


Drug Dosage Remarks
Beta2-Agonists Adverse Reactions
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
  • Epinephrine: Dyspnea, hyperglycemia, restlessness, palpitations, tachycardia, tremors, sweating, hypersalivation, weakness, dizziness, headache, coldness of extremities, hypertension, flushing, hypotension
Special Instructions
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
Salbutamol 50 mcg IM/SC may repeat 4 hourly as required
As 50 mcg/mL solution: 250 mcg slow IV injection may repeat as required
As 10 mcg/mL solution: 3-20 mcg/min IV infusion
Terbutaline 250-500 mcg SC/IM/slow IV 6 hourly or
3-5 mcg/mL at 0.5-1 mL/min IV infusion
Non-specific Sympathomimetic
Epinephrine (Adrenaline) 0.3-0.5 mg IM/SC every 5-15 minutes as required for up to 3 doses

Corticosteroids (Inhaled)


Drug  Available Strength
 Dosage Remarks
Beclometasone dipropionate (Beclomethasone dipropionate)

 50, 100, 250 mcg/puff MDI 200-100 mcg/day 

Adverse Reactions
  • Local effects (cough from upper airway irritation, dysphonia, oropharyngeal candidiasis); Paradoxical bronchospasm
  • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising and adrenal suppression
Special Instructions
  • Local effects may be minimized by using a spacer, gargling and spitting out with water
  • Not for relief of acute bronchospasm
  • Contraindicated in patients with recent nasal septal ulcers, surgery, or trauma
  • Use with caution in patients with heart failure, acute MI, DM, GI diseases, hepatic/renal impairment, myasthenia gravis, osteoporosis, seizure disorder, thyroid disease
100, 250 mcg/puff easi-breathe
200 mcg/dose easyhaler DPI
Budesonide


  100, 200 mcg/puff MDI
 200-800 mcg/day 
100, 200, 400 mcg/dose turbuhaler DPI; 100, 200, 400, 800 mcg/cap DPI
250 mcg/mL, 500 mcg/mL, 500 mcg/2 mL, 1 mg/2 mL inhalation solution
Ciclesonide
 80, 160 mcg/dose MDI  80-320 mcg/day
Fluticasone
 50, 125, 250 mcg/puff MDI  100-1,000 mcg 12 hourly 
50, 100, 250 mcg/dose accuhaler DPI; 50, 250 mcg/dose rotadisk DPI; 50, 125, 250 mcg/dose evohaler 
0.5 mg/2 mL, 2 mg/2 mL inhalation solution 
Mometasone 100, 200 mcg/dose for inhalation unit dose
 Depends on DPI device
200-400 mcg/day

Corticosteroids (Systemic)


Drug Dosage Remarks
Methylprednisolone,
Prednisolone,
Prednisone		 Asthma exacerbations:
40-80 mg/day PO divided 12-24 hourly x 5-10 days
 Adverse Reactions
  • Gastritis; If administered long-term: Adrenocortical insufficiency, osteoporosis, muscle wasting, pain or weakness, increased susceptibility to infection, impaired wound healing, electrolyte imbalances, weight gain, DM, skin thinning leading to striae & easy bruising, cataracts, glaucoma
Special Instructions
  • Take with food
  • Patients on long-term corticosteroids should receive preventive treatment for osteoporosis
  • Not for relief of acute bronchospasm
  • Use with caution in patients with heart failure, acute MI, DM, GI diseases, hepatic/renal impairment, myasthenia gravis, seizure disorder, osteoporosis, thyroid disease
  • Long-term treatment is not recommended due to its side effects
Bronchial asthma
Maintenance dose: Up to 64 mg PO as single dose on alternate days
Max dose: 100 mg/day
Status asthmaticus: 40 mg IV repeated as dictated by patient response

Cough & Cold Preparations


Drug Dosage Remarks
Lagundi
(Vitex negundo)		 300-600 mg PO 6-8 hourly
 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); Dermatologic effect (rash)
Special Instructions
  • Use with caution in patients with hypersensitivity to Lagundi

Antiasthmatic Preparations - Combination Products

 
Drug Dosage Remarks
Beclometasone/Formoterol 100 mcg/6 mcg: 1 or 2 inhalations 12 hourly
Max dose: 4 inhalations/day
May take 1 additional inhalation as needed in response to symptoms up to a total 8 inhalations/day		 Adverse Reactions

Beclometasone
  • Local effects (cough from upper airway irritation, dysphonia, oropharyngeal candidiasis); Paradoxical bronchospasm
  • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising and adrenal suppression
Formoterol
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
Salbutamol
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
Special Instructions

Beclometasone
  • Local effects may be minimized by using a spacer, gargling and spitting out with water
  • Not for relief of acute bronchospasm
  • Contraindicated in patients with recent nasal septal ulcers, surgery, or trauma
  • Use with caution in patients with heart failure, acute MI, DM, GI diseases, hepatic/renal impairment, myasthenia gravis, osteoporosis, seizure disorder, thyroid disease
Formoterol
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
  • Spacer device or valved holding chamber is advised when using MDI
Salbutamol
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
  • Spacer device or valved holding chamber is advised when using MDI
Beclometasone/Salbutamol
 50 mcg/100 mcg: 2 inhalations 4-6 hourly
Max dose: 12 inhalations/day
Beclometasone/Formoterol/Glycopyrronium 100 mcg/6 mcg/12.5 mcg: 2 inhalations 12 hourly
Max dose:  4 inhalations/day		 Adverse Reactions
  • Respiratory effects (asthma exacerbation, URTI); Oropharyngeal effects (oropharyngeal pain, dysphonia, oral candidiasis); Other effects (blurred vision, headache, musculoskeletal pain)
Special Instructions
  • Administer doses at the same time each day
  • Advise patient to rinse or gargle without swallowing after inhaling dose
  • Discontinue use if paradoxical bronchospasm occurs
  • Use with caution in patients with CV disorders, visual disturbances, hypokalemia, hyperglycemia, pulmonary TB, untreated infections, renal and hepatic impairment
Budesonide/Formoterol 80 mcg/4.5 mcg: 1-2 inhalations 12 hourly
160 mcg/4.5 mcg: 1-2 inhalations 12 hourly
200 mcg/6 mcg: 1-2 inhalations 12 hourly
320 mcg/9 mcg: 1-2 inhalations 12 hourly
400 mcg/12 mcg: 1-2 inhalations 12 hourly
Max dose: 4 inhalations/day		 Adverse Reactions

Budesonide, Fluticasone
  • Local effects (cough from upper airway irritation, dysphonia, oropharyngeal candidiasis); Paradoxical bronchospasm
  • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising and adrenal suppression
Formoterol, Salmeterol
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
Special Instructions

Budesonide, Fluticasone
  • Local effects may be minimized by using a spacer, gargling and spitting out with water
  • Not for relief of acute bronchospasm
  • Contraindicated in patients with recent nasal septal ulcers, surgery, or trauma
  • Use with caution in patients with heart failure, acute MI, DM, GI diseases, hepatic/renal impairment, myasthenia gravis, osteoporosis, seizure disorder, thyroid disease
Formoterol, Salmeterol
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
  • Spacer device or valved holding chamber is advised when using MDI
Fluticasone/Formoterol 50 mcg/5 mcg: 2 inhalations 12 hourly
125 mcg/5 mcg: 2 inhalations 12 hourly
250 mcg/10 mcg: 2 inhalations 12 hourly
Fluticasone/Salmeterol
 50 mcg/25 mcg: 2 inhalations 12 hourly
125 mcg/25 mcg: 2 inhalations 12 hourly
250 mcg/25 mcg: 2 inhalations 12 hourly
100 mcg/50 mcg: 1 inhalation 12 hourly
250 mcg/50 mcg: 1 inhalation 12 hourly
500 mcg/50 mcg: 1 inhalation 12 hourly 
Fluticasone/Vilanterol
 Initial dose:
100 mcg/25 mcg: 1 inhalation 24 hourly
Max dose:
200 mcg/25 mcg: 1 inhalation 24 hourly  		 Adverse Reactions
  • Respiratory effects (nasopharyngitis, pneumonia, cough, pharyngitis, URTI, oropharyngeal pain, sinusitis, rhinitis); GI effect (abdominal pain); Other effects (headache, pyrexia, back pain, muscle spasms)
Special Instructions
  • Avoid in patients with severe milk protein allergy
  • Discontinue use if paradoxical bronchospasm occurs
  • Use with caution in patients with CV disorders, visual disturbances, hypokalemia, pulmonary TB
Fluticasone furoate/Umeclidinium/
Vilanterol
 100 mcg/62.5 mcg/25 mcg:
1 inhalation 24 hourly
 Adverse Reactions
  • Respiratory effects (nasopharyngitis, URTI, bronchitis, viral infection, sinusitis, rhinitis, pneumonia, flu, cough); Other effects (headache, back pain, oropharyngeal pain, dysphonia)
Special Instructions
  • Do not use for the relief of acute symptoms
  • Rinse mouth with water after inhalation
  • Assess bone mineral density (BMD) prior to treatment and periodically thereafter
  • Use with caution in patients with moderate to severe hepatic impairment, severe CV disease, pulmonary tuberculosis, chronic or untreated infections, ocular herpes simplex, narrow-angle glaucoma, prostatic hyperplasia, bladder-neck obstruction, DM, convulsive disorders, thyrotoxicosis, ketoacidosis, on corticosteroids or long-acting beta2-agonist monotherapy
  • Hypercortisolism, adrenal suppression and adrenal function impairment may occur
Indacaterol/Mometasone
 150 mcg/80 mcg: 1 inhalation 24 hourly
150 mcg/160 mcg: 1 inhalation 24 hourly
150 mcg/320 mcg: 1 inhalation 24 hourly
Max dose:150 mcg/320 mcg 24 hourly 		 Adverse Reactions
  • Respiratory effects (nasopharyngitis, asthma exacerbation, URTI, oropharyngeal pain, dysphonia); Other effects (headache, musculoskeletal pain)
Special Instructions
  • Administer doses at the same time each day
  • Discontinue use if paradoxical bronchospasm occurs
  • Use with caution in patients with CV disorders, visual disturbances, hypokalemia, pulmonary TB, untreated infections
Indacaterol/Mometasone/
Glycopyrronium 		 150 mcg/160 mcg/50 mcg: 1 inhalation 24 hourly
Max dose: 150 mcg/160 mcg/50 mcg 24 hourly
Ipratropium bromide/Fenoterol  20 mcg/50 mcg: 1 puff for prompt relief
If there is no improvement after 5 minutes, 1 dose may be given; further doses may be required if there is no relief after 2 administrations
Intermittent and long-term treatment:
1 puff up to 8 hourly
Max dose: 8 puffs/day
0.5 mg/1.25 mg/4 mL solution:
1 nebulization 24 hourly 		 Adverse Reactions

Ipratropium
  • Respiratory effects (URTI, bronchitis, sinusitis); CV effects (chest pain, palpitation); CNS effects (headache, dizziness); GI effects (dry mouth, bad taste, dyspepsia, nausea); Hypersensitivity effects (urticaria, angioedema, rash, bronchospasm)
Fenoterol, Salbutamol
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
Special Instructions

Ipratropium
  • Avoid contact of eyes with inhalation solution
  • Use with caution in patients with prostatic hyperplasia, patients predisposed to narrow-angle glaucoma, bladder neck obstruction, myasthenia gravis
  • Check patient’s inhaler technique for optimum delivery of drug
  • Not used as first-line treatment
    • Should be added to beta2-agonist therapy
Fenoterol, Salbutamol
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
  • Spacer device or valved holding chamber is advised when using MDI

 
Ipratropium bromide/Salbutamol  20 mcg/100 mcg: 2 inhalations 6 hourly
Max dose: 12 inhalations/day
500 mcg/2.5 mg/2.5 mL unit dose vial (UDV): 1 inhalation 6-8 hourly 
Mometasone/Formoterol
 100 mcg/5 mcg: 2 inhalations 12 hourly
200 mcg/5 mcg: 2 inhalations 12 hourly 		 Adverse Reactions

Mometasone
  • Local effects (cough from upper airway irritation, dysphonia, oropharyngeal candidiasis); Paradoxical bronchospasm
  • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising and adrenal suppression
Formoterol
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
Special Instructions

Mometasone
  • Local effects may be minimized by using a spacer, gargling and spitting out with water
  • Not for relief of acute bronchospasm
  • Contraindicated in patients with recent nasal septal ulcers, surgery, or trauma
  • Use with caution in patients with heart failure, acute MI, DM, GI diseases, hepatic/renal impairment, myasthenia gravis, osteoporosis, seizure disorder, thyroid disease
Formoterol
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
  • Spacer device or valved holding chamber is advised when using MDI
Salbutamol/Budesonide
(Albuterol/Budesonide)
 90 mcg/80 mcg: 2 inhalations PO as needed
Max dose: 12 inhalations/day 		 Adverse Reactions

Salbutamol
  • CV effects (angina, palpitation, chest pain, tachycardia); CNS effects (headache, irritability, seizure); Dermatologic effects (urticaria, rash); Endocrine effects (hyperglycemia, hypokalemia); Respiratory effects (asthma exacerbation, bronchospasm, cough, viral infection); Other effects (anaphylaxis, allergy)
Budesonide
  • Local effects (cough from upper airway irritation, dysphonia, oropharyngeal candidiasis); Paradoxical bronchospasm
  • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising and adrenal suppression
Special Instructions

Salbutamol
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency, arrhythmia, hypertension, HF, glaucoma, hypokalemia, seizure disorder
    • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
  • Spacer device or valved holding chamber is advised when using MDI
Budesonide
  • Local effects may be minimized by using a spacer, gargling and spitting out with water
  • Not for relief of acute bronchospasm
  • Contraindicated in patients with recent nasal septal ulcers, surgery, or trauma
  • Use with caution in patients with heart failure, acute MI, DM, GI diseases, hepatic/renal impairment, myasthenia gravis, osteoporosis, seizure disorder, thyroid disease

Leukotriene Modifiers


Drug Dosage Remarks
5-Lipoxygenase Inhibitor
Zileuton 600 mg PO 6 hourly
Extended release: 1,200 mg PO 12 hourly
 Adverse Reactions
  • Headache, GI upset, increased liver enzymes, rashes; Leukopenia has occurred in a few patients
Special Instructions
  • Avoid in patients with hepatic impairment or liver disease
  • Monitor liver enzymes before and periodically during therapy
  • Should not be used for acute asthma attacks
Leukotriene Receptor Antagonists
Montelukast 10 mg PO 24 hourly at bedtime Adverse Reactions
  • Generally well-tolerated: Headache, GI upset
  • Less commonly: Generalized pain, arthralgia, myalgia, fever, dizziness; Hypersensitivity effects
  • Zafirlukast: Raised liver enzymes, rarely symptomatic hepatitis, hyperbilirubinemia
  • Very rarely: Agranulocytosis, bleeding, bruising and edema, systemic eosinophilia consistent with Churg-Strauss disease
  • Neuropsychiatric effects have been observed (eg agitation, aggression, depression, insomnia)
Special Instructions
  • Zafirlukast: Avoid in patients with hepatic impairment or cirrhosis
  • Should not be used for acute asthma attacks
Zafirlukast 20 mg PO 12 hourly

Monoclonal Antibodies


Drug Dosage Remarks
Anti-Immunoglobulin E (Anti-IgE) Antibody
Omalizumab Dose depends on pretreatment IgE level and body weight
75-600 mg in 1-4 SC injection every 2-4 weeks
Max dose: 600 mg every 2 weeks		 Adverse Reactions
  • Musculoskeletal effects (arthralgia, myalgia, joint swelling); Dermatologic effect (pruritus); GI effect (upper abdominal pain); Respiratory effect (pharyngitis); CNS effects (headache, dizziness); Other effects(fatigue, pyrexia, injection site reactions)
Special Instructions
  • Max of 150 mg should be delivered per injection site
  • Should not be used for the treatment of acute asthma exacerbations, acute bronchospasm or status asthmaticus
  • Systemic or inhaled corticosteroids should not be abruptly discontinued upon initiation of Omalizumab therapy
  • Use with caution in patients at risk of helminth infections, children <6 years old
Interleukin (IL) Inhibitors
Benralizumab
 30 mg SC every 4 weeks for the first 3 doses, then every 8 weeks thereafter

Adverse Reactions

  • Respiratory effect (pharyngitis); Other effects (hypersensitivity reactions, headache, pyrexia, injection site reaction)

Special Instructions

  • Should not be used to treat acute asthma exacerbations
  • Use with caution in patients with helminth infection, children <12 years old
  • Abrupt discontinuation of corticosteroids after initiation of Benralizumab is not recommended
Dupilumab 400 mg SC (two 200 mg injection) followed by 200 mg SC every other week
Patients with severe asthma and on oral corticosteroids or with severe asthma and comorbid moderate to severe atopic dermatitis: Initial dose: 600 mg SC (two 300 mg injection) followed by 300 mg SC every other week

Adverse Reactions

  • Injection site reaction, very rare cases of anaphylactic reaction

Special Instructions

  • Initial two SC injection should be consecutively administered into different injection sites
  • Should not be used to treat acute asthma symptoms or acute exacerbations, acute bronchospasms or status asthmaticus
  • Use with caution in adult asthma patients with eosinophilic conditions, atopic dermatitis patients with comorbid asthma, patients with hepatic impairment or severe renal impairment, children <12 years old
  • Treat patients with pre-existing helminth infections prior to initiation of treatment
Mepolizumab 100 mg SC once every 4 weeks

Adverse Reactions

  • Dermatologic effects (eczema, injection site reactions); Musculoskeletal effect (back pain); Respiratory effects (nasal congestion, lower respiratory tract infection, pharyngitis); Other effects (UTI, headache, pyrexia, upper abdominal pain)

Special Instructions

  • Should not be used to treat acute asthma exacerbations
  • Use with caution in patients with helminth infection, acute and delayed systemic reactions
  • Abrupt discontinuation of corticosteroid after initiation of Mepolizumab is not recommended
Reslizumab
 3 mg/kg IV infusion over 20-50 minutes once every 4 weeks Adverse Reactions
  • Anaphylaxis, oropharyngeal pain, malignancy
Special Instructions
  • Should not be used for the treatment of acute asthma symptoms, acute exacerbations, acute bronchospasm, or status asthmaticus
  • Contraindicated in patients <18 years old
  • Corticosteroids should be tapered gradually
  • Use with caution in patients at risk of helminth infections
Thymic Stromal Lymphopoietin Blocker
Tezepelumab 210 mg SC every 4 weeks

Adverse Reactions

  • Hypersensitivity effects (eg rash, allergic conjunctivitis); Injection site reactions; Other effects (arthralgia, back pains, pharyngitis)
  • May develop neutralizing antibodies; although anti-antibodies were generally low and transient

Special Instructions

  • Avoid giving live virus vaccines in patients receiving treatment
  • Should not be used for the treatment of acute asthma symptoms, acute exacerbations, acute bronchospasm, or status asthmaticus
  • Use with caution in patients at risk of helminth infections

Other Drugs Acting on the Respiratory System


Drug Dosage Remarks
Bacterial lysate (Lyophilized H influenzae,
D pneumoniae, K pneumoniae, K ozaenae,
S aureus, S pyogenes, S viridans,
N catarrhalis)		 Acute treatment: 50 mg under the tongue 24 hourly x 10 days
Long-term treatment: 50 mg under the tongue 24 hourly x 10 consecutive days/month x 3 months
 Adverse Reactions
  • GI effects (nausea, diarrhea, upper abdominal pain, gastric upset); Other effects (skin itching, cutaneous reactions, urological problems)
Special Instructions
  • Contraindicated in patients with autoimmune disease, cardiopulmonary insufficiency, conditions with compromised immunity, active TB, rheumatic disease

Xanthines


Drug Dosage Remarks
Aminophylline 5-6 mg/kg IV over 20-30 minutes Adverse Reactions
  • GI effects (irritation, nausea/vomiting, abdominal pain, diarrhea, gastroesophageal reflux); CNS effects (CNS stimulation, headache, anxiety, restlessness, dizziness, tremor); CV effects (palpitations, tachycardia)
  • Serum concentration>15-20 mcg/mL (85-110 μmol/L) are associated with increased risk of adverse effects including lethal adverse reactions
Special Instructions
  • Use with caution in patients with peptic ulcer, hyperthyroidism, hypertension, cardiac arrhythmias or other CV disease, epilepsy, heart failure, hepatic dysfunction or chronic alcoholism, acute febrile illness and in the elderly
  • Many drug interactions occur with Theophylline including smoking (which increases the Theophylline clearance)
  • Serum concentration monitoring is necessary to ensure concentration are within therapeutic range
    • Serum concentration needs to be measured if a patient is changed from one extended-release product to another, if higher dose is used, or if overdose is suspected
    • Optimal therapeutic concentration: 5-15 mcg/mL (28-85 μmol/L)
Choline theophyllinate
 Initial dose: 0.2-0.4 g PO 24 hourly
Maintenance dose: 0.8-1.2 g/day PO divided 6-8 hourly 
Diprophylline (Dyphylline)  15 mg/kg PO 6 hourly 
Doxofylline 400 mg PO 8-12 hourly
Theophylline1 250 mg PO 12 hourly
Extended-release: 5-8 mg/kg/day PO divided 12 hourly
Maintenance dose: 7-12 mg/kg/day PO divided 12 hourly
1Many different formulations for Theophylline are available. Please see the latest MIMS for specific formulations and prescribing information.

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.   
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs