Cromolyn Sodium Inhalation Solution

Management of bronchial asthma in adults and pediatric patients 2 years of age and older: usual starting dosage is the contents of 1 vial administered by nebulization 4 times daily at regular intervals.

Effect of cromolyn sodium inhalation solution therapy is dependent upon its administration at regular intervals, as directed. Cromolyn sodium inhalation solution should be introduced into the patient's therapeutic regimen when the acute episode has been controlled, the airway has been cleared and the patient is able to inhale adequately.

Prevention of acute bronchospasm following exercise or exposure to cold dry air, environmental agents (eg, animal danders, toluene diisocyanate, pollutants): usual dose is 1 vial administered via nebulization shortly before exposure to the precipitating factor.

Cromolyn sodium inhalation therapy in relation to other treatment for asthma:

Nonsteroidal agents

• Cromolyn sodium inhalation solution should be added to the patient's existing treatment regimen (eg, bronchodilators).
• An attempt may be made to decrease concomitant medication usage gradually if clinical response to cromolyn sodium inhalation solution is evident (usually within 2-4 weeks) and if asthma is under good control.
• If concomitant medications are eliminated or required on no more than an as-needed basis, the frequency of administration of cromolyn sodium inhalation solution may be titrated downward to the lowest level consistent with the desired effect; usual decrease is from 4 to 3 vials per day, reduce gradually to avoid exacerbation.
• In patients whose dosage has been titrated to fewer than 4 vials per day, an increase in the dose of cromolyn sodium inhalation solution and the introduction of, or increase in, symptomatic medications may be needed if the patient's clinical condition deteriorates.

Corticosteroids

• In patients receiving corticosteroids for bronchial asthma management, dosage of corticosteroids should be maintained following the introduction of cromolyn sodium inhalation solution.
• An attempt to decrease corticosteroids should be made if the patient improves.
• Even if the corticosteroids-dependent patient fails to show symptomatic improvement following cromolyn sodium inhalation solution administration, the potential to decrease corticosteroids may still be present; gradual tapering (with close supervision) of corticosteroids may be attempted.
• Consideration should be given to reinstituting corticosteroid therapy if a patient is subjected to significant stress, such as a severe asthmatic attack, surgery, trauma or severe illness while being treated or within 1 year (occasionally up to 2 years) after prolonged corticosteroid treatment has been terminated.
• Continued close supervision of the patient is essential if for any reason cromolyn sodium inhalation solution is withdrawn in cases where its use permitted a reduction in corticosteroid use; severe manifestations of asthma may occur and may require immediate therapy and possible reintroduction of corticosteroids.