General

**Off Market Drug**
This medication is no longer available in the United States. Information provided here is for reference purposes only.

Pronunciation:
trye-am-sin-oh-lone

Trade Name(s)

• Azmacort

Ther. Class.

anti-inflammatories (steroidal)

Pharm. Class.

corticosteroids

Indications

• Maintenance treatment of asthma as prophylactic therapy.
• May decrease requirement for or eliminate use of systemic corticosteroids in patients with asthma.

Action

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic Effect(s):

• Decreases frequency and severity of asthma attacks.
• Improves asthma symptoms.

Pharmacokinetics

Absorption: 25%. Action is primarily local after inhalation.

Distribution: Crosses placenta; enters breast milk in small amounts.

Metabolism and Excretion: Metabolized by the liver after absorption from lungs; 40% excreted in urine, 60% in feces.

Half-life: 88 min.

TIME/ACTION PROFILE (improvement in symptoms)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity (product contains chlorofluorocarbon propellants and alcohol)
• Acute attack of asthma/status asthmaticus.

Use Cautiously in:

• Active untreated infections
• Diabetes or glaucoma
• Underlying immunosuppression (due to disease or concurrent therapy)
• Systemic corticosteroid therapy (should not be abruptly discontinued when inhalable therapy is started; additional corticosteroids needed in stress or trauma)
• Pregnancy, lactation, or children <6 yr (safety not established; prolonged or high-dose therapy may lead to complications).

Adverse Reactions/Side Effects

Derm: rash

EENT: pharyngitis, dysphonia, oropharyngeal fungal infections, sinusitis

Neuro: headache

Resp: bronchospasm, wheezing

GI: abdominal pain, diarrhea, dry mouth, vomiting

Endo: adrenal suppression (high-dose, long-term therapy only), decreased growth (children), weight gain

GU: vaginal moniliasis

MS: back pain, myalgia

Misc: flu-like syndrome

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None known.

Route/Dosage

Inhaln (Adults and Children  >12 yr): 2 inhalations 3–4 times daily or 4 inhalations twice daily; higher initial doses should be reserved for more severe asthma (not to exceed 16 inhalations/day).

Inhaln (Children  6–12 yr): 1–2 inhalations 3–4 times daily or 2–4 inhalations twice daily (not to exceed 12 inhalations/day).

Availability

Inhalation aerosol: 100 mcg/metered inhalation in 20-g canister (delivers 240 metered inhalations)

Assessment

• Monitor respiratory status and lung sounds. Pulmonary function tests may be assessed periodically during and for several mo after a transfer from systemic to inhalation corticosteroids.
• Assess patients changing from systemic to inhalation corticosteroids for signs of adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia) during initial therapy and periods of stress. If these signs appear, notify physician or other health care professional immediately; condition may be life-threatening.
• Monitor for withdrawal symptoms (joint or muscular pain, lassitude, depression) during withdrawal from oral corticosteroids.
• Monitor growth rate in children receiving chronic therapy; use lowest possible dose.

Lab Test Considerations:

Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

• May cause increased serum and urine glucose concentrations if significant absorption occurs.

Potential Diagnoses

• Ineffective airway clearance (Indications) 
• Risk for infection (Side Effects) 

Implementation

• After desired clinical effect is obtained, decrease dose to lowest amount required to control symptoms. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
• Inhaln Allow at least 1 min between inhalations of aerosol medication.

Patient/Family Teaching

• Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Advise patient not to discontinue medication without consulting health care professional; gradual decrease is required.
• Advise patients using inhalation corticosteroids and bronchodilator to use bronchodilator first and to allow 5 min to elapse before administering the corticosteroid, unless otherwise directed by health care professional.
• Advise patient that inhalation corticosteroids should not be used to treat an acute asthma attack but should be continued even if other inhalation agents are used.
• Patients using inhalation corticosteroids to control asthma may require systemic corticosteroids for acute attacks. Advise patient to use regular peak flow monitoring to determine respiratory status.
• Caution patient to avoid smoking, known allergens, and other respiratory irritants.
• Advise patient to notify health care professional if sore throat or mouth occurs.
• Instruct patient whose systemic corticosteroids have been recently reduced or withdrawn to carry a warning card indicating the need for supplemental systemic corticosteroids in the event of stress or severe asthma attack unresponsive to bronchodilators.
• Metered-Dose Inhaler: Instruct patient in the proper use of the metered-dose inhaler. Canister must be primed prior to first use. Do this by releasing 2 actuations into air away from face. If not used for more than 3 days, reprime with 2 actuations. Shake inhaler well. Exhale completely and then close lips firmly around mouthpiece. While breathing in deeply and slowly, press down on canister and hold breath for as long as possible to ensure deep instillation of medication. Remove inhaler from mouth and breath out gently. Allow 1–2 min between inhalations. Rinse mouth with water or mouthwash after each use to minimize fungal infections, dry mouth, and hoarseness. Wash inhalation assembly at least daily in warm running water (see medication administration techniques).

Evaluation/Desired Outcomes

• Management of the symptoms of chronic asthma.
• Improvement in asthma symptoms.