Bronchodilators
Epinephrine (e pi NEF rin)
Primatene Mist, Asthmanefrin Refill, S2 (Racepinephrine)
t
MDI 0.125 mg/puff; nebulizer solution 2.25%
MDI 1–2 puffs q 4 hr PRN; nebulizer 1 vial q 3 hr PRN
Not recommended for routine management of asthma
Tachycardia, hypertension, nervousness, sleeplessness
OTC inhaler, OTC nebulizer solution; use with caution
Albuterol (al BYOO ter ole)
Ventolin/Proventil/ProAir HFA, generics
DPI/MDI 90 mcg/puff; nebulizer 0.63 mg/3 mL, 1.25 mg/3 mL, 2.5 mg/3 mL
MDI or DPI 2–4 puffs q 4–6 hr PRN; nebulizer solution 2.5 mg q 4–6 hr PRN
Quick relief of mild asthma symptoms; reliever therapy; prevention of exercise-induced bronchospasm
Dose related: nervousness, chest pain, increased serum glucose, cough, tremor
SABA
Levalbuterol
(lev al BYOO ter ol)
Xopenex
MDI 45 mcg/puff; nebulizer 0.31 mg/3 mL, 0.63 mg/3 mL, 1.25 mg/3 mL, 1.25 mg/0.5 mL
MDI 1–4 puffs q 4–6 hr PRN; nebulizer 0.63–1.25 mg q 6–8 hr PRN;
Salmeterol (sal ME te role)
Serevent Diskus
DPI 50 mcg/puff
1 puff q 12 hr
Symptom prevention; controller therapy
Headache, hypertension, dizziness, chest pain
LABA; not appropriate for monotherapy; must always be prescribed with ICS or other control medication
Theophylline (the OFF i lin)
Elixophyllin, Theo-24
Elixir/oral solution 80 mg/15 mL; Theo-24 100 mg, 200 mg, 300 mg, 400 mg; 24 hour-ER tablet 400 mg, 600 mg; 12 hour-ER tablet 300 mg, 450 mg
Individualize dose based on theophylline blood levels
Symptom prevention; controller therapy; not routinely recommended
Tachycardia, nausea/vomiting, headache, dizziness, insomnia
Oral; never increase or double a missed dose; increased side effects and drug interactions
Inhaled Corticosteroids
Beclomethasone (be kloe METH a sone)
QVAR RediHaler
MDI 40 mcg/puff, 80 mcg/puff
80–640 mcg/day
Symptom prevention; controller therapy for persistent asthma
Oral thrush, hoarse voice, dysphonia
2 weeks needed to see full effect; rinse mouth after each use
Budesonide (byoo DES oh nide)
Pulmicort Flexhaler Pulmicort suspension for inhalation
DPI 90 mcg/puff, 180 mcg/puff; suspension 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL
DPI 180–1,440 mcg/day; suspension 0.5–2 mg/day
Fluticasone (floo TIK a sone)
Flovent HFA/Diskus, Arnuity Ellipta, ArmonAir Digihaler
DPI Diskus 50 mcg/blister, 100 mcg/blister, 250 mcg/blister; MDI 44 mcg/puff, 110 mcg/puff, 220 mcg/puff; DPI (furoate) 50 mcg/puff, 100 mcg/puff, 200 mcg/puff; DPI (propionate) 55 mcg/puff, 113 mcg/puff, 232 mcg/puff
DPI 200–2,000 mcg/day; MDI 176–1,760 mcg/day; DPI (furoate) 100–200 mcg/day; DPI (propionate) 110–464 mcg/day
Mometasone (moe MET a sone)
Asmanex Twisthaler, Asmanex HFA
DPI 110–220 mcg/puff; MDI 50–200 mcg/puff
DPI 110–880 mcg/day; MDI 400–800 mcg/day
Ciclesonide (sye KLES oh nide)
Alvesco
MDI 80 mcg/puff, 160 mcg/puff
160–640 mcg/day
Combinations
Fluticasone/salmeterol (floo TIK a sone) (sal ME te role)
Advair Diskus/HFA, AirDuo RespiClick/Digihaler, Wixela Inhub
Diskus and Inhub DPI 100/50 mcg/puff, 250/50 mcg/puff, 500/50 mcg/puff; HFA MDI 45/21 mcg/puff, 115/21 mcg/puff, 230/21 mcg/puff; RespiClick/Digihaler MDI 55/14 mcg/puff, 113/14 mcg/puff, 232/14 mcg/puff
1–2 puffs twice daily
Symptom prevention; controller therapy for persistent asthma
Oral thrush, hoarse voice, dysphonia, headache, hypertension, dizziness, chest pain
ICS/LABA; 2 weeks needed to see full effect; use MDI with spacer; dry powder inhalers (DPI) and breath-actuated inhalers CANNOT be used with a spacer; rinse mouth after each use
Fluticasone/vilanterol (floo TIK a sone) (VYE lan ter ol)
Breo Ellipta
DPI 100/25 mcg/puff, 200/25 mcg/puff
1 puff once daily
Symptom prevention; controller therapy for persistent asthma
ICS/LABA; 2 weeks needed to see full effect; rinse mouth after each use
Budesonide/formoterol (byoo DES oh nide) (for MOH te rol)
Symbicort
MDI 80/4.5 mcg/puff, 160/4.5 mcg/puff
2 puffs twice daily
Symptom prevention; controller therapy for persistent asthma
ICS/LABA; 2 weeks needed to see full effect; use with spacer; rinse mouth after each use
Mometasone/fomoterol (moe MET a sone) (for MOH te rol)
Dulera
MDI 50/5 mcg/puff, 100/5 mcg/puff, 200/5 mcg/puff
2 puffs twice daily
Symptom prevention; controller therapy for persistent asthma
ICS/LABA; 2 weeks needed to see full effect; use with spacer; rinse mouth after each use
Fluticasone/umeclidinium/vilanterol (floo TIK a sone) (ue me kli DIN ee um) (VYE lan ter ol)
Trelegy Ellipta
DPI 100/62.5/25 mcg/puff, 200/62.5/25 mcg/puff
1 puff once daily
Symptom prevention; maintenance therapy
Oral thrush, hoarse voice, dysphonia, URI, dry mouth, metallic taste, throat irritation, cough, headache, hypertension, dizziness, chest pain,
ICS/LAMA/LABA; 2 weeks needed to see full effect; rinse mouth after each use; not for rapid symptom relief
Leukotriene Modifiers
Montelukast (mon te LOO kast)
Singulair
Chewable tablet 4 mg, 5 mg; granule packet 4 mg; tablet 10 mg
4–10 mg/day
Symptom prevention; prevention of exercise-induced bronchospasm; allergic rhinitis
Headache, dizziness, heartburn, stomach pain, tiredness, mood/behavior changes
Doses above 10 mg will not increase effect in adults; give at bedtime; not for rapid symptom relief
Zafirlukast (za FIR loo kast)
Accolate
Tablet 10 mg, 20 mg
20–40 mg/day
Symptom prevention; allergic rhinitis
Nausea, loss of appetite, pain in the right upper part of the abdomen, excessive tiredness, lack of energy
Take on empty stomach; check liver function; many drug interactions; not for rapid symptom relief
Zileuton (zye LOO ton)
Zyflo
Tablet 600 mg (IR or ER)
IR 600 mg 4 times daily; ER 1,200 mg twice daily
Symptom prevention
Headache, heartburn, diarrhea, muscle pain, nose and throat irritation, pain or fullness in the face
Do not chew or crush; adults only; check liver function; many drug interactions; not for rapid symptom relief
Immunomodulators
Omalizumab (oh mah lye ZOO mab)
Xolair
SUBQ prefilled syringe 75 mg/0.5 mL, 150 mg/1 mL; reconstituted 150 mg
150–375 mg SUBQ q 2–4 weeks
Prevention of symptoms for moderate to severe allergic asthma; add-on therapy
Bruising at site, redness, pain, stinging, delayed anaphylaxis
Not effective for rapid symptom relief; allow pre-filled syringe to warm to room temperature for 15 to 30 minutes; leave in carton to protect from light; monitor for 2 hours post-dose for anaphylaxis
Benralizumab (ben ra LIZ ue mab)
Fasenra, Fasenra Pen
SUBQ prefilled syringe/auto-injector 30 mg/mL
30 mg SUBQ q 4 weeks × 3 doses followed by 30 mg q 8 weeks
Prevention of symptoms for severe eosinophilic asthma; add-on therapy
Headache, sore throat
Not effective for rapid symptom relief; warm at room temperature for 30 min prior to administration
Dupilumab (doo PIL ue mab)
Dupixent
SUBQ prefilled syringe 100 mg/0.67 mL, 200 mg/1.14 mL, 300 mg/2 mL; pen injector 200 mg/1.14 mL, 300 mg/2 mL
400-600 mg SUBQ × 1 dose followed by 200-300 mg SUBQ every other week; child/adolescent dosing based on age and weight
Prevention of symptoms for severe eosinophilic asthma or corticosteroid-dependent asthma; add-on therapy
Bruising at site, redness, pain, itchiness, headache, inflammation of the eyes
Not effective for rapid symptom relief; warm at room temperature for 30 min (100 and 200 mg syringe or pen) or 45 min (300 mg syringe or pen) prior to administration
Mepolizumab (me poe LIZ ue mab)
Nucala
SUBQ auto-injector, prefilled syringe, reconstituted 100 mg/mL; 40 mg/0.4 mL prefilled syringe
40–100 mg SUBQ q 4 weeks
Prevention of symptoms for severe eosinophilic asthma; add-on therapy
Bruising at site, redness, pain, itchiness, headache, fatigue
Not effective for rapid symptom relief; prefilled syringe/auto-injector warm at room temperature for 30 min prior to administration; do not shake reconstituted solution
Reslizumab (res LIZ ue mab)
Cinqair
IV solution 100 mg/10 mL
3 mg/kg IV q 4 weeks
Prevention of symptoms for severe eosinophilic asthma; add-on therapy
Throat irritation
Not effective for rapid symptom relief; allow diluted solution to reach room temperature
Tezepelumab
Tezspire
210 mg/1.91 mL prefilled syringe
210 mg SUBQ q 4 weeks
Prevention of symptoms for severe asthma; add-on therapy
Bruising at site, pain, throat irritation
Not effective for rapid symptom relief; warm prefilled syringe at room temperature for 60 min prior to administration
