Inhaled corticosteroids (ICS) (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Please consider if a steroid emergency card needs to be given to the patient alongside the traditional steroid treatment card.  This is to support the timely recognition and treatment of potential adrenal crisis and is suitable for some patients on oral, inhaled, topical or rectal steroids.  For more information, including which patients should receive the card, see HIS for details.  Steroid emergency cards have been distributed to, hospitals, GP surgeries and community pharmacies. Primary care can order replacement cards from 01463 706886.

See Peri-operative guidelines for patients with or at risk of adrenal insufficiency

BUDESONIDE - (First line)

Therapy notes

Formulation and dosage details

Formulation:

PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device.

  • Dry powder for inhalation (Easyhaler® Budesonide, Pulmicort® Turbohaler®) 100 micrograms, 200 micrograms, 400 micrograms/metered inhalation

Dosage:

By inhalation of powder, 200 micrograms to 1·6mg daily in 2 divided doses, in less severe cases 200 to 400 micrograms daily. Specify brand when prescribing to ensure correct device is dispensed.

Formulation and dosage details

Formulation:

Nebuliser suspension 500 micrograms/2mL, 1mg/2mL

Dosage:

Reserve budesonide nebuliser solution for the treatment of croup in children who are unable to swallow dexamethasone tablets; refer to BNF for Children.

MHRA advice: Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists (August 2020) (www.gov.uk).

BECLOMETASONE DIPROPIONATE

Therapy notes

  • MHRA advice: Clenil Modulite® and Qvar® are not interchangeable; prescribe by brand name.
  • For a patient with stable symptoms, the equivalent dose of Qvar® is half that of Clenil Modulite® and other CFC-containing beclometasone inhalers.
    ie 100 micrograms aerosol inhalation of Qvar® is equivalent to 200 micrograms aerosol inhalation of Clenil Modulite® and other CFC-containing beclometasone inhalers.

Formulation and dosage details

Formulation:

ALTERNATIVE: Metered dose inhalers (MDI) (Pressurised inhalation)To be considered in the small proportion of patients who are unable to use a DPI.

  • Aerosol inhalation (Clenil Modulite®) 50 micrograms, 100 micrograms, 200 micrograms, 250 micrograms/metered inhalation

Dosage:

By aerosol inhalation, Clenil Modulite®, 200 micrograms twice daily, (in more severe cases initially 300 to 400 micrograms twice daily); may give up to 1mg twice daily as per SIGN158 guideline.

Formulation and dosage details

Formulation:

ALTERNATIVE: Metered dose inhalers (MDI) (Pressurised inhalation)To be considered in the small proportion of patients who are unable to use a DPI.

  • Aerosol inhalation (Qvar®) 50 micrograms, 100 micrograms/ metered inhalation

Dosage:

By aerosol inhalation, Qvar®, 50 to 200 micrograms twice daily.

Formulation and dosage details

Formulation:

ALTERNATIVE: Metered dose inhalers (MDI) (Pressurised inhalation)To be considered in the small proportion of patients who are unable to use a DPI.

  • Breath-actuated aerosol inhalation (Qvar Easi-Breathe®) 50 micrograms, 100 micrograms/metered inhalation

Dosage:

By aerosol inhalation, Qvar® Easibreathe, 50 to 200 micrograms twice daily.

FLUTICASONE PROPIONATE

Therapy notes

  • Note: Increasing the dose of fluticasone propionate above 1mg/day is unlikely to confer extra clinical benefit and will increase the risk of systemic side-effects. Counsel patients on systemic side-effects, step down where appropriate and review regularly.

Formulation and dosage details

Formulation:

PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device.

  • Dry powder for inhalation (Flixotide® Accuhaler®) disk containing blisters of fluticasone propionate 50 micrograms, 100 micrograms, 250 micrograms, 500 micrograms/blister

Dosage:

By inhalation of powder, 100 to 250 micrograms twice daily, increased according to severity of asthma; doses above 500 micrograms twice daily initiated by a specialist.

Formulation and dosage details

Formulation:

ALTERNATIVE: Metered dose inhalers (MDI) (Pressurised inhalation)To be considered in the small proportion of patients who are unable to use a DPI.

  • Aerosol inhalation 50 micrograms, 125 micrograms, 250 micrograms/metered inhalation

Dosage:

By aerosol inhalation, 100 to 250 micrograms twice daily, increased according to severity of asthma; doses above 500 micrograms twice daily initiated by a specialist.

Editorial Information

Document Id: F353