Action

Inhibits release of histamine and reacting substances of anaphylaxis from mast cells, stabilizing the cell membrane and reducing the allergic response and inflammatory reaction

Availability

Nasal solution: 40 mg/ml (5.2 mg/spray) in 13-ml container (100 sprays) or 26-ml container (200 sprays)

Ophthalmic solution: 4%

Oral solution: 100 mg/5 ml

Solution for nebulization: 10 mg/ml

Indications and dosages

➣ Mastocytosis

Adults and children ages 13 and older: 200 mg P.O. q.i.d.

Children ages 2 to 12: 100 mg P.O. q.i.d.

➣ Vernal keratoconjunctivitis, vernal conjunctivitis, and vernal keratitis

Adults and children ages 4 and older: One to two drops of ophthalmic solution in each eye four to six times daily at regular intervals

➣ To prevent and relieve nasal symptoms of hay fever and other nasal allergies

Adults and children ages 2 and older: Spray once into each nostril. To prevent nasal allergy symptoms, use up to 1 week before contact with cause of allergy. To relieve nasal symptoms, repeat three to four times daily q 4 to 6 hours. If needed, may use up to six times per day. Use every day while in contact with allergen.

➣ Prevention of acute bronchospasm

Adults and children ages 2 and older: 20 mg q.i.d. via nebulization at regular intervals or no more than 1 hour before exposure to triggering event

➣ Management of bronchial asthma

Adults and children ages 2 and older: 20 mg via nebulization q.i.d. at regular intervals

Off-label uses

• Proctitis

• Ulcerative colitis

• Urticaria

Contraindications

• Hypersensitivity to drug

• Status asthmaticus

Precautions

Use cautiously in:

• renal or hepatic impairment, acute bronchospasm attacks

• pregnant or breastfeeding patients

• children younger than age 5.

Administration

• Administer oral form 30 minutes before meals and at bedtime.

• Before using nasal spray, have patient clear nasal passages by blowing nose.

• Don't expose solutions to direct sunlight.

Adverse reactions

CNS: headache, drowsiness, dizziness

EENT: nasal irritation, sneezing, epistaxis, postnasal drip (with nasal solution); stinging of eyes, lacrimation (with ophthalmic solution)

GI: nausea, diarrhea, stomachache, swollen parotid glands

GU: difficult or painful urination, urinary frequency

Musculoskeletal: myopathy

Respiratory: wheezing, cough, bronchospasm

Skin: erythema, rash, urticaria, angioedema

Other: altered taste, substernal burning, allergic reactions including anaphylaxis, serum sickness

Interactions

None significant

Patient monitoring

• Monitor pulmonary function periodically.

• Evaluate patient for signs and symptoms of overdose, including bronchospasm and difficult or painful urination.

Patient teaching with nasal form

• Teach patient how to instill nasal spray as directed.

• Tell patient that drug may cause unpleasant taste, but that rinsing mouth and performing frequent oral care may help. Also inform him that drug may cause headache.

• Advise patient to report increased sneezing; nasal burning, stinging, or irritation; sore throat; hoarseness; or nosebleed.

With oral form-

• Tell patient to take oral form 30 minutes before meals.

With ophthalmic form-

• Instruct patient to wash hands before using.

• Teach patient how to instill drops: Instruct him to tilt his head back and look up, place drops inside lower eyelid, close his eye, and roll eyeball in all directions. Tell him not to blink for about 30 seconds, and then to apply gentle pressure to inner corner of eye for 30 seconds.

• Caution patient not to let applicator tip touch eye or any other surface.

• Tell patient drug may cause temporary stinging of eye or blurred vision.

• Advise patient not to wear contact lenses during therapy.

With all forms-

• As appropriate, review all other significant adverse reactions.