In the form of inhalation. The recommended dose depends on the severity of the disease. With a stable course of asthma, mild to moderate The recommended initial dose of Asmanex® Twisthaler® is 400 μg once a day. Inhalation recommended to do in the evening. In some patients (for example, who received prior inhaled glucocorticosteroids in high doses), more adequate control of the course of the disease is achieved when the daily dose of 400 μg is divided into 2 inhalations. In a number of patients with maintenance therapy, it is possible to reduce the daily dose to 200 μg once a day in the evening. In these cases, you should use the drug Asmanex® Twisthaler® with a content of mometasone furoate 200 μg in 1 dose.
The dose should be selected individually (until a minimum dose is provided that provides adequate control over the course of asthma).
In severe AD the initial recommended dose is 400 μg 2 times a day, which corresponds to the maximum recommended daily dose of 800 μg. After achieving effective control of asthma symptoms, the dose of Asmanex® Twisthaler® should be gradually reduced to a minimum effective dose.
When switching from oral GKC to therapy with Asmanex® Twisthaler® first, both drugs are used simultaneously. After about a week of simultaneous application, the oral GCS gradually begins to be canceled, reducing its daily dose or skipping one dose. The next dose reduction is carried out after 1 or 2 weeks, depending on the patient's condition. The dose should not be reduced by more than 2.5 mg prednisolone per day (or its equivalent). Cancellation must be carried out gradually. This requires careful monitoring of the patient's condition, including indicators of the function of breathing (in order not to miss the moment of worsening of the course of bronchial asthma) and adrenal function (to exclude the failure of adrenal cortex function).
With COPD the recommended dose is 800 mcg / day.Most patients can take the entire dose once a day in the evening. For some patients, the drug is more effective 400 μg 2 times a day.
Terms of use of the inhaler-Twistheiler
Before opening the Twistheiler, make sure that it is in an upright position, and the counter and the pointer on the cover are aligned. Then Twistheiler is opened by sliding the white cover counterclockwise while holding the Twistheiler base in a fixed position. The dose counter notes the use of 1 dose.
Further Twistheyler should be placed in the mouth and, with a mouthpiece around his mouth, inhale quickly and deeply. Then take the mouthpiece out of your mouth and hold your breath for 10 seconds or for as long as it is comfortable for the patient. The patient should not exhale through Twistheiler.
To close the Twistheyler, you must return the lid to its place immediately after inhalation and turn the lid clockwise, while gently pushing it down until it clicks and the lid completely closes. The arrow on the lid is fully aligned with the counter window.At the same time, a new dose of the drug is loaded for the next inhalation.
The patient should be advised to rinse the mouth after each inhalation. This reduces the risk of oral candidiasis.
The counter display will show when the last dose is loaded. After dose 01, the counter will show 00 and the lid will be locked. After this, the inhalation will become impossible and Twistheiler should be discarded.
Twistheiler must be kept dry and clean. The mouthpiece from the outside can be wiped with dry gauze or cloth. Twistheiler can not be washed with water.
Application in pediatric practice
The safety and efficacy of Asmanex® Twistheiler® in children under 12 years of age have not been studied.
It is recommended to regularly monitor the growth of adolescents who received long-term therapy for inhalation. If the growth slows down, the current therapy should be reviewed to reduce the dose of inhaled glucocorticosteroids to a minimum, at which effective control over the symptoms of the disease is achieved.