Posology : מינונים

4.2 Posology and Method of Administration
Flixotide Inhaler is for inhalation by oral inhalation only.

Patients should be made aware of the prophylactic nature of therapy with inhaled fluticasone propionate and that it should be taken regularly even when they are asymptomatic. The onset of therapeutic effect is 4 to 7 days, although some benefit may be apparent as soon as 24 hours for patients who have not previously received inhaled steroids.

The dosage of fluticasone propionate should be adjusted according to the individual response.

If patients find that relief with short-acting bronchodilator treatment becomes less effective or they need more inhalations than usual, medical attention must be sought.

It is intended that each prescribed dose is given by a minimum of 2 inhalations.

In patients who find co-ordination of a pressurised metered-dose inhaler difficult a spacer may be used with Flixotide inhaler.

Asthma:

Adults and adolescents over 16 years of age:-
 100 to 1000 micrograms twice daily.

Patients should be given a starting dose of inhaled fluticasone propionate which is appropriate for the severity of their disease:-

Mild asthma:             100 to 250 micrograms twice daily.
Moderate asthma:         250 to 500 micrograms twice daily.
Severe asthma:           500 to 1000 micrograms twice daily.

The dose may then be adjusted until control is achieved or reduced to the minimum effective dose, according to the individual response.

Alternatively, the starting dose of fluticasone propionate may be gauged at half the total daily dose of beclomethasone dipropionate or equivalent as administered by metered-dose inhaler.

Children over 4 years of age:-

50-100 micrograms twice daily.
Children should be given a starting dose of inhaled fluticasone propionate which is appropriate for the severity of their disease.

Many children’s asthma will be well controlled using the 50 to 100 mcg twice daily dosing regimen. For those patients whose asthma is not sufficiently controlled, additional benefit may be obtained by increasing the dose up to 200 mcg twice daily.

The dose may then be adjusted until control is achieved, or reduced to the minimum effective dose, according to individual response.

Children aged 1 to 4 years
Flixotide Inhaler CFC Free 50mcg: 50 to 100 mcg twice daily.
Inhaled fluticasone propionate is of benefit to younger children in the control of frequent and persistent asthma symptoms.
Clinical trials in 1 to 4 years old children have shown that the optimal control of asthma symptoms is achieved with 100mcg twice daily.
However, children should be given a starting dose of inhaled fluticasone propionate which is appropriate for the severity of their disease, this may be 50 or 100 mcg twice daily.
The diagnosis and treatment of asthma should be kept under regular review.
Once asthma symptoms have been controlled, the dose of fluticasone propionate should be reduced to the lowest dose which maintains control of the asthma symptoms.
Administered via a paediatric space device with a face mask.

Special patient groups:

There is no need to adjust the dose in elderly patients or in those with hepatic or renal impairment.
Chronic obstructive pulmonary disease (COPD):

Adult dose:

500 micrograms twice daily, used as an adjunct to long-acting bronchodilators (e.g. LABAs).
Medication must be used daily for optimum benefit which may take three to six months. If there is no improvement after three to six months then the patient should undergo medical assessment.

Only the 250 microgram device is suitable for the administration of this dose.

Testing your inhaler
Before using for the first time or if your inhaler has not been used for a week or more, remove the mouthpiece cover by gently squeezing the sides of the cover, shake the inhaler well, and release two puffs into the air to make sure that it works.

Using your inhaler
1. Remove the mouthpiece cover by gently squeezing the sides of the cover.
2. Check inside and outside of the inhaler including the mouthpiece for the presence of loose objects.
3. Shake the inhaler well to ensure that any loose objects are removed and that the contents of the inhaler are evenly mixed.
4. Hold the inhaler upright between fingers and thumb with your thumb on the base, below the mouthpiece.
5. Breathe out as far as is comfortable and then place the mouthpiece in your mouth between your teeth and close your lips around it but do not bite it.
6. Just after starting to breathe in through your mouth press down on the top of the inhaler to release fluticasone propionate while still breathing in steadily and deeply.
7. While holding your breath, take the inhaler from your mouth and take your finger from the top of the inhaler. Continue holding your breath for as long as is comfortable.
8. If you are to take further puffs keep the inhaler upright and wait about half a minute before repeating stages 3 to 7.
9. Afterwards, rinse your mouth with water and spit it out.
10. Replace the mouthpiece cover by firmly pushing and snapping the cap into position.


IMPORTANT
Do not rush Stages 5, 6 and 7. It is important that you start to breathe in as slowly as possible just before operating your inhaler.
Practise in front of a mirror for the first few times. If you see 'mist' coming from the top of the inhaler or the sides of your mouth you should start again from stage 2.
If your physician has been given you different instructions for using your inhaler, please follow them carefully. Tell your physician if you have any difficulties.

Cleaning
Your inhaler should be cleaned at least once a week.
1. Remove the mouthpiece cover.
2. Do not remove the canister from the plastic casing.
3. Wipe the inside and outside of the mouthpiece with a dry cloth or tissue.
4. Replace the mouthpiece cover.

DO NOT PUT THE METAL CANISTER INTO WATER.