1.2. Pediatrics
ICS as individual agents are FDA-approved for use in pediatric asthma management in children as young as 4 years of age. Pediatric therapy initiation differs by age for individual agents and is summarized in Table 3. Prescribed dosages exceeding these recommendations will be reviewed.
Drug Name | Dosage Form/Strength | Patient Age/Maximum Recommended Dosage |
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beclomethasone dipropionate HFA (QVAR Redihaler) | inhalation aerosol: 40 mcg/actuation |
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inhalation aerosol: 80 mcg/actuation |
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budesonide (Pulmicort Flexhaler) | inhalation powder: 90 mcg/actuation |
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inhalation powder: 180 mcg/actuation |
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ciclesonide (Alvesco) | inhalation aerosol: 80 mcg/actuation |
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inhalation aerosol: 160 mcg/actuation |
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fluticasone furoate (Arnuity Ellipta) | dry powder inhaler: 50 mcg/actuation |
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dry powder inhaler: 100 mcg/actuation |
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dry powder inhaler: 200 mcg/actuation |
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fluticasone propionate HFA (Flovent HFA, generics) | inhalation aerosol: 44 mcg/actuation |
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inhalation aerosol: 110 mcg/actuation |
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inhalation aerosol: 220 mcg/actuation |
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fluticasone propionate (Flovent Diskus) | dry powder inhaler: 50 mcg/actuation |
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dry powder inhaler: 100 mcg/actuation |
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dry powder inhaler: 250 mcg/actuation |
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fluticasone propionate (ArmonAir Digihaler) | dry powder inhaler: 55 mcg/actuation |
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dry powder inhaler: 113 mcg/actuation |
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dry powder inhaler: 232 mcg/actuation |
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mometasone HFA (Asmanex HFA) | inhalation aerosol: 50 mcg/actuation |
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inhalation aerosol: 100 mcg/actuation |
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inhalation aerosol: 200 mcg/actuation |
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mometasone (Asmanex Twisthaler) | inhalation powder: 110 mcg/actuation |
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inhalation powder: 220 mcg/actuation |
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Legend:
- * initial fluticasone furoate dose in patients not on ICS is 100 mcg once/day; if 100 mcg not effective, dose should be increased to 200 mcg once daily
- ^ prednisone should be tapered slowly, beginning at least one week after mometasone use
Combined therapy with aerosolized inhaled ICS and long-acting beta2-agonists is only FDA-approved for use in asthma treatment in children greater than or equal to 5 years of age; combined ICS/ long-acting beta2-agonist therapy as inhalation powder is FDA-approved for use in asthma management in children 4 years of age and older. Maximum recommended orally inhaled doses for available aerosolized corticosteroids as combination therapy are summarized in Table 4. Prescribed dosages exceeding these recommendations will be reviewed.
Drug Name | Dosage Form/Strength | Patient Age/Maximum Recommended Dosage |
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budesonide/ formoterol (Symbicort) | inhalation aerosol: 80 mcg/4.5 mcg/ actuation | 6 to 11 years of age: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 320 mcg/18 mcg/day |
12-17 years of age: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 320 mcg/18 mcg/day | ||
inhalation aerosol: 160 mcg/4.5 mcg/actuation | 12-17 years of age: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 640 mcg/18 mcg /day | |
fluticasone propionate/ salmeterol xinafoate (Advair HFA, generics) | inhalation aerosol: 45 mcg/21 mcg/ actuation | 12-17 years of age: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 180 mcg/84 mcg/day |
inhalation aerosol: 115 mcg/21 mcg/ actuation | 12-17 years of age: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 460 mcg/84 mcg/day | |
inhalation aerosol: 230 mcg/21 mcg/ actuation | 12-17 years of age: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 920 mcg /84 mcg/day | |
fluticasone propionate/salmeterol (Advair Diskus, generics) | inhalation powder: 100 mcg/50 mcg/ actuation | 4-11 years of age: 2 actuations/day (1 actuation twice daily); total dose = 200 mcg/100 mcg/day |
inhalation powder: 100 mcg/50 mcg/actuation | 12-17 years of age: 2 actuations/day (1 actuation twice daily); total dose = 200 mcg/100 mcg/day | |
inhalation powder: 250 mcg/50 mcg/actuation | 12-17 years of age: 2 actuations/day (1 actuation twice daily); total dose = 500 mcg/100 mcg/day | |
inhalation powder: 500 mcg/50 mcg/actuation | 12-17 years of age: 2 actuations/day (1 actuation twice daily); total dose = 1000 mcg/100 mcg/day | |
fluticasone propionate/salmeterol (AirDuo RespiClick) | inhalation powder: 55 mcg fluticasone/14 mcg salmeterol/ actuation | 12-17 years of age: 2 actuations/day in divided doses (1 actuation twice daily); total dose = 110 mcg/28 mcg/day |
113 mcg fluticasone/14 mcg salmeterol/actuation | 12-17 years of age: 2 actuations/day in divided doses (1 actuation twice daily); total dose = 226 mcg/28 mcg/day | |
232 mcg fluticasone/14 mcg salmeterol/actuation | 12-17 years of age: 2 actuations/day in divided doses (1 actuation twice daily); total dose = 464 mcg/28 mcg/day | |
fluticasone propionate/salmeterol (AirDuo Digihaler) | 55 mcg fluticasone/ 14 mcg salmeterol/inhalation | Greater than or equal to 12 years of age: 2 actuations/day in divided doses (1 actuation twice daily); total dose = 110 mcg/28 mcg/day |
inhalation powder: 113 mcg fluticasone/14 mcg salmeterol/inhalation | Greater than or equal to 12 years of age: 2 actuations/day in divided doses (1 actuation twice daily); total dose = 226 mcg/28 mcg/day | |
inhalation powder: 232 mcg fluticasone/14 mcg salmeterol/inhalation | Greater than or equal to 12 years of age: 2 actuations/day in divided doses (1 actuation twice daily); total dose = 464 mcg/28 mcg/day | |
mometasone/formoterol (Dulera) | inhalation aerosol: 50 mcg/5 mcg/ actuation | 5-11 years of age: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 200 mcg/ 20 mcg/ day |
inhalation aerosol: 100 mcg/5 mcg/ actuation | 12-17 years of age: patients on medium-dose inhaled corticosteroids: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 400 mcg/20 mcg/day | |
200 mcg/5 mcg/actuation | 12-17 years of age: patients on high-dose inhaled corticosteroids: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 800 mcg/20 mcg/day |
Number of maximum actuations per day based on dose of salmeterol and formoterol, and independent of inhaled corticosteroid dose.