Tag Archives: medication 101

Medication 101: Clenil Modulite

Ah good ol’ Clenil Modulite… Like I said earlier, I’m going to be banging out a few Medications 101 since I am a bit behind with them. Clenil was the first preventer inhaler I took back in July 2012 before I moved onto combination inhalers. In the UK Clenil is a very common first preventer inhaler. Clonal modulite contains Beclometasone Dipropionate, a corticosteroid, which is used to reduce inflammation in the lungs and is used to prevent and reduce asthma symptoms. However, Clenil is a slow acting medication and so should not be used in attacks or to reduce acute symptoms.

Doses:

Clenil Modulate comes in 4 separate doses: 50, 100, 200 and 250mcg of Beclometasone Dipropionate per accusation. The usual starting dose for Clenil is 400mcg twice a day [in adults], but can be increased up to 1,600-2,000mcg if needed. Your dose will be decided by your doctor.

I started off taking the typical dose of 400mcg a day via 2 puffs of Clenil Modulite 100 twice a day. Unfortunately, this alone did not control my asthma sufficiently to be used alone and that is why I moved onto a combination inhaler.

Precautions:

Clenil modulite is not indicated for use in an acute attack, or for people who are allergic to beclometasone dipropionate.

Care should be taken when taking Clenil modulite if any of the following applies to you [and tell your doctor if any of these do apply to you]:

  • if you are, or have ever been treated for Tuberculosis
  • if your Asthma is getting worse despite Clenil Modulite [needing your reliever inhaler more often, still experiencing asthma symptoms etc]

Side effects:

  • Allergic reactions – rashes, hives, itching, swelling of face, lips, eyes, throat or tongue
  • Oral thrush – more likely if you take more than 400mcg a day
  • Hoarse or sore throat
  • Changes in normal production of cortisol in body [cortisol suppression] – unusual, and only usually occurs after high doses of clenil for long periods of time
  • Stunted growth – again this is unusual and is associated with high doses of clenil for prolonged periods of time
  • Decrease in bone density, glaucoma, cataracts – again is associated with high doses of clenil for prolonged periods of time
  • Sleeping problems, depression or feeling worried, restless, nervousness, irritability or excitability
  • Headaches
  • Nausea

I was lucky and experienced no side effects from Clenil, although there are precautions you can take to reduce the symptoms of thrush and hoarseness such as taking Clenil through a spacer, and brushing your teeth/rinsing your mouth after taking Clenil.

Pros and Cons

+ Side effects are usually quite mild

+ Can be taken via spacer

+ Some flexibility in dose

+ There are plenty other preventer inhalers to try if this isn’t right for you

Only available in aerosol form [in this brand]

Not available in the US or Canada

Sources:

Patient information leaflet

Medication 101: Ventolin

It’s be a while since I have done a Medication 101 so I am going to try and pop a few out now.

I’ve been taking Ventolin for nearly 3 years now, since June 2012. I’ve taken Ventolin through 2 different devices, the Ventolin Evohaler which is the typical aerosol inhaler that most people are familiar with, and then I also used the Ventolin Accuhaler for a short period from January 2013 to October 2013.

Ventolin is a brand name for Salbutamol [AKA Albuterol in the US] which is a Short Acting Beta 2 antagonist (SABA) or in layman terms a fast acting reliever inhaler. It is used to to relieve spasms in the smooth muscle around the airways which produces asthma symptoms/bronchospasm [cough, wheeze, tight chest, shortness of breath]. Most people with asthma are treated with a reliever inhaler and a preventer inhaler, and it is very important to be aware of which inhaler is your reliever. The reliever inhaler is the inhaler that is going to help you out when you are experiencing symptoms or having an attack. [Note; some people use a SMART or MART regimes, please always use your inhalers as directed by your doctor. This is simply to provide general information about Ventolin].

Doses:

The dose of Ventolin is variable. The Ventolin Evohaler contains 100mcg of Salbutamol per accusation and the Ventolin Accuhaler contains 200mcg of Salbutamol per accusation. Most people take 100-200mcg of Ventolin to relieve symptoms but may take up to 1000mcg when needed. Please phone an ambulance ASAP if your symptoms are not easing even after taking your inhaler, or if you don’t have your inhaler with you. Asthma can be very serious, don’t mess around with it.

Precautions:

Consult your doctor before you take Ventolin if you are hypersensitive to Salbutamol Sulphate or HFA 134a which is the aerosol in the Ventolin Evohaler.

Special care is also advised to be taken when taking the Ventolin Evohaler if you have high blood pressure, have an overactive thyroid or have a history of heart problem including angina or an irregular heart rhythm. Please consult a doctor or pharmacist if you call under any of those categories.

Side effects:

I have starred [*] all the side effects I have experienced when taking Ventolin.

  • Allergic reactions [affecting less than 1 in 10,000 people] – Please seek medical attention ASAP if you experience swelling of the face, lips tongue or throat, if you have difficulty with breathing, if you have difficulty swallowing, if you develop an itchy rash, if you feel faint, feel light headed or collapse.
  • Common side effects [affecting less than 1 in 10 people] – Headache*, feeling shaky*, heart palpitations* [please consult doctor about this].
  • Uncommon side effects [affecting less than 1 in 100 people] – mouth and throat irritation, muscle cramps*
  • Rare side effects [affecting less than 1 in 1,000 people] – low blood potassium levels, peripheral dilation [increased blood flow to extremities]
  • Very rare side effects [affecting less than 1 in 10,000 people] – changes in sleep patterns, changes in behaviour [e.g. restlessness, excitability

I have found that Ventolin/Salbutamol has got me out of some sticky situations but if you find that you aren’t responding to your reliever inhaler any more or you are still having issues with your asthma after taking you inhaler, go to the hospital. Don’t hang around because you aren’t sure if your symptoms are bad enough to seek medical advice. Asthma can be life threatening so be pro-active!

Source:
Patient information leaflet.

Medication 101: Symbicort

Symbicort was the second of three combination inhalers I have tried and although it worked well for me, I did experience some quite significant side effects that meant that I should change to a different combination inhaler.

Symbicort like Flutiform is a preventer inhaler used to reduce asthma symptoms and prevent attacks. Symbicort contains 2 different medications and is therefore a combination inhaler. Symbicort is made up of a steroid [budesonide] and a long acting bronchodilator [Formoterol], and is indicated for use in people with moderate to severe asthma which isn’t controlled by a low-medium dose steroid inhaler alone.

Dose:

Symbicort comes in 3 different doses, the 100/6 [containing 100mcg Budesonide and 6mcg Formoterol], the 200/6 and the 400/12.
[Note: these doses are for the Symbicort turbohaler available in the UK, doses for the aerosol versions of Symbicort may vary]

Symbicort tends to be taken as 1-2 inhalations twice daily [max 8 inhalations a day for 100/6 and 200/6 doses]. However, some patients [age 18 and over] may benefit from Symbicort SMART therapy where Symbicort is used as both a preventer and reliever inhaler with a maximum of 12 inhalations taken a day [DO NOT SELF PRESCRIBE THE SMART THERAPY, SPEAK TO YOUR DOCTOR] Please note that the SMART regime is only available in 100/6 and 200/6 doses.

I took Symbicort from January 2013 all the way through to March 2014, so for quite a long time. I took the 100/6 dose and started off with 2 inhalations twice a day, then had it increased to 3 inhalations twice a day which worked when I wasn’t flaring or didn’t have a cold, but when I was flaring/ill I increased it to 4 inhalation twice a day.

Precautions:

Tell your doctor before you take Symbicort if you have diabetes, a chest infection, high blood pressure, thyroid problems, adrenal problems, low levels of potassium in your blood or severe liver problems.

You should also let your doctor know of you are taking any of the following medications before you take Symbicort including beta-blockers, medication for a fast, uneven or irregular heartbeat, heart failure medications, diuretics, theophylline for asthma, anti-depressants, anti-psychotics, anti-virals used to treat HIV, antibiotics, Parkinson’s medications or thyroid medications.

Side effects:

[I have marked the side effects I have experiences with an asterisk]

Common side effects occurring in less than 1 in 10 people include:
•Heart palpitations *
•Thrush
•Mild sore throat
•Headache

Uncommon side effects occurring in less than 1 in 100 people include:
•Feeling restless *
•Feeling nervous or agitated
•Disturbed sleep
•Feeling dizzy
•Nausea
•Fast heart beat *
•Muscle cramps * [these would wake me up in the middle of the night and were really painful, but I could usually sort them out quickly]
•Bruising of skin

Rare side effects occurring in less than 1 in 1000 people include:
•Bronchospasm * [I would end up having to take my reliever inhaler after taking Symbicort because of the bronchospasms, and this was the reason I switched to Flutiform]
•Rash, itching
•Low levels of potassium in blood
•Uneven heartbeat

Very rare side effects occurring in less than 1 in 10,000 people include:
•Depression
•Behavioural changes (especially in children)
•Angina
•Increase in blood glucose levels
•Changes in taste
•Blood pressure changes

Almost all of the side effects that I experienced [with the exception of bronchoconstriction] with Symbicort were a result of Formoterol, but I have also found that formoterol is the most effective long acting bronchodilator I have tried… But I have also found that the side effects didn’t effect me enough to warrant me changing to a different combination inhaler, until I started to experience bronchospasm, which my doctor and I have identified was a result of Symbicort being a dry powder inhaler.

Pros:
+ very flexible dose
+ easy to use
+ no need for a spacer as it is a dry powder inhaler
+ available as an aerosol in the US
+ Has a dose counter

Cons:
Only available as an aerosol in the US
it’s surprisingly loud and therefore hard to take discretely
Only contains 120 doses in the 100/6 and 200/6 doses which meant that I was going through and inhaler about every 15 days when I was taking 4 puffs twice a day which meant a lot of trips to the pharmacy… The 400/12 only has 60 doses.

Sources:
Patient information leaflet

Medication 101: Flutiform

This is my second post that I am going to do for Medications 101 but this is the first post I will be doing on an Asthma Medication.

I have been taking Flutiform since March 2014 so about 9 months now and so far it has controlled my asthma the best out of every inhaler I have tried to date. Flutiform is a preventer inhaler meaning that it is used to reduce the inflammation in the lungs, therefore reducing asthma symptoms, and hopefully preventing attacks. Flutiform is also a combination inhaler meaning that it contains 2 different medications, one of which is a steroid used to reduce inflammation in the lungs, and the other is a Long Acting Bronchodilator [Long Acting Beta 2 Antagonist… AKA LABA] which is used to relax the smooth muscles in the airways therefore reducing symptoms of asthma. LABAs work for approximately 12 hours [except for Vilanterol which works for approximately 24 hours and therefore only needs to be taken once a day] and are used to help reduce the amount of Short Acting Bronchodilators [Short-acting beta 2 antagonist… AKA SABA] such a Salbutamol [Ventolin] and Terbutaline [Bricanyl] that a person needs.

The steroid component of Flutiform is Fluticasone and the LABA component is Formoterol.

Flutiform tends to be indicated for use in people ages 12 or older with moderate to severe asthma more so than in people with mild asthma, where the use of a steroid inhaler alone doesn’t control a persons asthma.

Doses:

Flutiform is available in 3 different doses; the 50/5 [containing 50mcg of Fluticasone and 5mcg of Formoterol], the 125/5 and the 250/10. Most people take 2 puffs twice a day through a spacer however your doctor will decide the best dose for you.

I have been on the 125/5 and the 50/5 doses mainly at 2 puffs twice a day but I have been allowed to increase the dose of the 125/5 inhaler to 2 puffs 3-4 times a day [could also be taken as 3-4 puffs twice a day] in an attempt to avoid prednisolone during a flare… and it worked!

Precautions:

Flutiform isn’t indicated for anyone who is allergic or hypersensitive to Fluticasone or Formoterol or any of the ingredients that Flutiform contains [see section 6 of this leaflet].

You should also speak to your doctor before taking Flutiform if you have or have had TB [Tuberculosis] in the past, if you have a chest infection, if you have any heart problems, if you have an aneurysm, if you have diabetes, if you have high blood pressure, if you have an overactive thyroid, if you have low levels of potassium in the blood, if you have poor adrenal gland functioning or if you have liver problems.

You should also talk to your doctor about before taking Flutiform if you are taking certain medications including beta-blockers, theophyllines, adrenaline and adrenaline-like medications, additional LABAs, some antihistamines, some high blood pressure medications, some heart failure medications, some anti-depressants, some antipsychotics, some anti-fungal medications, some anti-virals, some antibiotics, some Parkinson’s medications, some medications used to treat an under active thyroid, certain medications used to treat Hodgkin’s disease and some medications used to induce labour.

Side effects:

[I have indicated the side effects that I have experienced with an asterisk]

Uncommon side effects occurring in approximately1 in 100 people include:

  • increase in blood glucose level
  • worsening of asthma
  • headache
  • shaking *
  • irregular heartbeat or palpitations *
  • dizziness
  • changes in voice/hoarseness
  • dry mouth, sore/irritated throat
  • swelling of hands, ankles or feet

Rare side effects occurring in approximately 1 in 1000 people include:

  • thrush
  • inflammation of sinuses
  • fast heartbeat *
  • muscle spasms
  • coughing or shortness of breath
  • diarrhoea
  • indigestion
  • difficulty sleeping
  • agitation
  • rash
  • high blood pressure

Pros:

+ Many of the side effects are quite mild

+ There are quite a few other combination inhalers available if this one isn’t the right combination for you

+ Can be taken through a spacer as it is an aerosol which increases medication delivery, while reducing the risk of thrush

+ There is some flexibility in doses

Cons:

Is not available in the US or Canada

Is only available as an aerosol

Sources:

  • Patient information leaflet [See here]

Medication 101: Plaquenil/Hydroxychloroquine

I started taking Plaquenil/Hydroxychloroquine in November 2014 after being diagnosed with an autoimmune disease that doesn’t quite fit the criteria for Lupus. So far I haven’t noticed much difference but it can take 3 months for plaquenil to take effect.

Plaquenil is actually an anti malarial medication but is used in autoimmune conditions as a Disease Modifying Anti-Rheumatic Drug [DMARD]. Plaquenil works to reduce the inflammation caused by certain autoimmune conditions [where a person’s immune system attacks their body]. Plaquenil can be used to treat Lupus [both Systemic and Discoid],Connective Tissue Diseases [including Mixed Connective Tissue disease, and Undifferentiated Connective Tissue Disease], Rheumatoid Arthritis and Juvenile Arthritis.

Doses:

The usual dose of Plaquenil is 200-400mg but it has been known to be prescribed in doses as high as 600mg for people with Rheumatoid Arthritis. Plaquenil comes in 200mg tablets and doses of 400mg and over are usually split, taken once in the morning and once in the evening/nighttime.

[Note: Plaquenil is prescribed in much higher doses when used in the treatment for malaria] 

Right now I take 200mg twice a day, with the hopes of reducing this dose in March 2015 if my disease activity is at an adequate level, however Plaquenil is considered relatively safe so I won’t be too concerned if I need to stay on 400mg a day for longer.

Precautions:

Plaquenil is not indicated for use for people who are allergic to hydroxychloroquine, or similar medications [e.g. quinines, and quinones], for people who are pregnant or breastfeeding, or are intending to get pregnant or for people who have retina problems.

Before taking Plaquenil you should have your eyes examined as a baseline assessment, and this examination should be repeated every year that you are on Plaquenil to compare your vision to your baseline assessment. This is because in some cases plaquenil can build up behind your retina causing retina toxicity.

Side Effects:

Side effects that require medical attention [speak to your doctor]:  Allergic reactions [rash, swallowing and/or breathing problems, swelling of eyelids, lips, tongue, face and/or throat], visual changes [blurry vision, changes in the way you see colour, and/or light sensitivity], muscle weakness, muscle cramps, muscle spasms, changes in sensation [e.g. tingling], severe skin reactions [especially where blistering/peeling of skin occurs around mouth, eyes, nose and genitals], high temperatures, bruising more easily, anaemia [possible symptoms include dizziness, pale skin, fatigue, feeling faint, shortness of breath], liver problems [causing jaundice], lower blood glucose levels [feeling shaky, nervous, sweaty], seizures, Psoriasis

Side effects that might not need medical attention if persist for less than a few days [speak to your pharmacist]: Skin rashes, itching, changes in colour of skin inside mouth and nose, hair loss, loss of hair colour/lightening, feeling sick, diarrhoea, loss of appetite, stomach pain, feeling nervous, ringing in ears [tinnitus], headaches

Pros:

+ Considered a mild DMARD as it’s side effects are relatively mild in comparison to other DMARDs

Cons:

Takes a while to work. People usually notice a reduction in symptoms around the 3 month mark but it can take up to 6 months to take full effect. I have been taking this for about 5 weeks and I haven’t noticed a difference yet but it’s early days… I will keep you updated for when I do]

There is currently a shortage of Plaquenil in the US [see here]

This is the first of many Plaquenil tablets that I will be taking.... LETS DO THIS!

 

Sources: