Tag Archives: medication

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

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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

Psoriatic Arthritis: advancements in medicine

I recently signed up to receive news from the Arthritis Foundation and on Wednesday I got an email which was all about a new medication called Otezla (Apremilast), that has just been approved by the FDA for Psoriatic Arthritis.

I know a couple of people with Psoriatic Arthritis and so it’s nice to see that research is focusing on other types of arthritis and not only Rheumatoid Arthritis, which I find sometimes draws more attention than other types of arthritis… And I have read opinions on other blogs, of people who seem to share this thought.

Otezla is a selective phosphodiesterase 4 inhibitor, which sounds really complicated but what it actually does it block an enzyme (called phosphodiesterase 4, funnily enough) which plays quite a major role in the inflammation that Psoriatic Arthritis causes…. Meaning that this medication reduces the inflammation!

Clinical trials showed that not only was Otezla effective, but it was relatively safe too, in that it doesn’t seem to increase the risk of serious infection like so many Biologics do!

I’m not suggesting that Otezla will revolutionise the treatment of Psoriatic Arthitis, there is no evidence to suggest that BUT it does give people more options, which is really needed, not only in Psoriatic Arthritis but in all types of arthritis. I know people who are worried about running out of medication to try so maybe, just maybe this med might help. This is the second new medication that has been approved by the FDA for the treatment of Psoriatic Arthritis in the last 6 months, the other being Stelara, so it does really look like there is more and more research going into arthritis, and psoriatic arthritis in particular.

And what’s more Otezla is administered orally by taking a tablet! I found that concept quite novel as all of the biological medications I know of either have to be injected or infused… Although there are quite a few DMARDs (disease-modifying anti-rheumatic drugs) that are taken orally, methotrexate, sulfasalazine and leflunomide come to mind.

I haven’t been able to find much on when Otezla will be reaching the UK and Europe but I will do a bit more digging, and hopefully Otezla will be approved very soon here!