The recommended total daily dose of Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler are lower than that for current CFC-BDP products and should be adjusted to the individual patient. Proper instruction and good inhaler technique is necessary to get maximum benefit from inhaler. Patients should be advised that Arite Beclometasone 100mcg/actuation Metered Dose Inhaler may have a different taste and feel than a CFC inhaler. Patients should be instructed to rinse their mouth out each time after using inhaler.
Starting and Maintenance Dose:
The recommended dose of Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler in adults are as follows: For mild to moderate asthma: 50mcg to 200mcg twice daily.
For more severe asthma: doses up to 400mcg twice daily.
Maximum recommended daily dose: 800mcg.
In children aged five years and over, the recommended dose is 50mcg twice daily.
Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler must be used on a regular basis even when patients are asymptomatic. When patients' symptoms remain satisfactorily controlled, the dose can be gradually reduced to the minimum effective dose to maintain control. Doses of beclometasone dipropionate can be titrated up or down by switching between Arite Beclometasone 50mcg/actuation Metered Dose Inhaler (a lower strength) and Arite Beclometasone 100mcg/actuation Metered Dose Inhaler (a higher strength) as required.
Transferring Patients from a CFC-BDP Inhaler to Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler:
Step 1 - Consider the dose of CFC-BDP appropriate to the patients' current condition. Symptomatic patients may require an increased dose of CFC-BDP and this increased dose should be considered in transferring patients to Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler.
Step 2 - Convert the appropriate CFC-BDP dose to the Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler dose according to the table as follows: (see table.)
Click on icon to see table/diagram/image
Special Patient Groups: Elderly and Patients with Hepatic or Renal Impairment:
No special dosage recommendations are made.
Patients Not Receiving Systemic Corticosteroids:
For patients who are inadequately controlled with bronchodilators and who are not receiving systemic corticosteroids, it is recommended that they continue to use a bronchodilator when treatment with Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler commences. Any improvement in respiratory function is usually apparent in 1 to 4 weeks. Some of the patients who do not respond during this period may have excessive mucus in their bronchi so that the drug is unable to penetrate to its site of action. A short course of systemic steroids in relatively high dosage should be given to eliminate mucus and other inflammatory changes in the lungs. Continuation of treatment with Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler usually maintains the improvement achieved with the oral steroid while it is being withdrawn gradually. Exacerbation of asthma caused by infection is usually controlled by appropriate antibiotic treatment and, if necessary, by increasing the dose of Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler. However, it may be necessary to give a short, intensive course of systemic steroids to tide over the duration of the stress.
Steroid Dependent Patients:
As recovery from impaired adrenocortical function, caused by prolonged systemic steroid therapy is slow, adrenocortical function should be monitored regularly. The patient's asthma should be in a stable state before being given inhaled steroids in addition to the usual maintenance dose of systemic steroid. Withdrawal of systemic steroids should be gradual, starting about seven days after the introduction of Arite Beclometasone 50mcg/actuation and 100mcg/actuation Metered Dose Inhaler therapy. For daily oral doses of prednisolone of 10mg or less, dose reduction in 1 mg steps at intervals of not less than one week is recommended. The dose reduction scheme should be chosen to correlate with the magnitude of the maintenance systemic steroid dose. Some patients feel unwell experiencing aches and pains, tiredness and even depression during the withdrawal phase despite maintenance or even improvement of respiratory function. These withdrawal symptoms should be treated symptomatically and the patient should be encouraged to persevere with the inhaler and withdrawal of systemic steroids. However, if there are objective signs of adrenal insufficiency, it may be necessary to resume systemic steroid treatment temporarily. Most patients can be successfully transferred to inhaled steroids with maintenance of good respiratory function, but special care is necessary for the first months after the transfer until the hypothalamic-pituitary-adrenal (HPA) system has sufficiently recovered to enable the patient to cope with emergencies such as trauma, surgery or severe infections. It may be advisable to provide such patients with a supply of oral steroid to use in such emergencies. The dose of inhaled steroids should be increased at this time and then gradually reduced to the maintenance level after the systemic steroid has been discontinued. Discontinuation of systemic steroids may cause exacerbation of allergic diseases such as atopic eczema and rhinitis previously controlled by the systemic drug. These should be treated symptomatically with antihistamines and/or topical therapy.
Method of administration:
This product is recommended for those patients who have demonstrated consistent good technique with coordinating actuation and inhalation. The patient should read the instruction leaflet before use. Before first use of the inhaler, or if the inhaler has not been used for two weeks or more, prime the inhaler by releasing two puffs into the air.
Instructions for Use:
i) Take the cover off the mouthpiece.
ii) Breathe out as far as is comfortable and then immediately place the mouthpiece in mouth and close lips around it.
iii) Start to breathe in slowly and deeply through mouth and press down on the canister inside the inhaler. This releases one puff of medicine. It is important that patient carry on breathing in after the puff is released.
iv) Hold breath for 10 seconds, then breathe out slowly.
v) If doctor has prescribed more than one puff, repeat steps (ii) to (iv) again. After use, replace the cover on the mouthpiece.
For normal hygiene, the mouthpiece of inhaler should be cleaned weekly with a clean, dry tissue or cloth. Patients should also rinse their mouth with water each time after using inhaler. Do not wash or put any part of inhaler in water.