Generic name product may be available in the U.S.
Other commonly used names are cromoglicic
acid
, cromoglycic acid
, sodium cromoglicate
, and sodium cromoglycate
.
Description
Cromolyn (KROE-moe-lin)
is used to prevent the
symptoms of asthma. When it is used regularly, cromolyn lessens the number
and severity of asthma attacks by reducing inflammation in the lungs. Cromolyn
is also used just before exposure to conditions or substances (for example,
exercise, allergens, such as pollen, aspirin, chemicals,
cold air, or air pollutants) that cause bronchospasm (wheezing or difficulty
in breathing). Cromolyn will not help an asthma or bronchospasm attack that
has already started.
Cromolyn may be used alone or with other asthma medicines, such as bronchodilators
(medicines that open up narrowed breathing passages) or corticosteroids (cortisone-like
medicines).
Cromolyn inhalation works by acting on certain inflammatory cells in the
lungs to prevent them from releasing substances that cause asthma symptoms
or bronchospasm.
This medicine is available only with your doctor's prescription, in the
following dosage forms:
Inhalation
-
Capsules for inhalation (Canada)
-
Inhalation aerosol (U.S. and Canada)
-
Inhalation solution (U.S. and Canada)
It is very important that you read and
understand the following information.
If any of it causes you special
concern, check with your doctor. Also,
if you have any
questions
or if you want more information about this medicine or your
medical problem,
ask your doctor, nurse, or pharmacist.
Before Using This Medicine
In deciding to use a medicine,
the risks of using the medicine must be weighed against the good it will do.
This is a decision you and your doctor will make. For cromolyn inhalation,
the following should be considered:
Allergies--Tell your doctor if you have ever had any unusual or
allergic reaction to cromolyn or to any other inhalation aerosol medicine.
Also,
tell your health care professional if you are allergic to any other substances,
such as preservatives.
Pregnancy--Cromolyn has not been studied in pregnant women.
However, when taken during pregnancy to control the mother's asthma, cromolyn
has not been shown to cause birth defects or other problems
in the baby. Studies in animals have shown that cromolyn causes a reduction
in the number of successful pregnancies
and a decrease in the weight of the animal fetus only when given by injection
in very large amounts. Before taking this medication, make sure
your doctor knows if you are pregnant or if you may become pregnant.
Breast-feeding--It is not known whether cromolyn passes into
the breast milk. However, this medicine has not been reported to cause problems
in nursing babies. Although most medicines pass into breast milk in small
amounts, many of them may be used safely while breast-feeding. Mothers who
are using this medicine and who wish to breast-feed should discuss this with
their doctor.
Children--Although there is
no specific information comparing the use of cromolyn in children with use
in other age groups, this medicine is not expected to cause different side
effects or problems in children than it does in adults. The inhalation solution
form of this medicine should not be used in children younger than 2 years
of age, and the inhalation aerosol should not be used in children younger
than 5 years of age.
Older adults--Many medicines have not been studied specifically
in older people. Therefore, it may not be known whether they work exactly
the same way they do in younger adults. Although there is no specific information
comparing the use of cromolyn inhalation in the elderly with use in other
age groups, this medicine is not expected to cause different side effects
or problems in older people than it does in younger adults.
Other medical problems--The presence of other medical problems
may affect the use of cromolyn. Make sure you tell your doctor if you have
any other medical problems, especially:
-
Heart disease or
-
Irregular heartbeat--The propellants used to deliver the medicine
in the aerosol inhaler may worsen these conditions
Proper Use of This Medicine
Cromolyn oral inhalation is used to help prevent symptoms
of asthma or bronchospasm (wheezing or difficulty in breathing). Cromolyn
will not relieve an asthma or a bronchospasm attack that has already started.
It
is important to use cromolyn at regular times as directed by your doctor.
Use cromolyn inhalation only as directed
. Do
not use more of it and do not use it more often than your doctor ordered.
To do so may increase the chance of side effects.
Cromolyn inhalation usually comes with patient directions. Read them carefully
before using this medicine. If you do not understand the directions that come
with the inhaler or if you are not sure how to use the inhaler, ask your health
care professional to show you how to use it. Also, ask your health care professional
to check regularly how you use the inhaler to make sure you are using it properly.
For patients using
cromolyn inhalation aerosol
:
-
The cromolyn aerosol canister provides about 112 or 200 inhalations,
depending on the size of the canister your doctor ordered. You should try
to keep a record of the number of inhalations you use so you will know when
the canister is almost empty. This canister, unlike some other aerosol canisters,
cannot be floated in water to test its fullness.
-
When you use the inhaler for the first time, or if you have not used
it in a while, the inhaler may not deliver the right amount of medicine with
the first puff. Therefore, before using the inhaler, test or prime it.
-
To test or prime the inhaler
:
-
Insert the medicine container (canister) firmly into the clean mouthpiece
according to the manufacturer's directions. Check to make sure the canister
is placed properly into the mouthpiece.
-
Take the cap off the mouthpiece and shake the inhaler three or four
times.
-
Hold the inhaler well away from you at arm's length and press the
top of the canister, spraying the medicine one time into the air. The inhaler
will now be ready to provide the right amount of medicine when you use it.
-
To use the inhaler
:
-
Using your thumb and one or two fingers, hold the inhaler upright,
with the mouthpiece end down and pointing toward you.
-
Take the cap off the mouthpiece. Check the mouthpiece to make sure
it is clear. Do not use the inhaler with any other mouthpieces.
-
Gently shake the inhaler three or four times.
-
Hold the mouthpiece away from your mouth and breathe out slowly and
completely to the end of a normal breath.
-
Use the inhalation method recommended by your doctor.
-
Open-mouth method: Place the mouthpiece about 1 to 2 inches (2 fingerwidths)
in front of your widely opened mouth. Make sure the inhaler is aimed into
your mouth so the spray does not hit the roof of your mouth or your tongue.
Avoid
spraying in eyes.
-
Closed-mouth method: Place the mouthpiece in your mouth between your
teeth and over your tongue with your lips closed tightly around it. Make sure
your tongue or teeth are not blocking the opening.
-
Tilt your head back a little. Start to breathe in slowly through
your mouth. At the same time, press the top of the canister once to get one
puff of medicine. Continue to breathe in slowly for 3 to 4 seconds until you
have taken a full deep breath. It is important to press down on the canister
and breathe in slowly at the same time so the medicine gets into your lungs.
This step may be difficult at first. If you are using the closed-mouth method
and you see a fine mist coming from your mouth or nose, the inhaler is not
being used correctly.
-
Hold your breath as long as you can up to 10 seconds (count slowly
to ten). This gives the medicine time to settle into your airways and lungs.
-
Take the mouthpiece away from your mouth and breathe out slowly.
-
If your doctor has told you to inhale more than 1 puff of medicine
at each dose, wait about 1 minute between puffs. Then, gently shake the inhaler
again, and take the second puff following exactly the same steps you used
for the first puff. Breathe in only one puff at a time.
-
When you are finished using the inhaler, wipe off the mouthpiece
and replace the cap.
-
Keep track of the number of sprays you have
used from the inhaler, and discard the inhaler after the labeled maximum number
of sprays has been used.
Your doctor may want you to use a spacer device with the inhaler. A spacer
makes the inhaler easier to use. It allows more of the medicine to reach your
lungs, rather than staying in your mouth and throat.
-
To use a spacer device with the inhaler
:
-
Attach the spacer to the inhaler according to the manufacturer's
directions. There are different types of spacers available, but the method
of breathing remains the same with most spacers.
-
Gently shake the inhaler and spacer well.
-
Hold the mouthpiece of the spacer away from your mouth and breathe
out slowly and completely.
-
Place the mouthpiece of the spacer into your mouth between your teeth
and over your tongue with your lips closed around it.
-
Press down on the canister top once to release one puff of medicine
into the spacer. Then, within 1 or 2 seconds, begin to breathe in slowly and
deeply through your mouth for 5 to 10 seconds. Count the seconds while inhaling.
-
Hold your breath as long as you can up to 10 seconds (count slowly
to 10).
-
Breathe out slowly.
-
Wait a minute between puffs. Then, gently shake the inhaler and spacer
again and take the second puff, following exactly the same steps you used
for the first puff. Do not spray more than one puff at a time into the spacer.
-
When you are finished using the inhaler, remove the spacer device
from the inhaler and replace the cap.
Clean the inhaler, mouthpiece, and spacer at least once a week.
-
To clean the inhaler
:
-
Remove the canister from the inhaler and set the canister aside.
Do not get the canister wet.
-
Wash the mouthpiece, cap, and the spacer in warm soapy water. Rinse
well with warm, running water.
-
Shake off the excess water and let the inhaler parts air dry completely
before putting the inhaler back together.
For patients using
cromolyn capsules for inhalation
:
-
Do not swallow the capsules. The medicine will
not work if you swallow it
.
-
This medicine is used with a special inhaler, either the
Spinhaler
or the
Halermatic
. If you do not
understand the directions that come with the inhaler or if you are not sure
how to use the inhaler, ask your health care professional to show you how
to use it. Also, ask your health care professional to check regularly how
you use the inhaler to make sure you are using it properly.
-
If you are using
cromolyn capsules for inhalation
with the
Spinhaler
:
-
To load the Spinhaler
:
-
Make sure your hands are clean and dry.
-
Insert the capsule into the inhaler just before using this medicine.
-
Hold the inhaler upright with the mouthpiece pointing down. Unscrew
the body of the inhaler from the mouthpiece.
-
Keep the mouthpiece pointing down and the propeller on the spindle.
Remove the foil from the capsule and insert the colored end of the cromolyn
capsule firmly into the cup of the propeller. Avoid too much handling of the
capsule, because moisture from your hands may make the capsule soft.
-
Make sure the propeller moves freely.
-
Screw the body of the inhaler back into the mouthpiece and make certain
that it is fastened well.
-
While keeping the inhaler upright with the mouthpiece pointing down,
slide the grey outer sleeve down firmly until it stops. This will puncture
the capsule. Then slide the sleeve up as far as it will go. This step may
be repeated a second time to make sure the capsule is punctured.
-
To use the Spinhaler
:
-
Check to make sure the mouthpiece is properly attached to the body
of the inhaler.
-
Hold the inhaler away from your mouth and breathe out slowly to the
end of a normal breath.
-
Place the mouthpiece in your mouth, close your lips around it, and
tilt your head back. Do not block the mouthpiece with your teeth or tongue.
-
Take a deep and rapid breath. You should hear and feel the vibrations
of the rotating propeller as you breathe in.
-
Take the inhaler from your mouth and hold your breath for a few seconds
or as long as possible.
-
Hold the inhaler away from your mouth and breathe out slowly and
completely to the end of a normal breath. Do not breathe out through the inhaler
because this may prevent the inhaler from working properly.
-
Keep taking inhalations of this medicine until all the powder from
the capsule is inhaled. A light dusting of powder remaining in the capsule
is normal and is not a sign that the inhaler is not working properly.
-
Throw away the empty capsule. Then return the inhaler to the container
and replace the lid on the container.
-
To clean the Spinhaler
:
-
At least once a week, brush off any powder left sticking to the propeller.
-
Take the inhaler apart and wash the parts of the inhaler with clean,
warm water.
-
Wash the inside of the propeller shaft by moving the propeller on
and off the steel spindle under water.
-
Shake out the excess water.
-
Allow all parts of the inhaler to dry completely before putting it
back together.
-
The Spinhaler should be replaced after 6 months.
-
If you are using
cromolyn capsules for inhalation
with the
Halermatic
:
-
To load the Halermatic
:
-
Make sure your hands are clean and dry.
-
Insert the capsule cartridge into the inhaler just before using this
medicine.
-
Remove the mouthpiece cover. Then pull off the mouthpiece.
-
Push a cromolyn capsule cartridge firmly down to the bottom of the
slot.
-
Slide the mouthpiece back on the body of the inhaler. Push down slowly
as far as the mouthpiece will go. This punctures the capsule cartridge and
lifts it into the rotation chamber. Do not repeat this step because the capsule
cartridge needs to be punctured only once.
-
To use the Halermatic
:
-
Hold the inhaler away from your mouth and breathe out slowly to the
end of a normal breath.
-
Place the mouthpiece in your mouth, close your lips around it, and
tilt your head back. Do not block the flow of medicine into the lungs with
your teeth or tongue.
-
Breathe in quickly and steadily through the mouthpiece.
-
Hold your breath for a few seconds to keep the medicine in the lungs
as long as possible. Then take the inhaler away from your mouth.
-
Hold the inhaler well away from your mouth and breathe out to the
end of a normal breath. Do not breathe out through the inhaler because this
may prevent the inhaler from working properly.
-
Keep taking inhalations of this medicine until all the powder from
the capsule is inhaled. A light dusting of powder remaining in the capsule
is normal and is not a sign that the inhaler is not working properly.
-
Throw away the empty capsule cartridge.
-
To clean the Halermatic
:
-
Brush away powder deposits each day with a brush.
-
When powder deposits build up, wipe them away with a slightly damp
cloth.
-
The mouthpiece may be washed separately if necessary. However, do
not wet the blue-based body of the inhaler. Be sure the mouthpiece grid is
dry before putting the inhaler back together.
-
The Halermatic should be replaced every 6 months.
For patients using
cromolyn inhalation solution
:
-
Cromolyn inhalation solution comes in a small glass container called
an ampul. The ampul must be broken gently to empty the contents. If you do
not understand the manufacturer's directions, ask your health care professional
to show you what to do.
-
Do not use the solution in the ampul if it is cloudy or contains
particles.
-
To break and empty the ampul
:
-
The glass ampul is weak at each end so the ends can be broken easily
by hand.
-
Hold the ampul away from the nebulizer and your face when you break
it. Hold the ampul at an angle and carefully break off the lower end. No solution
will come out.
-
Turn the ampul over so the open end faces up. Place a forefinger
carefully over the open end.
-
Keep your finger firmly in place and break off the lower end of the
ampul.
-
To empty the ampul, hold it over the bowl of the nebulizer unit and
remove your finger to let the solution flow out.
-
Throw away any solution left in the nebulizer after you have taken
your treatment.
-
Use this medicine only in a power-operated nebulizer that has an
adequate flow rate and is equipped with a face mask or mouthpiece. Your doctor
will advise you on which nebulizer to use. Make sure you understand exactly
how to use it. Hand-squeezed bulb nebulizers cannot be used with this medicine.
If you have any questions about this, check with your doctor.
For patients using
cromolyn oral inhalation
regularly (for example, every day):
-
In order for cromolyn to work properly, it must
be inhaled every day in regularly spaced doses as ordered by your doctor
.
Up to 4 weeks may pass before you feel the full effects of the medicine.
Dosing--The dose of cromolyn will be different for
different patients.
Follow your doctor's orders or the
directions on the label
. The following information includes only the
average doses of cromolyn inhalation.
If your dose is
different, do not change it
unless your doctor tells you to do so.
The number of doses you take each day, the time allowed between doses,
and the length of time you take the medicine depend on the medical problem
for which you are taking cromolyn inhalation.
-
For
inhalation aerosol
dosage form:
-
For prevention of asthma symptoms:
-
Adults and children 5 years of age or older--2 inhalations (puffs)
taken four times a day with doses spaced four to six hours apart.
-
Children up to 5 years of age--Cromolyn inhalation aerosol should
not be used in children younger than 5 years of age.
-
For prevention of bronchospasm caused by exercise or a condition
or substance:
-
Adults and children 5 years of age or older--2 inhalations (puffs)
taken at least ten to fifteen (but not more than sixty) minutes before exercise
or exposure to any condition or substance that may cause an attack.
-
Children up to 5 years of age--Cromolyn inhalation aerosol should
not be used in children younger than 5 years of age.
-
For
capsule for inhalation
dosage form:
-
For prevention of asthma symptoms:
-
Adults and children 2 years of age or older--20 mg (contents
of 1 capsule) used in an inhaler, taken four times a day with doses spaced
four to six hours apart.
-
Children up to 2 years of age--The capsule for inhalation should
not be used in children younger than 2 years of age.
-
For prevention of bronchospasm caused by exercise or a condition
or substance:
-
Adults and children 2 years of age or older--20 mg (contents
of 1 capsule) used in an inhaler, taken at least ten to fifteen
(but not more than sixty) minutes before exercise or exposure to any condition
or substance that may cause an attack.
-
Children up to 2 years of age--The capsule for inhalation should
not be used in children younger than 2 years of age.
-
For
inhalation solution
dosage form:
-
For prevention of asthma symptoms:
-
Adults and children 2 years of age or older--20 mg (contents
of 1 ampul) used in a nebulizer. This medicine should be used four times a
day with doses spaced four to six hours apart. Use a new ampul of solution
for each dose.
-
Children up to 2 years of age--Cromolyn inhalation solution
should not be used in children younger than 2 years of age.
-
For prevention of bronchospasm caused by exercise or a condition
or substance:
-
Adults and children 2 years of age or older--20 mg (contents
of 1 ampul) used in a nebulizer. This medicine should be used at least ten
to fifteen (but not more than sixty) minutes before exercise or exposure to
any condition or substance that may cause an attack. Use a new ampul of solution
for each dose.
-
Children up to 2 years of age--Cromolyn inhalation solution
should not be used in children younger than 2 years of age.
Missed dose--If you are using cromolyn regularly and you miss
a dose, use it as soon as possible. Then use any remaining doses for that
day at regularly spaced times.
Storage--To store this medicine:
-
Keep out of the reach of children.
-
Store the aerosol or solution form of this medicine at room temperature
away from heat or cold. Keep this medicine from freezing.
-
Store the capsule or solution form of this medicine away from direct
light. Store the aerosol form of this medicine away from direct sunlight.
-
Do not store the capsule form of this medicine in the bathroom, near
the kitchen sink, or in other damp places. Heat or moisture may cause the
medicine to break down.
-
Do not puncture, break, or burn the aerosol container, even if it
is empty.
-
Do not keep outdated medicine or medicine no longer needed. Be sure
that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
If your symptoms do not improve within 4 weeks or if your condition
becomes worse after you begin using cromolyn, check with your doctor
.
If you are also taking a corticosteroid or a bronchodilator
for your asthma along with this medicine, do not stop taking the corticosteroid
or bronchodilator even if your asthma seems better, unless you are told to
do so by your doctor
.
Dryness of the mouth or throat or throat irritation may occur after you
use this medicine. Gargling and rinsing your mouth or taking a drink of water
after each dose may help prevent these effects.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects.
Although not all of these side effects may occur, if they do occur they may
need medical attention.
Check with your doctor as soon as possible if any of the following side
effects occur:
Other side
effects may occur that usually do not need medical attention. These side effects
may go away during treatment as your body adjusts to the medicine. However,
check with your doctor if any of the following side effects continue or are
bothersome:
If you are using the cromolyn inhalation aerosol, you may notice an unpleasant
taste. This may be expected and will go away when you stop using the medicine.
Other side effects not listed above may also occur in some patients. If
you notice any other effects, check with your doctor.
