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Apo-Cromolyn (CA), Gastrocrom, Nalcrom (CA) (UK), Nasalcrom, Nu-Cromolyn (CA), Solu-Crom (CA)
Pharmacologic class: Chromone derivative
Therapeutic class: Mast cell stabilizer, antiasthmatic, ophthalmic decongestant
Pregnancy risk category B
Inhibits release of histamine and reacting substances of anaphylaxis from mast cells, stabilizing the cell membrane and reducing the allergic response and inflammatory reaction
Nasal solution: 40 mg/ml (5.2 mg/spray) in 13-ml container (100 sprays) or 26-ml container (200 sprays)
Ophthalmic solution: 4%
Oral solution: 100 mg/5 ml
Solution for nebulization: 10 mg/ml
⊘Indications and dosages
Adults and children ages 13 and older: 200 mg P.O. q.i.d.
Children ages 2 to 12: 100 mg P.O. q.i.d.
➣ Vernal keratoconjunctivitis, vernal conjunctivitis, and vernal keratitis
Adults and children ages 4 and older: One to two drops of ophthalmic solution in each eye four to six times daily at regular intervals
➣ To prevent and relieve nasal symptoms of hay fever and other nasal allergies
Adults and children ages 2 and older: Spray once into each nostril. To prevent nasal allergy symptoms, use up to 1 week before contact with cause of allergy. To relieve nasal symptoms, repeat three to four times daily q 4 to 6 hours. If needed, may use up to six times per day. Use every day while in contact with allergen.
➣ Prevention of acute bronchospasm
Adults and children ages 2 and older: 20 mg q.i.d. via nebulization at regular intervals or no more than 1 hour before exposure to triggering event
➣ Management of bronchial asthma
Adults and children ages 2 and older: 20 mg via nebulization q.i.d. at regular intervals
• Ulcerative colitis
• Hypersensitivity to drug
• Status asthmaticus
Use cautiously in:
• renal or hepatic impairment, acute bronchospasm attacks
• pregnant or breastfeeding patients
• children younger than age 5.
• Administer oral form 30 minutes before meals and at bedtime.
• Before using nasal spray, have patient clear nasal passages by blowing nose.
• Don't expose solutions to direct sunlight.
CNS: headache, drowsiness, dizziness
EENT: nasal irritation, sneezing, epistaxis, postnasal drip (with nasal solution); stinging of eyes, lacrimation (with ophthalmic solution)
GI: nausea, diarrhea, stomachache, swollen parotid glands
GU: difficult or painful urination, urinary frequency
Respiratory: wheezing, cough, bronchospasm
Skin: erythema, rash, urticaria, angioedema
Other: altered taste, substernal burning, allergic reactions including anaphylaxis, serum sickness
• Monitor pulmonary function periodically.
• Evaluate patient for signs and symptoms of overdose, including bronchospasm and difficult or painful urination.
Patient teaching with nasal form
• Teach patient how to instill nasal spray as directed.
• Tell patient that drug may cause unpleasant taste, but that rinsing mouth and performing frequent oral care may help. Also inform him that drug may cause headache.
• Advise patient to report increased sneezing; nasal burning, stinging, or irritation; sore throat; hoarseness; or nosebleed.
With oral form-
• Tell patient to take oral form 30 minutes before meals.
With ophthalmic form-
• Instruct patient to wash hands before using.
• Teach patient how to instill drops: Instruct him to tilt his head back and look up, place drops inside lower eyelid, close his eye, and roll eyeball in all directions. Tell him not to blink for about 30 seconds, and then to apply gentle pressure to inner corner of eye for 30 seconds.
• Caution patient not to let applicator tip touch eye or any other surface.
• Tell patient drug may cause temporary stinging of eye or blurred vision.
• Advise patient not to wear contact lenses during therapy.
With all forms-
• As appropriate, review all other significant adverse reactions.
Pharmacologic: mast cell stabilizers
†For ophthalmic use, see
|Cromolyn-inhalation||1–2 wk||2–4 wk||unknown|
|Cromolyn-nasal||1–2 wk||2–4 wk||unknown|
Adverse Reactions/Side Effects
Central nervous system
Ear, Eye, Nose, Throat
- nasal irritation (most frequent)
- nasal congestion
- irritation of the throat and trachea (most frequent)
- cough (most frequent)
- wheezing (most frequent)
- nausea (most frequent)
- unpleasant taste (most frequent)
- allergic reactions including anaphylaxis or worsening of conditions being treated (life-threatening)
Drug-Drug interactionNot known.
Availability (generic available)
- Inhalation: Evaluate pulmonary function testing before initiating therapy in asthmatics.
- Assess lung sounds and respiratory function before and periodically during therapy.
- Intranasal: Assess for symptoms of rhinitis (stuffiness, rhinorrhea).
Potential Nursing DiagnosesIneffective airway clearance (Indications)
- Reduction in dose of other asthma medications may be possible after 2–4 wk of therapy.
- Oral: Break open and squeeze contents of ampule into a glass of water. Stir solution. Drink all of liquid. Administer 30 min before meals and at bedtime.
- Inhalation: Medication should be used prophylactically, not during acute asthma attacks or status asthmaticus.
- Pretreatment with bronchodilator may be required to increase delivery of inhalation product.
- Do not use nebulizer solution that is cloudy or contains a precipitate. Compatible with acetylcysteine, epinephrine, isoetharine, isoproterenol, metaproterenol, and terbutaline solutions for up to 60 min.
- Instruct patient on correct use of medication. Medication must be used routinely and not more frequently than prescribed. Take missed doses as soon as remembered and space other doses at regular intervals. Do not double doses. Do not discontinue therapy without consulting health care professional, or exacerbation of symptoms may occur.
- Instruct patient not to discontinue concurrent corticosteroid or bronchodilator therapy without consulting health care professional.
- If cromolyn is prescribed before contact with known allergen or exercise, explain that it should be administered 10–15 min, and no earlier than 60 min, in advance.
- Inhalation: Caution patient to notify health care professional if asthmatic symptoms do not improve within 4 wk, worsen, or recur.
- Intranasal: Instruct patient to clear nasal passages before administration and to inhale through nose during administration.
- Instruct patient to start using product up to 1 wk before coming into contact with allergen and to use every day while in contact with allergen.
- Therapeutic effects, observable within 2–4 wk after beginning therapy, are demonstrated by: .
- Reduction in symptoms of asthma.
- Prevention of exercise-induced bronchospasm.
- Decrease in the symptoms of allergic rhinitis.