Nasalcrom


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Related to Nasalcrom: cromolyn sodium

cromolyn sodium

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

Action

Inhibits release of histamine and reacting substances of anaphylaxis from mast cells, stabilizing the cell membrane and reducing the allergic response and inflammatory reaction

Availability

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

Mastocytosis

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

Off-label uses

• Proctitis
• Ulcerative colitis
• Urticaria

Contraindications

• Hypersensitivity to drug
• Status asthmaticus

Precautions

Use cautiously in:
• renal or hepatic impairment, acute bronchospasm attacks
• pregnant or breastfeeding patients
• children younger than age 5.

Administration

• 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.

Adverse reactions

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

Musculoskeletal: myopathy

Respiratory: wheezing, cough, bronchospasm

Skin: erythema, rash, urticaria, angioedema

Other: altered taste, substernal burning, allergic reactions including anaphylaxis, serum sickness

Interactions

None significant

Patient monitoring

• 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.

cromolyn†

(kroe-moe-lin) ,

Apo-Cromolyn

(trade name),

Gastrocrom

(trade name),

NasalCrom

(trade name)

Classification

Therapeutic: antiasthmatics
Pharmacologic: mast cell stabilizers
Pregnancy Category: B
†For ophthalmic use, see

Indications

Inhalation: Prophylaxis (long-term control) of bronchial asthma.Prevention of exercise-induced bronchospasm. Intranasal: Prevention and treatment of seasonal and perennial allergic rhinitis. Oral: Mastocytosis.Treatment of food allergy.Treatment of inflammatory bowel disease (IBD).

Action

Prevents the release of histamine and slow-reacting substance of anaphylaxis (SRS-A) from sensitized mast cells.

Therapeutic effects

Decreased frequency and intensity of asthmatic episodes or allergic reactions.

Pharmacokinetics

Absorption: Oral: 0.5—2 %; Inhalation: Poorly absorbed systemically (total bioavailability is 8%); action is local. Small amounts may reach systemic circulation after inhalation.
Distribution: Because only small amounts are absorbed, distribution is not known.
Metabolism and Excretion: Small amounts absorbed are excreted unchanged in bile and urine.
Half-life: 80–90 min.

Time/action profile

ROUTEONSETPEAKDURATION
Cromolyn-inhalation1–2 wk2–4 wkunknown
Cromolyn-nasal1–2 wk2–4 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Acute attacks of asthma (inhalation).
Use Cautiously in: Renal or hepatic dysfunction; Bronchospasm—Will not relieve and may worsen acute attacks (inhalation); Obstetric / Lactation: Safety not established; Pediatric: Safety not established in children <2 yr.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Dermatologic

  • rash
  • urticaria
  • angioedema

Ear, Eye, Nose, Throat

    intranasal:
  • nasal irritation (most frequent)
  • nasal congestion
  • sneezing

Respiratory

    inhalation:
  • irritation of the throat and trachea (most frequent)
  • cough (most frequent)
  • wheezing (most frequent)
  • bronchospasm

Gastrointestinal

  • nausea (most frequent)
  • unpleasant taste (most frequent)

Miscellaneous

  • allergic reactions including anaphylaxis or worsening of conditions being treated (life-threatening)

Interactions

Drug-Drug interaction

Not known.

Route/Dosage

Inhalation (Adults and Children ≥2 yr) Nebulized solution:One ampule (20-mg) of the nebulizer solution 4 times daily. For prevention of bronchospasm, use one nebulized ampule (20 mg) 10–15 min before exposure to known precipitating situation.
Intranasal (Adults and Children ≥2 yr) 1 spray (5.2 mg/spray) into each nostril 3–4 times daily (up to 6 times daily).
Oral (Adults and Children > 12 yr) 200 mg 4 times a day.
Oral (Children 2–12 yr) 100 mg 4 times a day; not to exceed 40 mg/kg/day.

Availability (generic available)

Solution for nebulization: 10 mg/mL
Nasal solution: 40 mg/mL (5.2 mg/spray) in 13-mL (≥100 sprays) or 26-mL (≥200 sprays) containersOTC
Oral solution: 100 mg/5 mL

Nursing implications

Nursing assessment

  • 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 Diagnoses

Ineffective airway clearance (Indications)

Implementation

  • 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.

Patient/Family Teaching

  • 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.

Evaluation/Desired Outcomes

  • 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.

Nasalcrom

(nā′zəl-krŏm′)
A trademark for the drug cromolyn sodium.

Nasalcrom®

Cromolyn ENT An OTC agent for managing allergic rhinitis. See Allergic rhinitis.
References in periodicals archive ?
The best alternative would be preventive medication such as Nasalcrom, Economides says.
NasalCrom helps prevent the mast cell from breaking down halting the response before the triggers are released.
In April NasalCrom nasal spray was approved by the Food and Drug Administration as the only treatment for all nasal allergy symptoms for use in children as young as 2.
Nasalcrom works by turning off the allergic response before it begins.
Nasalcrom 4% Nasal Solution was cleared by the FDA for marketing as a prescription drug in 1983.
So there's a place where people can go for basic information on PediaCare and Nasalcrom and the like.
s Nasalcrom sliding more than 9% to $41 million, while Primatene Mist fell 11.
If cleared by the FDA, Nasalcrom would be the first OTC allergy treatment indicated for prevention as well as treatment of symptoms of allergic rhinitis.
and Pharmacia & Upjohn Consumer Healthcare with their respective brands of Primatene Mist and Nasalcrom.
In the United States Pharmacia's consumer health care division markets various nonprescription products, including Rogaine extra-strength for men, Rogaine for women, NasalCrom allergy prevention nasal spray, Cortaid, PediaCare and Dramamine.
s Children's NasalCrom, a nasal spray designed to stop an allergic response before it begins, and Health Products & Technologies America's (HTPA's) CoughPops, lollipops formulated with such cold-fighting ingredients as zinc, which are intended to make it more pleasant for children to take medicine when they are ill.
The new Children's NasalCrom Nasal Spray from Pharmacia & Upjohn is being promoted by the company as having no known drug interactions, which enables parents to use the product for children as young as six.