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(KROE-moe-lin SO-dee-uhm)
Crolom, Gastrocrom, Intal, Nasalcrom,  Nalcrom, Rynacrom
Class: Respiratory inhalant

 Action Stabilizes mast cells, which release histamine and other mediators of allergic reactions.

 Indications

Inhalation: Prophylaxis of severe bronchial asthma; prevention of exercise-induced asthma; prevention of acute bronchospasm induced by environmental pollutants and known antigens. Nasal solution: Prevention and treatment of allergic rhinitis. Oral: Treatment of mastocytosis. Ophthalmic: Treatment of vernal keratoconjunctivitis, vernal conjunctivitis and vernal keratitis. Unlabeled use(s): Oral form: Symptoms of food allergies; eczema; dermatitis; ulceration; urticaria pigmentosa; chronic urticaria; hay fever; and postexercise bronchospasm.

 Contraindications Standard considerations.

 Route/Dosage

Bronchial Asthma

ADULTS & CHILDREN (£ 5 YR FOR CAPSULES, ³ 2 YR FOR SOLUTION): Nebulization Initially 20 mg inhaled qid at regular intervals. ADULTS & CHILDREN > 5 YR: Aerosol 2 metered sprays (1600 mcg) inhaled qid at regular intervals.

Prevention of Acute Bronchospasm

ADULTS: 2 metered dose sprays or 20 mg via inhaled capsule or nebulizer (10–15 min but no longer than 60 min) before exposure to precipitating factor.

Seasonal or Perennial Rhinitis

ADULTS & CHILDREN > 6 YR: Nasal solution with spray device Begin treatment prior to contact with allergen and continue throughout exposure period. One spray (5.2 mg) in each nostril 3–6 times/day at regular intervals.

Mastocytosis

ADULTS: PO 200 mg qid ½ hr before meals and at bedtime. CHILDREN 2–12 YR: PO 100 mg qid ½ hr before meals and at bedtime (maximum 40 mg/kg/day). Note: Decrease in dosage maintenance levels is done gradually, except with major complication. Abrupt withdrawal may result in increased asthma symptoms. PREMATURE TO TERM INFANTS: Not recommended. TERM INFANTS-2 YR: PO 20 mg/kg/day in 4 divided doses (maximum 30 mg/kg/day).

Vernal keratoconjunctivitis, vernal conjunctivitis and vernal keratitis

ADULTS: SOLN 1 or 2 drops in each eye 4 to 6 times/day at regular intervals.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Dizziness; headache. DERM: Rash; urticaria; angioedema. EENT: Lacrimation; nasal stinging, burning or irritation; sneezing; nasal congestion; bad taste; swollen parotid gland; dry or irritated throat. GI: Nausea; substernal burning; diarrhea (oral form). GU: Dysuria; urinary frequency. OPHTHALMIC: Stinging; burning; watery eyes; itchy eyes; dryness around the eye; puffy eyes; eye irritation; and styes. RESP: Cough; wheezing; bronchospasm. OTHER: Joint pain and swelling.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Capsules: Use not recommended in children < 5 yr. Aerosol: Safety and efficacy not established in children < 5 yr. Nebulizer: Safety and efficacy not established in children < 2 yr. Nasal solution: Safety and efficacy not established in children < 6 yr. Acute asthma: Do not use for acute asthma attack. Effects depend on regular administration. Aerosol: Use with caution in patients with coronary artery disease or cardiac arrhythmias because of propellants in this preparation. Bronchospasm: Cough or bronchospasm may follow inhalation. Eosinophilic pneumonia: If signs of this condition occur, therapy will need to be discontinued. Hepatic or renal function impairment: Decreased dose is recommended. Hypersensitivity: Severe anaphylactic reactions may occur.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

Oral

  • Open and dissolve capsule contents completely in ½ glass of hot water. While stirring, add equal amount of cold water. Administer all of liquid. Do not mix with juice, milk or foods.
  • Administer ½ hr before meals and at bedtime.
  • Do not use oral capsules for inhalation.
  • Store in airtight, light-resistant container at room temperature.

Inhalation

  • Administer when patient’s airway is clear for inhalation. Do not administer during acute asthmatic attack.

Nebulizer Solution/Inhalation Capsules

  • Instruct patient to close eyes during inhalation to prevent accidental contact with eyes.
  • If bronchodilating inhalant is also prescribed, give bronchodilator 5–15 min before cromolyn to enhance drug delivery. Have patient exhale completely, place mouthpiece between lips and inhale deeply and rapidly, hold breath for few seconds, remove mouthpiece, then exhale. Repeat until entire dose is taken.

Aerosol

  • Store away from heat and direct sunlight. Protect from freezing. Do not puncture, break or burn container.
  • Use spacer (eg, Aero chamber) to enhance delivery of drug.
  • Inhalation capsules: Store in tight, light-resistant container. Avoid storing in moist environment (eg, bathroom).

Nasal

  • Clear patient’s nasal passages before administering spray. Have patient inhale medication through nose.
  • Hold container upright. Use pumping motion to force solution mist into nasal passages.
  • Store in airtight, light-resistant container.

Ophthalmic Solution

  • The effectiveness of cromolyn therapy is dependent on its administration at regular intervals, as directed.
  • Patient may experience a transient stinging or burning sensation following instillation of cromolyn.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Evaluate therapeutic effectiveness by decrease in frequency or severity of clinical symptoms or decrease in need for concomitant therapy over period of 4 wk.
  • Notify physician if these signs occur: wheezing or coughing after inhalation or stinging effect after nasal instillation; joint pain; severe wheezing, difficulty breathing, chills, sweating or chest pain, which may indicate eosinophilic pneumonia.

 Patient/Family Education

  • Explain that cromolyn is used for prevention, not treatment, of acute asthma attacks.
  • Give patient clear instructions about what to do during an acute asthma attack.
  • Teach patient correct use of administration device (see instructions in package). Have patient demonstrate its use.
  • Emphasize that inhalation capsules are not to be swallowed.
  • Explain that oral capsules are oversized to prevent powder from spilling when capsule is opened. Remind patient to dissolve powder in water only and to drink entire contents of solution.
  • Advise patient to minimize exposure to known allergens or precipitating factors.
  • Instruct patient with cold or exercise-induced asthma to use medication at least 10–15 min before exposure but no longer than 1 hr.
  • Advise patient to rinse mouth or gargle after oral inhalation to prevent throat irritation.
  • If patient is taking concurrent bronchodilators or corticosteroids, stress importance of not discontinuing abruptly, particularly systemic corticosteroids.
  • Advise patient that effectiveness of therapy is dependent on administration at regular intervals. Maximum effectiveness may take 4 wk.
  • Caution patient not to discontinue abruptly unless advised to do so by physician.
  • Instruct patient to report these symptoms to physician: increased difficulty in breathing, increased wheezing, difficulty in swallowing, joint pain or swelling, severe headache.
  • Patient should not wear contact lenses while using cromolyn ophthalmic solution.

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