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(NEH-doe-KROE-mill SO-dee-uhm)
Alocril, Tilade, Mireze
Class: Respiratory inhalant

 Action Inhibits release of mediators from inflammatory cell types associated with asthma, including histamine from mast cells and betaglucuronidase from macrophages. May also suppress local production of leukotrienes and prostaglandins. Inhibits development of bronchoconstriction responses to inhaled antigen and other challenges such as cold air.

 Indications Maintenance of mild to moderate bronchial asthma; treatment of itching caused by allergic conjunctivitis.

 Contraindications Standard considerations.

 Route/Dosage

SYMPTOMATIC ADULTS & CHILDREN > 12 YR: Aerosol inhalation 2 inhalations 4 times daily at regular intervals to provide 14 mg/day. May attempt lower frequency of doses (twice daily to 3 times daily) over several weeks in well-controlled patients.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Headache. EENT: Ocular burning; irritation and stinging; unpleasant taste; nasal congestion; conjunctivitis; eye redness; photophobia. GI: Nausea; vomiting; dyspepsia; abdominal pain. RESP: Rhinitis; upper respiratory tract infection; asthma. OTHER: Unpleasant taste.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children (aerosol inhalation): Safety and efficacy in children < 12 years of age not established. Children (ophthalmic): Safety and efficacy in children < 3 years of age not established. Acute bronchospasm: Should not be used for reversal of acute bronchospasm, particularly status asthmaticus. However, continue to administer during acute exacerbations, unless patient becomes intolerant to inhaled dosage forms. Cough/Bronchospasm: If cough or bronchospasm follows inhalation, may need to discontinue. Dosing interval: Optimal effect depends on administration at regular intervals, even during symptom-free periods.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Shake container well and invert before activation.
  • Clean inhaler ³ twice/wk.
  • Store in light-resistant container at room temperature.
  • Protect from heat and moisture.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Obtain baseline respiratory assessment, carefully documenting any shortness of breath, presence of mucus and breath sounds.

 Patient/Family Education

  • Ensure appropriate demonstration of how to connect medication and inhalant cartridge. Supply adequate information for home use.
  • Provide appropriate demonstration of how to administer inhalant dose.
  • Advise patient to increase fluid intake (if not contraindicated) to promote flow of nasal secretions.
  • Caution patient to avoid exhaling into mouthpiece to avoid moisture accumulation.
  • Tell patient to notify physician if coughing and bronchospasm occur with inhalation therapy. Alternative therapy may be needed.
  • Explain that therapeutic effect may take » 2 wk.
  • Tell patient that nedocromil sodium cannot be substituted for bronchodilator (for acute attacks) or steroids.
  • If patient being tapered from steroids, explain that increased asthmatic symptoms may occur and to notify physician if this occurs.
  • Demonstrate proper method of cleaning inhaler and remind patient that cleaning should be done ³ twice/wk.
  • Tell patient to report any adverse effects.

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