SUGGESTED SEQUENCE FOR USE OF MULTIPLE INHALED MEDICATIONS

 

 

 

 If Using ONLY Long-acting Medications

 

If using BOTH Short & Long-acting Medications

 

FIRST

 

FIRST (see Note 3)

Long-acting β-agonist (alone or combined)

 

Long-acting β-agonist (alone or combined)

   Brovana (arformorterol)

 

   Brovana (arformorterol)

  Foradil (formoterol), Performist (formoterol)

 

  Foradil (formoterol), Perforomist (formoterol)

  Oxis, Oxese (formoterol)

 

  Oxis, Oxese (formoterol)

  Serevent (salmeterol)

 

  Serevent (salmeterol)

  Advair (Serevent & Flovent)

 

  Advair (Serevent & Flovent)

  Duova (formoterol & tiotropium bromide)

 

  Duova (formoterol & tiotropium bromide)

  Seretide (salmetrol & fluticasone)

 

  Seretide (salmetrol & fluticasone)

  Symbicort (formoterol & budesonide)

 

  Symbicort (formoterol & budesonide)

 

SECOND

 

SECOND

Long-acting Anticholinergic

 

Long-acting Anticholinergic

   Spiriva (tiotropium bromide)

 

   Spiriva (tiotropium bromide)

   Tiova (tiotropium bromide)

 

   Tiova (tiotropium bromide)

   (Also, see note 4)

 

   (Also, see note 4)

 

LAST

 

THIRD

Steroid

 

Steroid

  Aerobid, Aerospan HFA (flunisolide)

 

  Aerobid, Aerospan HFA (flunisolide)

  Asmanex (mometasone)

 

  Asmanex (mometasone)

  Azmacort (triamcinolone)

 

  Azmacort (triamcinolone)

  dexamethasone

 

  dexamethasone

  Flovent, -HFA, -Diskus (fluticasone)

 

  Flovent, -HFA, -Diskus (fluticasone)

  Pulmicort (budesonide)

 

  Pulmicort (budesonide)

  QVAR, Vanceril (beclomethasone)

 

  QVAR, Vanceril (beclomethasone)

 

 

NOTES:

 

LAST

(1.) Take short-acting drugs at least 2 hours

 

Short-acting β-agonist (alone or combined)

before long-acting drugs in the same class to

 

  albuterol (salbutamol in UK)         

avoid interfering with the long-acting drug's action.

  Alupent (metaproterenol)

 

 

  Berotec (Canada) (feneterol)

(2.) If albuterol is used on a regular scheduled  

 

  Bricanyl (terbutaline)

 Basis,  always take it after the long-acting

 

  Bronkosol (isoetharine)

β-agonist, and never less than 2 hours before it.

 

  Maxair (pirbuterol)

 

 

  Medihaler-Iso, Isuprel (isoproterenol)

(3.) If you must use albuterol on a "rescue"

 

  ProAir, -HFA (albuterol)

basis, then wait two hours before taking a

 

  Proventil, -HFA (albuterol)

long-acting β-agonist.

 

  Ventolin, Airomir (Canada) (albuterol)

   

  Xopenex, -HFA (levalbuterol)

(4.) If Atrovent is used in addition to  Spiriva/

 

  Combivent (Atrovent & albuterol) (see note 4)

 Tiova,  always  take it after the Spiriva/

 

Mark Mangus, BSRC, RPFT, RRT

Tiova, and never less than 2 hours before it.

 

3/27/2006   (Rev2: 7/17/2007)

 

 

 

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