I. Singulair Fact File

Singulair was introduced by Merck Pharmaceuticals.

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck discovers, develops, manufactures and markets vaccines and medicines in over 20 therapeutic categories.

II. Singulair Medication

Generic Singulair is an approved medicine to help control asthma in adults and children as young as 12 months and to help relieve the symptoms of seasonal allergies in adults and children as young as 2 years.

Generic Singulair is a different kind of seasonal allergy medicine. Singulair medication is a leukotriene blocker that helps control seasonal allergy symptoms for a full 24 hours.

Singulair medication also:

• Helps to relieve a broad range of seasonal allergy symptoms for a full 24 hours
• Is the only seasonal allergy medicine that specifically blocks leukotrienes, an underlying cause of allergy symptoms
• Is a once-a-day tablet
• Is available in oral granules and cherry chewable tablets for children as young as 2 years
• Is approved to help control asthma
• Is not a steroid

Antiasthmatics: Information

There are two kinds of asthma medications:

• those that relieve your asthma symptoms
• those that control asthma symptoms
• The "relievers" are also called bronchodilators. Examples are:
• inhaled beta-2 agonists
• theophylline tablets
• inhaled ipratropium bromide

Many of the "controllers" are also known as anti-inflammatories. Examples are:

• corticosteroid inhalers
• corticosteroid tablets
• sodium cromoglycate
• nedocromil
• ketotifen
• leukotriene antagonists

Inhaled beta-2 agonists

Examples: Berotec, Bricanyl, ProAir

The inhaled beta-2 agonists work within minutes. They relieve symptoms by causing the muscle surrounding the airways (bronchial tubes) to relax. This widens the airways, making it easier to breathe. These medications also make the airway muscle less likely to contract if exposed to triggers like exercise and cold air, or irritants, such as dust and cigarette smoke.

Inhaled beta-2 agonists can be used under the following circumstances:

• to relieve symptoms of cough, chest tightness, wheezing, shortness of breath;
• a few minutes before exercising or exposure to any trigger you know worsens your asthma;
• before using Intal or corticosteroid inhalers, if these are prescribed.

Long-acting bronchodilators

Examples: Serevent, Foradil, Oxeze

• These are usually added to treatment if corticosteroid inhalers in optimum dosages are not controlling asthma symptoms adequately. They are not used without concurrent use of anti-inflammatory medications. They may be used to limit the dose of anti-inflammatory medication, which is needed to improve symptom control.
• They must be used regularly twice daily and not more frequently. Their effect lasts for 12 hours but Serevent takes about 30 minutes to start working, while Foradil or Oxeze starts to work sooner.
• A short-acting bronchodilator must still be carried and used to provide rapid relief of symptoms as needed.
• Their effects are similar to short-acting bronchodilators but they have a longer duration of action and some have a slower onset of action.

Ipratropium bromide (inhaled bronchodilator)

Ipratropium Bromide (Atrovent) has the same effect as a beta-2 agonist - that is, it opens up airways to make breathing easier - but it works in a different way. Atrovent is an inhaled anticholinergic medication that blocks signals from the nervous system that cause airways to narrow. Because Atrovent takes 1 to 2 hours to reach its maximum effect, it cannot be used as needed in the same way beta-2 agonists can. Instead, it's taken on a regular basis as prescribed.

Theophylline tablets (oral bronchodilator)

Examples: Short-acting: Aminophylline, Choledyl
Long-acting: Phyllocontin, Quibron-T, Respid, Somophyllin, Theo-Dur, Theolair SR
24-hour: Uniphyl

Oral bronchodilators work directly on airway smooth muscle, causing it to relax. As a result, the airways open up, improving breathing, and are less likely to contract if exposed to a trigger.

Maintaining the right dose is very important with oral bronchodilators so the dose must be adjusted by your doctor. To do this, your doctor may want to check the level of theophylline in your blood. Never increase the dose on your own as it could cause serious side effects.

How to use theophylline

Depending on the advice of your doctor, theophylline products can be taken to reverse symptoms of cough, chest tightness, wheezing or shortness of breath (Note: do not use the short-acting ones more than 4 times a day, the long-lasting ones more than 2 times a day, and Uniphyl more than once a day); in the evening, if shortness of breath disturbs your sleep; regularly, if your asthma is more severe.

There can be serious drug interactions with certain medications (eg. erythromycin) so if you are taking theophylline make sure you check with your physician or pharmacist to make sure you will not have any adverse drug interactions.

Corticosteroid inhalers

Examples: Low-dose inhalers: Flovent (daily dose of 50-400 µg per day), Pulmicort, Qvar, VancerilHigh-dose inhalers: Flovent (daily dose over 400 µg per day contains 125-250 µg per puff), Pulmicort, Qvar Unlike the bronchodilators, corticosteroid inhalers control asthma by reducing airway inflammation, swelling and mucus. In doing this, they actually allow bronchodilators to have a greater effect. Inhalers work similarly to tablets but smaller doses are needed to get the same effect and thus, side effects are reduced.

Corticosteroid inhalers do not relieve symptoms quickly the way bronchodilators do. They are used with, or in place of, corticosteroid tablets and always under the supervision of your doctor. If the corticosteroid medications do not keep your asthma under control, other medications may be needed.

Other controllers

There are other controllers that are not corticosteroids. These also reduce airway inflammation and may prevent allergic responses and protect againsvt the effect of cold air and exercise. Examples are Intal (sodium cromoglycate), Tilade (nedocromil), and Zaditen (ketotifen), which are occasionally used in adults and adolescents. These controllers have no major side effects with the exception of Zaditen, which can cause drowsiness and weight gain. Some patients may still get symptoms even on high doses of these medications and thus may require other medications.

Corticosteroid Tablets

Examples: Prednisone, Medrol

If all other medications have failed to control your asthma or if your asthma becomes severe, Corticosteroid Tablets may be used. In these cases, the bronchial tubes are likely to be very inflamed, swollen and mucus-filled. Corticosteroid tablets reduce the inflammation, swelling and mucus and help bronchodilators work better.

Although this medication starts to work within a few hours, it may take several days to clear up asthma symptoms. As a general rule, corticosteroid tablets are the last medication to be added when symptoms worsen and the first to be stopped when they improve.

How to use corticosteroid tablets

Corticosteroid tablets must be taken exactly as prescribed by your doctor. The usual starting dose is 6-8 tablets daily and this is maintained until symptoms clear. Once that happens, the dose can be reduced.

There are other things to remember while taking his medication:

• If symptoms do not clear after 5 days or get worse while you're on this medication, call your doctor.
• Never suddenly stop taking your medication unless your doctor advises it.
• Keep taking your regular asthma medication in addition to the corticosteroid tablets.
• Other things to consider
• Since corticosteroid medication can increase your appetite, you might have to watch what you eat to avoid weight gain.
• Avoid ASA or drugs containing ASA, such as aspirin Tablets (check labels carefully) since these can increase the risk of stomach irritation.
• Be sure to tell your doctor if you have taken corticosteroid tablets in the past 2 years, because you may need them during a serious illness, operation or accident.

Leukotriene antagonists

Examples: Accolate and Generic Singulair

These are medication, which block the effects of one group of chemicals produced by the membranes of inflammatory cells in asthma, the leukotrienes. These medications have been shown to reduce the asthmatic response triggered by cold air, exercise, allergens and aspirin.

Effects are additive to those of the inhaled bronchodilators and the effects appear similar in potency to a low dose of inhaled corticosteroid. Therefore, they may be used to limit the dose of inhaled corticosteroid, which is needed, or in mild to moderate asthma may be used in place of inhaled corticosteroids.

Not everyone with asthma will respond to leukotriene antagonists and, if used, your doctor will want to monitor your response over the first 6-8 weeks of treatment.

Accolate may interact with other medications such as blood thinning medication (Coumadin - Warfarin) so adjustments in the dosage may be needed with these.

Asthma: Information

Asthma is a chronic disease (one that cannot be cured). When you have asthma, the air passages in your lungs are very sensitive and can be inflamed and swollen. In addition, certain triggers can cause the muscles of the air passages to squeeze, resulting in narrowed air passages. This process is called bronchoconstriction. Triggers can also cause the air passages to produce extra mucus, making it harder to breathe.

Asthma symptoms can be triggered by particles known as allergens. For many people, allergens-such as pollen, dust, or mold-are usually harmless. For many people with asthma, however, it's a different story. The body mistakes these particles for dangerous invaders and works to fight them off. Symptoms can worsen, resulting in an asthma attack.

Some Ultrasensitive air passages can be more easily irritated by things other than allergens. Exposure to irritants such as cigarette smoke, perfume, and air pollution can sometimes trigger asthma attacks. In addition, a cold, the flu, or a virus can cause asthma flare-ups; as can exercise, weather changes, very cold air, and even stress.

The most common symptoms of an asthma attack are:

• Chest tightness
• Coughing
• Shortness of breath
• Wheezing

Sometimes coughing is the only symptom. Asthma symptoms often occur at night or during exercise, but they can occur at any time. (Note: Other conditions, such as respiratory infections, may also cause wheezing, especially in children.)

Diagram 1: Causes of Asthma

Diagram 2: Causes of Asthma

Air reaches the lungs by passing through the windpipe (trachea) which divides into two large tubes (bronchi), one for each lung.

Each bronchi further divides into other smaller tubes (bronchioles), which lead to tiny air sacs (alveoli), through which oxygen is absorbed into the bloodstream and carbon dioxide is transferred out of the body.

Asthma involves both bronchi and bronchioles but not the alveoli.

These airways are kept clean by the tiny hairs (cilia) which trap particles in a thin layer of mucus. This is then swept through the windpipe to be coughed up or swallowed.

In Asthma, the airways become oversensitive to the particles, and cause a reaction.

This results in:

• A tightening of the muscles surrounding the airways
• Inflammation and swelling of the airway
• Increased mucus production which restricts or clogs the airway

Once the airways are narrowed, less oxygen enters the blood and carbon dioxide levels in the body begin to increase. This could lead to a more severe condition requiring emergency treatment.

Common asthma triggers and tips for avoiding them

The following is a list of many common asthma triggers. Talk to your doctor if you're concerned about how any of these triggers may affect you or your child.

Pollen: If you're sensitive to pollen, stay indoors and keep windows closed on days when pollen counts are high. Don't hang clothes or bedding outside because a light coating of pollen can stick to your laundry and end up back inside with you.

Dust mites: These microscopic creatures are some of the most common asthma triggers. They live in bedding, carpeting, and stuffed furniture. To reduce your exposure to them, cover your mattress and pillows with vinyl dust-proof cases. If possible, consider removing wall-to-wall carpeting.

Mold: If you react to mold, clean shower stalls and sinks regularly, and check for dampness in your basement. Try not to keep too many indoor plants because mold grows in moist soil. Also, limit the use of indoor humidifiers because mold can grow in the filters.

Animals: Animal dander (skin particles) triggers asthma in many people. If you have asthma, it may be best not to have a pet. If you do have a pet, try to keep it outside the house, or at least away from where you sleep. Removing carpeting, which harbors these animal particles, may also help.

Cockroaches: For people who have asthma and live in the city, exposure to cockroaches may be a problem. Because many insecticides can also irritate asthma, it's best to use traps and clean frequently to help control cockroaches.

Colds and viruses: Colds, viruses, and sinus infections can trigger asthma or make it worse, especially in young children. Talk to your doctor about treating cold symptoms, and ask about getting a flu shot.

Emotions: Of course, emotions themselves don't cause asthma. Crying and laughing, however, can change the way you breathe, which may actually trigger an attack.

Exercise and physical activity: Some people get asthma symptoms only when they exercise or do something physical, especially in cold, dry air. For many people with asthma, however, exercise may be only one of several triggers. If your asthma symptoms worsen when you exercise or are active, talk to your doctor. Also, be sure you understand how to take your medicine to reduce the risk of an attack or to treat an attack should one occur.

Medications: Some medicines can trigger an attack in Many people. Ask your doctor if there are any medicines you should avoid.

Smoke: Tobacco smoke is a major cause of asthma symptoms in children and adults. Secondhand smoke is especially irritating to people with asthma. Don't be afraid to ask people not to smoke around you; most will understand. Fortunately, many restaurants, offices, and public places are now smoke free.

Side effects of Antiasthmatics

All beta-2 agonist & long acting bronchodilators can cause trembling, nervousness, flushing and increased heart rate.

Some most common side effects of theophylline are an upset stomach with heartburn, nausea, diarrhea or loss of appetite. Other possible side effects include: headaches; nervousness; sleeplessness; rapid heart beat; in children, difficulty concentrating at home or school.

All these side effects may worsen if you drink a lot of caffeinated coffee. In addition, high blood levels of theophylline can result in other serious side effects such as convulsions.

Side effects of corticosteroid inhalers: If you're on higher doses, you may get a hoarse voice. A sore throat may also occur usually due to irritation or sometimes, a yeast infection.

There are a number of ways to help prevent these potential problems:

• Thoroughly gargle and rinse out your mouth after using the inhaler.
• Use a spacer device with your inhaler (You will still need to rinse afterwards.)
• Use your inhaler before brushing your teeth, which then acts as your rinse.
• Antifungal drops or lozenges are available for treating oral yeast infections, you will see whites spots in your mouth and throat if you have one.

Side effects of high dose inhaled steroids: For those over fifty years of age, cataracts and glaucoma could occur. It is important to obtain an eye examination.

• Osteoporosis is another potential side effect with high doses of corticosteroids. Calcium supplements, hormone replacement therapy or other medications can be helpful. Regular exercise can help in the prevention and treatment of this. Bone density screening can help to detect this.

Side Effects of Corticosteroid Medication: Regular corticosteroid Medication are usually added only when high doses of inhaled steroid, which are much safer, do not adequately control asthma. When your doctor puts you on corticosteroid tablets for a period of longer than 3 weeks, he or she will try to find the smallest dose necessary to control your symptoms so that side effects can be minimized. Possible side effects include a puffy face, increased appetite and weight gain, and stomach irritation, which can be sometimes prevented if you take your medication with a meal or milk.

• At higher doses taken for longer periods additional side effects include diabetes, high blood pressure, weakening of the bones (osteoporosis) and cataracts. To reduce side effects, your doctor may suggest alternate-day dosing instead of every day and taking the entire dosage in the morning.

Accolate and Generic Singulair have no significant short-term side effects.

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III. Useful links

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

harmacy sites

http://www.merck.com

http://www.hsforum.com/stories/storyReader$1509 ,

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504,

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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