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Monday, September 13, 2010

Asthma meds discontinued

Fair or not, the FDA is phasing out some once popular inhalers. This was the topic of a recent post of mine at

Seven Classic Asthma Meds to Be Discontinued

by Rick Frea Tuesday, July 06, 2010,

Like it or not, the Food and Drug Administration (FDA) has made it official that seven classic asthma and COPD medicines will be phased out by December 2013. Yet there remain many medicinal options to help you maintain good control of your asthma, or maybe obtain even better control.

According to
this press release from the FDA, the following are the affected products and there phase-out dates:
  1. nedocromil (Tilade), June 14, 2010

  2. metaproterenol (Alupent), June 14, 2010

  3. triamcinolone (Azmacort), December 31, 2010

  4. cromolyn (Intal), December 31, 2010

  5. flunisolide (Aerobid), June 30, 2011

  6. albuterol and ipratropium in combination (Combivent), December 31, 2013
    pirbuterol (
    Maxair), December 31, 2013

As you may have noticed, manufacturers have stopped making Tilade, Intal, Alupent and Azmacort.

The phase out is not because these meds no longer work for asthma and COPD patients, but due to "longstanding U.S. obligations under the
Montreal Protocol" to get rid of substances that are believed to "deplete the ozone layer."

Basically, all of these inhalers "contain ozone-depleting chlorofluorocarbons (CFCs), which are propellants that move medication out of the inhaler and into the lungs of patients."

Azmacort and Aerobid are inhaled corticosteroids used to control the chronic inflammation in the air passages of the lungs, although better inhaled corticosteroids are now available, such as Flovent and
Pulmicort Turbohaler.

Likewise, most asthmatics now get their inhaled corticosteroid fix in combination with long acting beta adrenergic (LABA) medicine like
Serevent or Foradil via combination inhalers like Advair and Symbicort.

Intal and Tilade were mast cell stabilizers also used to treat chronic inflammation in the lungs. Newer medicines have proven to do the same job and better.

Alupent was the predecessor to
Albuterol and Xopenex and pretty much outlived its usefulness anyway. It has more cardiac side effects than Albuterol. I remember my heart pounding after using it, something that rarely happens with Albuterol.

Maxair is another beta adrenergic medicine that I'm less familiar with, although it's been a nice alternative to Albuterol for many patients.

Combivent is the only medicine on this list that is still being used by a lot of patients, although not by many asthmatics. This is mainly a medicine to help COPD patients improve lung function. As you can see
here, the makers of Combivent are working on a replacement medicine they hope to be available by the phase-out date.

Manufacturers could easily keep these products on the market by changing the CFC propellant to an HFA propellant, such as what occurred with Albuterol. However, the change would not be cost efficient with these seven medicines.

So you can see, most asthmatics shouldn't be affected so much by this phase out, as most of us are no longer prescribed them. However, as I can see by some of your comments to
this q&a segment, some asthmatics are still taking one or more of these medicines, and are concerned.

Tilade or Intal seems to be the medicine some asthmatics are most concerned about. Some have noted they've been on this medicine for years, it has worked great to control their asthma, and they don't want to change.

Others have noted bad reactions to the more popular asthma meds, such as Flovent, Pulmicort, Singulair, Advair or Symbicort. It is for this reason they are on Intal or Tilade, and they don't want to change.

Another reason asthmatics have continued to take these medicines is because CFC inhalers are less expensive than the alternatives. Medicines like Advair, Symbicort and Singulair can be extremely expensive, especially for those without health insurance.

To be honest, and if I had my way, these asthmatics wouldn't have to make any changes. Yet I have no power, no magic potion, so if you're on one of these medicines you'll have no choice but to make a change.

So, if you are presently on one of these medicines, what can you do?

1. Work with your doctor on finding the best available medicine to control your asthma, or to keep your asthma under control. You might be surprised, though, because some of the newer medicines work better, and need to be taken less often.

2. You can become active and petition your local Congressman. Good luck if you choose this route.

Below I will list each medicine and some good alternatives you might discuss with your doctor:

1. Tilade or Intal: Singulair, Advair or Symbicort are good options to control your asthma. If you have a bad history with these meds don't give up, because there are still other options to discuss with your doctor.

2. Azmacort or Aerobid: No problem here. You can simply switch to better inhaled corticosteroids like Flovent. The newer corticosteroids are more powerful, last longer, and need to be taken less often.

4. Alupent or Maxair: Albuterol or Xopenex are your only options here.

5. Combivent: Atrovent and Albuterol are still available. You just won't have the option of taking them in one inhaler.

Some people still contend it's not fair the government has chosen to save the ozone based on a theory at the expense of asthmatics. As it is, you'll have no choice but to work with your doctor to find alternative medicine to control your asthma.

Don't fret, because you may just be surprised at all the better asthma options available to you. You may find, as I did a few years ago, that newer asthma meds result in even better asthma control for you.


Anonymous said...

Sorry, haven't found anything as good as Aerobid. I now have a froggy voice because he has me on Advair and the steroid makes mush of my vocal cords. I was stable for 15 to 20 years on Aerobid and do these people out there care??? evidently not. So I will continue to walk around sounding like a frog and so what that I'm a singer and forget that now. Oh well...such is life.

Anonymous said...

As a BSN prepared registered nurse of 37 years, and a person that has exercise induced asthma….I would add that the discontinuation of Intal, a non steroidal medication that “works as well” as steroidal medications is a major disservice to anyone who benefited from it. When steroid based inhalers came the medical professionals all discounted the long term use of inhaled steroids as having any possibility of impacting the risk for osteoporosis, but since then there has been substantial evidence to say those assumption was wrong.

Given the choice for rescue inhalers, of which there have been a mere 3 available to prescribe, for anyone with cardiac side effects of irregular heart rates from albuterol, the reduction of the market to two with the soon to be discontinued availability of pirbuterol (Maxair) should be considered a major public safety hazard. Many a health care professional are all too well aware that the pharmaceutical companies are pulling the plugs on products or not producing them in sufficient amounts to avoid shortages, for chemotherapeutic, vaccines such as TDAP, B12, and other medications. The extent to which the safe practice of health care for individuals, and certain groups is being jeopardized seems to be escaping the attention of our decision makers and regulatory agencies.