Aerospan

Flunisolide is a steroid. It prevents the release of substances in the body that cause inflammation.

Flunisolide inhalation is used to prevent asthma attacks. It will not treat an asthma attack that has already begun.

Flunisolide may also be used for other purposes not listed in this medication guide.

Flunisolide inhalation will not work fast enough to treat an asthma attack. Use only a fast acting inhalation medicine for an asthma attack.

You should not use flunisolide if you are allergic to it.

Flunisolide can worsen an infection you already have, or reactivate an infection you recently had. Before using this medicine, tell your doctor about any illness or infection you have had within the past several weeks, especially tuberculosis.

FDA pregnancy category C. It is not known whether flunisolide inhalation will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether flunisolide inhalation passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Flunisolide inhalation can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medicine.

Do not give this medicine to a child younger than 5 years old.

Long-term use of steroids may lead to bone loss (osteoporosis), especially if you smoke, if you do not exercise, if you do not get enough vitamin D or calcium in your diet, or if you have a family history of osteoporosis. Talk with your doctor about your risk of osteoporosis.

Avoid being near people who are sick or have infections. Steroid medicine can lower the blood cells that help your body fight infections. This can make it easier for you to get sick from being around others who are ill. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medicine.

There may be other drugs that can interact with flunisolide inhalation. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Aerospan is a prescription medication used to treat chronic asthma. 

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Other drugs may interact with flunisolide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Storage

Oral Inhalation

25°C (may be exposed to 15–30°C);105 protect from excessive heat and freezing temperatures.105 Avoid prolonged sunlight exposure.105

Inhaler contents are under pressure.105 Do not puncture, use, or store near heat or open flame; expose to temperatures >49°C; or place into a fire or incinerator for disposal.105

• If you have an allergy to flunisolide or any other part of this medicine.
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

This is not a list of all drugs or health problems that interact with Aerospan.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else's drugs.
• Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
• Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
• Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about Aerospan, please talk with your doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

• This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Aerospan. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using Aerospan.

Review Date: October 4, 2017

Pregnancy

Pregnancy Category C. There are no adequate and well-controlled studies of flunisolide in pregnant women. Aerospan should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

As with other corticosteroids, flunisolide has been shown to be teratogenic and fetotoxic in rabbits and rats at approximately 1 and 3 times the maximum recommended daily inhalation dose on a mg/m2 basis, respectively (doses of 40 and 200 mcg/kg/day, respectively).

Experience with oral corticosteroids since their introduction in pharmacologic, as opposed to physiological, doses suggests that rodents are more prone to teratogenic effects from corticosteroids than humans.

Nonteratogenic Effects

Hypoadrenalism may occur in infants born of mothers receiving corticosteroids during pregnancy. Such infants should be carefully monitored.

Nursing Mothers

It is not known whether flunisolide is excreted in human milk. Because other corticosteroids are excreted in human milk, caution should be exercised when Aerospan is administered to nursing women.

Pediatric Use

The safety and effectiveness of Aerospan has been studied in children 4- 17 years of age. In clinical studies, the efficacy of Aerospan was not established in children 4-5 years of age, although the adverse reaction profile observed in patients exposed to Aerospan was similar between the 4-5 year age group (n=21), the 6-11 year age group (n=210), the 12-17 year age group (n=30), and those patients 18 years of age and older (n=258). The safety and effectiveness of Aerospan has not been studied in patients less than 4 years of age.

Effects on Growth

Controlled clinical studies have shown that orally inhaled corticosteroids may cause a reduction in growth velocity in pediatric patients. In these studies, the mean reduction in growth velocity was approximately one cm per year (range 0.3 to 1.8 cm per year) and appears to depend upon the dose and duration of exposure. This effect was observed in the absence of laboratory evidence of hypothalamic-pituitary-adrenal (HPA) axis suppression, suggesting that growth velocity is a more sensitive indicator of systemic corticosteroid exposure in pediatric patients than some commonly used tests of HPA axis function. The long-term effects of this reduction in growth velocity associated with orally inhaled corticosteroids, including the impact on final adult height, are unknown. The potential for "catch up" growth following discontinuation of treatment with orally inhaled corticosteroids has not been adequately studied. The growth of pediatric patients receiving orally inhaled corticosteroids, including Aerospan, should be monitored routinely (e.g., via stadiometry). The potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the risks/benefits of treatment alternatives. To minimize the systemic effects of orally inhaled corticosteroids, including Aerospan, each patient should be titrated to the lowest dose that effectively controls his/her symptoms.

The potential effect of Aerospan on growth rates in children was assessed in a 52 week randomized, placebo controlled study conducted in 242 prepubescent children age 4 to 9.5 years (145 males, 97 females) with mild persistent asthma. Treatment groups were Aerospan 160 mcg twice daily and placebo. Growth velocity was estimated for each patient using the slope of the linear regression of height over time using observed data in the intent to treat population who had at least 3 height measurements. The mean growth velocities were 6.19 cm/year in the placebo group and 6.01 cm/year in the Aerospan treated group (difference from placebo -0.17 cm/year; 95% CI: -0.58, 0.24).

Geriatric Use

Clinical studies of Aerospan included 21 patients 65 to 78 years of age exposed to Aerospan. These studies did not include sufficient numbers of patients aged 65 years and over to determine whether they respond differently from younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

In a double-blind, placebo-controlled study, 18 mg of flunisolide was administered via the CFC formulation over a three-hour period (nine times the maximum labeled daily dose) in 94 patients with acute asthma, and no clinically deleterious effects were observed.

Carcinogenesis, Mutagenesis, Impairment of Fertility

In a 22 month study in Swiss mice, flunisolide at oral doses up to 500 mcg/kg/day (approximately 3 and 4 times the maximum recommended daily inhalation dose [MRDID] in adults and children on a mg/m2 basis) did not demonstrate any carcinogenic effects.

In a two year study in Sprague Dawley rats, administration of flunisolide in the diet at a dose of 2.5 mcg/kg/day (less than MRDID in adults or children on a mg/m2 basis) resulted in an increased incidence of mammary gland adenomas and islet cell adenomas of the pancreas in females. The significance of these findings for humans is unknown. There were no significant increases in the incidence of any tumor type in female rats at a dose of 1.0 mcg/kg/day (less than MRDID in adults or children on a mg/m2 basis), or in male rats at a dose of 2.5 mcg/kg/day (less than MRDID in adults or children on a mg/m2 basis).

Flunisolide showed no mutagenic activity when tested in in vitro bacterial assay systems (Ames Assay and the Rec-assay) and no clastogenic activity when tested in the in vitro chromosomal aberration assay using Chinese Hamster CHL cells and in the in vivo mouse bone marrow chromosomal aberration assay.

Studies on the effects of flunisolide on fertility in female rats showed that flunisolide, at an oral dose of 200 mcg/kg/day (approximately 3 times MRDID on a mg/m2 basis) impaired fertility, but was devoid of such effects at doses up to 40 mcg/kg/day (less than MRDID on a mg/m2 basis).