Cromolyn (Inhalation)

Brand Names : Intal, Intal Inhaler, Intal Syncroner, Novo-cromolyn, PMS-Sodium Cromoglycate, cromoglicic acid, cromoglycic acid, sodium cromoglicate, sodium cromoglycate

Proper Use of This Medicine

Cromolyn oral inhalation is used to help prevent symptoms of asthma or bronchospasm (wheezing or difficulty in breathing). Cromolyn will not relieve an asthma or a bronchospasm attack that has already started. It is important to use cromolyn at regular times as directed by your doctor.

Use cromolyn inhalation only as directed . Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of side effects.

Cromolyn inhalation usually comes with patient directions. Read them carefully before using this medicine. If you do not understand the directions that come with the inhaler or if you are not sure how to use the inhaler, ask your health care professional to show you how to use it. Also, ask your health care professional to check regularly how you use the inhaler to make sure you are using it properly.

For patients using cromolyn inhalation aerosol :

• The cromolyn aerosol canister provides about 112 or 200 inhalations, depending on the size of the canister your doctor ordered. You should try to keep a record of the number of inhalations you use so you will know when the canister is almost empty. This canister, unlike some other aerosol canisters, cannot be floated in water to test its fullness.
• When you use the inhaler for the first time, or if you have not used it in a while, the inhaler may not deliver the right amount of medicine with the first puff. Therefore, before using the inhaler, test or prime it.
• To test or prime the inhaler :
  • Insert the medicine container (canister) firmly into the clean mouthpiece according to the manufacturer's directions. Check to make sure the canister is placed properly into the mouthpiece.
  • Take the cap off the mouthpiece and shake the inhaler three or four times.
  • Hold the inhaler well away from you at arm's length and press the top of the canister, spraying the medicine one time into the air. The inhaler will now be ready to provide the right amount of medicine when you use it.
• To use the inhaler :
  • Using your thumb and one or two fingers, hold the inhaler upright, with the mouthpiece end down and pointing toward you.
  • Take the cap off the mouthpiece. Check the mouthpiece to make sure it is clear. Do not use the inhaler with any other mouthpieces.
  • Gently shake the inhaler three or four times.
  • Hold the mouthpiece away from your mouth and breathe out slowly and completely to the end of a normal breath.
  • Use the inhalation method recommended by your doctor.
    • Open-mouth method: Place the mouthpiece about 1 to 2 inches (2 fingerwidths) in front of your widely opened mouth. Make sure the inhaler is aimed into your mouth so the spray does not hit the roof of your mouth or your tongue. Avoid spraying in eyes.
    • Closed-mouth method: Place the mouthpiece in your mouth between your teeth and over your tongue with your lips closed tightly around it. Make sure your tongue or teeth are not blocking the opening.
  • Tilt your head back a little. Start to breathe in slowly through your mouth. At the same time, press the top of the canister once to get one puff of medicine. Continue to breathe in slowly for 3 to 4 seconds until you have taken a full deep breath. It is important to press down on the canister and breathe in slowly at the same time so the medicine gets into your lungs. This step may be difficult at first. If you are using the closed-mouth method and you see a fine mist coming from your mouth or nose, the inhaler is not being used correctly.
  • Hold your breath as long as you can up to 10 seconds (count slowly to ten). This gives the medicine time to settle into your airways and lungs.
  • Take the mouthpiece away from your mouth and breathe out slowly.
  • If your doctor has told you to inhale more than 1 puff of medicine at each dose, wait about 1 minute between puffs. Then, gently shake the inhaler again, and take the second puff following exactly the same steps you used for the first puff. Breathe in only one puff at a time.
  • When you are finished using the inhaler, wipe off the mouthpiece and replace the cap.
  • Keep track of the number of sprays you have used from the inhaler, and discard the inhaler after the labeled maximum number of sprays has been used.

Your doctor may want you to use a spacer device with the inhaler. A spacer makes the inhaler easier to use. It allows more of the medicine to reach your lungs, rather than staying in your mouth and throat.

• To use a spacer device with the inhaler :
  • Attach the spacer to the inhaler according to the manufacturer's directions. There are different types of spacers available, but the method of breathing remains the same with most spacers.
  • Gently shake the inhaler and spacer well.
  • Hold the mouthpiece of the spacer away from your mouth and breathe out slowly and completely.
  • Place the mouthpiece of the spacer into your mouth between your teeth and over your tongue with your lips closed around it.
  • Press down on the canister top once to release one puff of medicine into the spacer. Then, within 1 or 2 seconds, begin to breathe in slowly and deeply through your mouth for 5 to 10 seconds. Count the seconds while inhaling.
  • Hold your breath as long as you can up to 10 seconds (count slowly to 10).
  • Breathe out slowly.
  • Wait a minute between puffs. Then, gently shake the inhaler and spacer again and take the second puff, following exactly the same steps you used for the first puff. Do not spray more than one puff at a time into the spacer.
  • When you are finished using the inhaler, remove the spacer device from the inhaler and replace the cap.

Clean the inhaler, mouthpiece, and spacer at least once a week.

• To clean the inhaler :
  • Remove the canister from the inhaler and set the canister aside. Do not get the canister wet.
  • Wash the mouthpiece, cap, and the spacer in warm soapy water. Rinse well with warm, running water.
  • Shake off the excess water and let the inhaler parts air dry completely before putting the inhaler back together.

For patients using cromolyn capsules for inhalation :

• Do not swallow the capsules. The medicine will not work if you swallow it .
• This medicine is used with a special inhaler, either the Spinhaler or the Halermatic . If you do not understand the directions that come with the inhaler or if you are not sure how to use the inhaler, ask your health care professional to show you how to use it. Also, ask your health care professional to check regularly how you use the inhaler to make sure you are using it properly.
• If you are using cromolyn capsules for inhalation with the Spinhaler :
  • To load the Spinhaler :
    • Make sure your hands are clean and dry.
    • Insert the capsule into the inhaler just before using this medicine.
    • Hold the inhaler upright with the mouthpiece pointing down. Unscrew the body of the inhaler from the mouthpiece.
    • Keep the mouthpiece pointing down and the propeller on the spindle. Remove the foil from the capsule and insert the colored end of the cromolyn capsule firmly into the cup of the propeller. Avoid too much handling of the capsule, because moisture from your hands may make the capsule soft.
    • Make sure the propeller moves freely.
    • Screw the body of the inhaler back into the mouthpiece and make certain that it is fastened well.
    • While keeping the inhaler upright with the mouthpiece pointing down, slide the grey outer sleeve down firmly until it stops. This will puncture the capsule. Then slide the sleeve up as far as it will go. This step may be repeated a second time to make sure the capsule is punctured.
  • To use the Spinhaler :
    • Check to make sure the mouthpiece is properly attached to the body of the inhaler.
    • Hold the inhaler away from your mouth and breathe out slowly to the end of a normal breath.
    • Place the mouthpiece in your mouth, close your lips around it, and tilt your head back. Do not block the mouthpiece with your teeth or tongue.
    • Take a deep and rapid breath. You should hear and feel the vibrations of the rotating propeller as you breathe in.
    • Take the inhaler from your mouth and hold your breath for a few seconds or as long as possible.
    • Hold the inhaler away from your mouth and breathe out slowly and completely to the end of a normal breath. Do not breathe out through the inhaler because this may prevent the inhaler from working properly.
    • Keep taking inhalations of this medicine until all the powder from the capsule is inhaled. A light dusting of powder remaining in the capsule is normal and is not a sign that the inhaler is not working properly.
    • Throw away the empty capsule. Then return the inhaler to the container and replace the lid on the container.
  • To clean the Spinhaler :
    • At least once a week, brush off any powder left sticking to the propeller.
    • Take the inhaler apart and wash the parts of the inhaler with clean, warm water.
    • Wash the inside of the propeller shaft by moving the propeller on and off the steel spindle under water.
    • Shake out the excess water.
    • Allow all parts of the inhaler to dry completely before putting it back together.
    • The Spinhaler should be replaced after 6 months.
• If you are using cromolyn capsules for inhalation with the Halermatic :
  • To load the Halermatic :
    • Make sure your hands are clean and dry.
    • Insert the capsule cartridge into the inhaler just before using this medicine.
    • Remove the mouthpiece cover. Then pull off the mouthpiece.
    • Push a cromolyn capsule cartridge firmly down to the bottom of the slot.
    • Slide the mouthpiece back on the body of the inhaler. Push down slowly as far as the mouthpiece will go. This punctures the capsule cartridge and lifts it into the rotation chamber. Do not repeat this step because the capsule cartridge needs to be punctured only once.
  • To use the Halermatic :
    • Hold the inhaler away from your mouth and breathe out slowly to the end of a normal breath.
    • Place the mouthpiece in your mouth, close your lips around it, and tilt your head back. Do not block the flow of medicine into the lungs with your teeth or tongue.
    • Breathe in quickly and steadily through the mouthpiece.
    • Hold your breath for a few seconds to keep the medicine in the lungs as long as possible. Then take the inhaler away from your mouth.
    • Hold the inhaler well away from your mouth and breathe out to the end of a normal breath. Do not breathe out through the inhaler because this may prevent the inhaler from working properly.
    • Keep taking inhalations of this medicine until all the powder from the capsule is inhaled. A light dusting of powder remaining in the capsule is normal and is not a sign that the inhaler is not working properly.
    • Throw away the empty capsule cartridge.
  • To clean the Halermatic :
    • Brush away powder deposits each day with a brush.
    • When powder deposits build up, wipe them away with a slightly damp cloth.
    • The mouthpiece may be washed separately if necessary. However, do not wet the blue-based body of the inhaler. Be sure the mouthpiece grid is dry before putting the inhaler back together.
    • The Halermatic should be replaced every 6 months.

For patients using cromolyn inhalation solution :

• Cromolyn inhalation solution comes in a small glass container called an ampul. The ampul must be broken gently to empty the contents. If you do not understand the manufacturer's directions, ask your health care professional to show you what to do.
• Do not use the solution in the ampul if it is cloudy or contains particles.
• To break and empty the ampul :
  • The glass ampul is weak at each end so the ends can be broken easily by hand.
  • Hold the ampul away from the nebulizer and your face when you break it. Hold the ampul at an angle and carefully break off the lower end. No solution will come out.
  • Turn the ampul over so the open end faces up. Place a forefinger carefully over the open end.
  • Keep your finger firmly in place and break off the lower end of the ampul.
  • To empty the ampul, hold it over the bowl of the nebulizer unit and remove your finger to let the solution flow out.
  • Throw away any solution left in the nebulizer after you have taken your treatment.
• Use this medicine only in a power-operated nebulizer that has an adequate flow rate and is equipped with a face mask or mouthpiece. Your doctor will advise you on which nebulizer to use. Make sure you understand exactly how to use it. Hand-squeezed bulb nebulizers cannot be used with this medicine. If you have any questions about this, check with your doctor.

For patients using cromolyn oral inhalation regularly (for example, every day):

• In order for cromolyn to work properly, it must be inhaled every day in regularly spaced doses as ordered by your doctor . Up to 4 weeks may pass before you feel the full effects of the medicine.

Dosing - The dose of cromolyn will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of cromolyn inhalation. If your dose is different, do not change it unless your doctor tells you to do so.

The number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking cromolyn inhalation.

• For inhalation aerosol dosage form:
  • For prevention of asthma symptoms:
    • Adults and children 5 years of age or older - 2 inhalations (puffs) taken four times a day with doses spaced four to six hours apart.
    • Children up to 5 years of age - Cromolyn inhalation aerosol should not be used in children younger than 5 years of age.
  • For prevention of bronchospasm caused by exercise or a condition or substance:
    • Adults and children 5 years of age or older - 2 inhalations (puffs) taken at least ten to fifteen (but not more than sixty) minutes before exercise or exposure to any condition or substance that may cause an attack.
    • Children up to 5 years of age - Cromolyn inhalation aerosol should not be used in children younger than 5 years of age.
• For capsule for inhalation dosage form:
  • For prevention of asthma symptoms:
    • Adults and children 2 years of age or older - 20 mg (contents of 1 capsule) used in an inhaler, taken four times a day with doses spaced four to six hours apart.
    • Children up to 2 years of age - The capsule for inhalation should not be used in children younger than 2 years of age.
  • For prevention of bronchospasm caused by exercise or a condition or substance:
    • Adults and children 2 years of age or older - 20 mg (contents of 1 capsule) used in an inhaler, taken at least ten to fifteen (but not more than sixty) minutes before exercise or exposure to any condition or substance that may cause an attack.
    • Children up to 2 years of age - The capsule for inhalation should not be used in children younger than 2 years of age.
• For inhalation solution dosage form:
  • For prevention of asthma symptoms:
    • Adults and children 2 years of age or older - 20 mg (contents of 1 ampul) used in a nebulizer. This medicine should be used four times a day with doses spaced four to six hours apart. Use a new ampul of solution for each dose.
    • Children up to 2 years of age - Cromolyn inhalation solution should not be used in children younger than 2 years of age.
  • For prevention of bronchospasm caused by exercise or a condition or substance:
    • Adults and children 2 years of age or older - 20 mg (contents of 1 ampul) used in a nebulizer. This medicine should be used at least ten to fifteen (but not more than sixty) minutes before exercise or exposure to any condition or substance that may cause an attack. Use a new ampul of solution for each dose.
    • Children up to 2 years of age - Cromolyn inhalation solution should not be used in children younger than 2 years of age.

Missed dose - If you are using cromolyn regularly and you miss a dose, use it as soon as possible. Then use any remaining doses for that day at regularly spaced times.

Storage - To store this medicine:

• Keep out of the reach of children.
• Store the aerosol or solution form of this medicine at room temperature away from heat or cold. Keep this medicine from freezing.
• Store the capsule or solution form of this medicine away from direct light. Store the aerosol form of this medicine away from direct sunlight.
• Do not store the capsule form of this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not puncture, break, or burn the aerosol container, even if it is empty.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.