Tilade® CFC-Free
2 mg
Qualitative and Quantitative Composition
The active component of Tilade® CFC-free is nedocromil sodium 1.4085% w/w. Each canister provides at least 112 actuations each containing 2 mg of nedocromil sodium ex-valve and 1.9 mg ex-standard actuator.
Pharmaceutical Form
Tilade® CFC-free is presented as a metered dose inhaler containing nedocromil sodium as a suspension in the new, non - CFC propellant HFA-227.
Clinical Particulars
Therapeutic indications
Tilade® CFC-free is indicated in the treatment of bronchial asthma (whether extrinsic or intrinsic in nature, and including asthmatic bronchitis, late onset asthma, exercise induced asthma, and bronchospasm provoked by a variety of stimuli such as cold air, inhaled allergens, atmospheric pollutants and other irritants). Tilade® CFC-free is intended for regular prophylactic treatment and not for symptomatic relief.
In the management of asthma, Tilade® CFC-free improves pulmonary function, reduces the frequency and severity of attacks and reduces bronchospasm, cough and bronchial hyper-responsiveness.
In patients already receiving treatment for their asthma, Tilade® CFC-free can be given in addition to all existing therapies and will in many cases provide added therapeutic benefit. Having established this benefit of Tilade® CFC-free, it may be possible to gradually reduce or eliminate concomitant therapy.
Posology and method of administration
The inhaler should be well shaken, the dust cap removed and after each actuation the aerosol inhaled slowly and deeply. To avoid condensation of moisture in the inhaler and blocking of the spray, exhalation through the inhaler should be avoided. The dust-cap should be replaced following use.
Adults, including the elderly and children over 2 years of age:
The recommended dosage is two actuations 2 to 4 times a day; the dosage to be adjusted within this range according to the needs of the patient. The usual maintenance dosage is 2 inhalations twice daily, but in more severe cases or to gain initial control of symptoms, two inhalations 4 times daily may be needed.
Tilade® CFC-free, in a single (4mg) dose of 2 inhalations a few minutes before exposure, affords protection for several hours against bronchospasm provoked by exercise, cold air, inhaled allergens, atmospheric pollutants and other irritants.
A total dose of 8 actuations per day should not be exceeded.
Contraindications
Tilade® CFC-free is contraindicated in patients with known hypersensitivity to any of its constituents.
Special warnings and special precautions for use
Tilade® CFC-free should not be used for the relief of an acute attack of bronchospasm.
Interaction with other medicinal products and other forms of interaction
Nedocromil sodium has been used in association with numerous other drugs in man, including oral and inhaled beta-adrenergic agonists, inhaled and oral corticosteroids, theophylline and other methylxanthines and ipratropium bromide. No interactions have been observed in humans and animals.
Use during pregnancy and lactation
Category B1: Studies with nedocromil sodium in pregnant or lactating animals have failed to reveal a hazard. However, as with all medicines, caution should be exercised, especially during the first trimester of pregnancy.
On the basis of animal studies and its physicochemical properties, it is considered that only negligible amounts of nedocromil sodium may pass into human breast milk. There is no information to suggest that the use of nedocromil sodium by nursing mothers has any undesirable effects on the baby.
Effects on ability to drive and use machines
Tilade® CFC-free has no known effect on ability to drive or operate machinery.
Undesirable effects
Few side effects have been reported, principally headache and upper gastrointestinal tract symptoms (nausea, vomiting, dyspepsia, and abdominal pain). These are usually mild and transient. In common with other inhaled medications Tilade® CFC-free may produce cough or bronchospasm.
Overdose
Animal studies have not shown evidence of toxic effects of nedocromil sodium even at high dosage, nor have extended human studies revealed any safety hazard with the drug. Overdosage is therefore unlikely to cause problems. However, if suspected, treatment should be supportive and directed to the control of the relevant symptoms.
Pharmacological Properties
Pharmacodynamic properties
Nedocromil sodium is a novel pyranoquinoline derivative which inhibits the activity of a range of inflammatory cells known to be involved in asthma. Thus nedocromil sodium inhibits the release of inflammatory mediators and the chemotactic response of eosinophils and neutrophils. Cytokines are a series of protein molecules with a diverse range of potent inflammatory effects on the airways and their release from cells such as human alveolar macrophages, bronchial epithelial cells and mast cells is markedly suppressed by nedocromil sodium. The release of preformed mediators such as histamine and rapidly synthesised eicosanoids from mast cells is also prevented by the compound. Activation of sensory nerves in isolated bronchial muscle results in bronchoconstriction and this response is inhibited by nedocromil sodium.
In animal models, nedocromil sodium inhibits antigen induced bronchospasm airway oedema formation, the late reaction, bronchial hyperreactivity and citric acid induced cough. In addition it inhibits bronchial hyperreactivity induced by non-specific agents such as cigarette smoke and sulphur dioxide. The late asthmatic reaction and bronchial hyperreactivity can also be suppressed when the compound is administered after the early reaction.
In asthmatic patients nedocromil sodium inhibits antigen-induced immediate and late reactions and reduces bronchial hyperreactivity. The drug is also capable of inhibiting the late reaction when administered after the early reaction. Bronchospasm induced by non-specific factors such as exercise, fog, cold air, adenosine and sulphur dioxide is prevented by nedocromil sodium. The release of histamine into the bronchial lumen following challenge with antigen or hyperosmolar saline is significantly reduced by treatment with nedocromil sodium. The anti-inflammatory effects of the drug in asthmatic patients are demonstrated by its ability to inhibit antigen induced influx of eosinophils in lavage fluid and to reduce the numbers of activated eosinophils in the bronchial submucosa after 16 weeks treatment.
Pharmacokinetic properties
After inhalation of nedocromil sodium (in common with other drugs inhaled using an MDI) a small fraction reaches the lungs, while a major portion of the dose is deposited in the mouth or oropharynx and swallowed. The oral absorption of nedocromil sodium from the gastrointestinal tract is low, being approximately 2% of an orally administered dose. Hence, nedocromil sodium measured in plasma following inhalation is considered to represent mainly the drug absorbed by the airways. After inhalation, plasma concentrations of nedocromil sodium reach a maximum within one hour post-dosing and decline with a half-life of 1-2 hours.
Nedocromil sodium is moderately (up to 89%) and reversibly bound to human plasma proteins, and is not metabolised in man or animals. In man nedocromil sodium is excreted unchanged in the urine (approximately 70%) and in faeces (approximately 30%).
Preclinical safety data
Animal studies have failed to reveal toxic effects with nedocromil sodium even at high doses.
Pharmaceutical Particulars
List of excipients
Polyvinylpyrrolidone (Povidone) K30, polyethylene glycol (PEG) 600, levomenthol, 1,1,1, 2, 3,3,3 heptafluoropropane (HFA 227).
Incompatibilities
None known.
Shelf life
24 months.
Special precautions for storage
Store below 30°C, not in a refrigerator.
As the aerosol inhaler canister is pressurised it should be protected from heat or direct sunlight and should not be punctured or incinerated even when empty.
Store out of reach of children.
Nature and contents of container
A metered dose pressurised aerosol. The 19 ml aluminium canister is fitted with a 100 microlitre metering valve which delivers 112 actuations (each containing 2 mg nedocromil sodium per shot from the valve, or 1.9 mg from the standard actuator), after initial priming.
If the inhaler is new, it should be primed by actuating 4 times prior to inhalation. If not used for more than 3 days, additional priming with 2 actuations is advised.
Each metered dose inhaler unit consists of an aerosol canister and a plastic actuator, with a dustcap.
The metered dose inhaler unit is supplied as a single pack in a carton together with a patient information leaflet.
Cleaning Instructions
It is very important to keep the plastic mouthpiece clean to prevent the build-up of excess powder, which can then be difficult to remove and cause blockage to occur. The plastic mouthpiece must be regularly cleaned and left to dry overnight at least EVERY THREE DAYS from the start of use.
Please follow the cleaning instructions below:
- Remove the plastic dust-cap and the metal canister from the plastic mouthpiece before cleaning.
- Wash the plastic mouthpiece through the top for one minute, using hand-hot (about 45°C) tap water.
- Wash the plastic mouthpiece in the other direction for one minute, using hand-hot (about 45°C) tap water.
- Shake out the excess water from the inside the plastic mouthpiece, where the nozzle of the metal canister fits, by tapping it on a hard surface.
- Leave the plastic mouthpiece to dry thoroughly overnight.
- Ensure that the plastic mouthpiece is completely dry before replacing the canister, and that the white rubber cover is pushed firmly down onto the metal canister.
Important
Should the inhaler become blocked, remove the plastic dust-cap and metal canister (as in Step 1.) and soak the plastic mouthpiece in hot water for 20 minutes. Then repeat steps 2 - 6. Always make sure that the mouthpiece is thoroughly dried. Never try to unblock the mouthpiece with a pin. This will damage the inhaler.
Do not put the metal canister into water.
Do not remove the white rubber cover from the metal canister
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