CROMOLYN SODIUM

(kroe'moe-lin)

Disodium Cromoglycate, Crolom, DSCG, Fivent

, Intal, Nasalcrom, Opticrom, Rynacrom

, Vistacrom

, Gastrocrom
Classifications: mast cell stabilizer; antiinflammatory; antiasthmatic;
Therapeutic:antiasthmatic; antiinflammatory
Pregnancy Category: B

Availability

20 mg/2 mL solution for nebulization; 800 mcg spray; 40 mg/mL nasal solution; 4% ophth solution; 100 mg/5 mL oral concentrate.

Action

Synthetic asthma prophylactic agent with unique action. Inhibits release of bronchoconstrictors—histamine and SRS-A (slow-reacting substance of anaphylaxis) from sensitized pulmonary mast cells, thereby suppressing an allergic response. Additionally, cromolyn may also reduce the release of inflammatory leukotrienes.

Therapeutic Effect

Particularly effective for IgE-mediated or "extrinsic asthma" precipitated by exposure to specific allergen (e.g., pollens, dust, animal dander), by inhibiting the release of bronchoconstrictors.

Uses

Primarily for prophylaxis of mild to moderate seasonal and perennial bronchial asthma and allergic rhinitis. Also used for prevention of exercise-related bronchospasm, prevention of acute bronchospasm induced by known pollutants or antigens, and for prevention and treatment of allergic rhinitis. Orally for systemic mastocytosis. Ophthalmic use: Allergic ocular disorders, conjunctivitis, vernal keratoconjunctivitis.

Unlabeled Uses

Orally for prophylaxis of GI and systemic reactions to food allergy.

Contraindications

Use of aerosol (because of fluorocarbon propellants) in patients with coronary artery disease or history of arrhythmias; dyspnea, acute asthma, status asthmaticus, or acute bronchospasm; patients unable to coordinate actions or follow instructions. Safe use in children <2 y not determined.

Cautious Use

Renal or hepatic dysfunction; pregnancy (category B), lactation.

Route & Dosage

Allergies
Adult: Inhalation Metered dose inhaler or capsule: 1 spray or 1 capsule inhaled q.i.d.; nasal solution: 1 spray in each nostril 3–6 times/d at regular intervals
Child: Inhalation >6 y, Metered dose inhaler or capsule: same as for adult; >6 y, nasal solution: same as for adult

Conjunctivitis

See Appendix A-1

Mastocytosis
Adult: PO 2 ampules q.i.d. 30 min a.c. and h.s.
Child (2–12 y): PO 1 ampule q.i.d. 30 min a.c. and h.s.

Administration

Patients should receive detailed instructions for loading and administering the spinhaler or nasalmatic device. See manufacturer's instructions. Therapeutic effect is dependent on proper inhalation technique.
Advise patient to clear as much mucus as possible before inhalation treatments.
Instruct patient to exhale as completely as possible before placing inhaler mouthpiece between lips, tilt head backward and inhale rapidly and deeply with steady, even breaths. Remove inhaler from mouth, hold breath for a few seconds, then exhale into the air. Repeat until entire dose is taken.
Caution patient not to exhale into inhaler because moisture from breath will interfere with its proper operation. Also inform patient that capsule is intended for inhalation only and is ineffective if swallowed.
Protect cromolyn from moisture and heat. Store in tightly closed, light-resistant container at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects (≥1%)

Body as a Whole: Peripheral eosinophilia, angioedema, bronchospasm, anaphylaxis (rare). GI: Swelling of parotid glands, dry mouth, slightly bitter after-taste, nausea, vomiting, esophagitis. CNS: Headache, dizziness, peripheral neuritis. Skin: Erythema, urticaria, rash, contact dermatitis. Special Senses: Sneezing, nasal stinging and burning, dryness and irritation of throat and trachea; cough; nasal congestion, itchy, puffy eyes, lacrimation, transient ocular burning, stinging.

Interactions

Drug: No clinically significant interactions established.

Pharmacokinetics

Absorption: Approximately 8% of dose absorbed from lungs. Onset: 1 wk with regular use. Peak: 15 min. Duration: 4–6 h; may last as long as 2–3 wk. Elimination: Excreted in bile and urine in equal amounts. Half-Life: 80 min.

Nursing Implications

Assessment & Drug Effects

Withhold drug and notify physician if any of the following occur; angioedema or bronchospasm.
Monitor for exacerbation of asthmatic symptoms including breathlessness and cough that may occur in patients receiving cromolyn during corticosteroid withdrawal.
For patients with asthma, therapeutic effects may be noted within a few days but generally not until after 1–2 wk of therapy.

Patient & Family Education

Throat irritation, cough, and hoarseness can be minimized by gargling with water, drinking a few swallows of water, or by sucking on a lozenge after each treatment.
Talk to your physician about what to do in the event of an acute asthmatic attack. Cromolyn is of no value in acute asthma.
Cromolyn does not eliminate the continued need for therapy with bronchodilators, expectorants, antibiotics, or corticosteroids, but the amount and frequency of use of these medications may be appreciably reduced.
Report any unusual signs or symptoms. Hypersensitivity reactions (see Signs & Symptoms, Appendix F) can be severe and life-threatening. Drug should be discontinued if an allergic reaction occurs.
Treatment with cromolyn 15 min before doing protracted exercises reportedly blunts the effects of vigorous exercise as well as cold air.
Ophthalmic use: Do not wear soft contact lenses during therapy with ophthalmic drug. They may be worn within a few hours after therapy is discontinued.
Learn the proper technique for instillation of ophthalmic drops.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(66)