Frequently-Used Pulmonary Medicines
Welcome to our “frequently used pulmonary medications” home page. To use this page, select the class of medications from the first directory or select the specific medication you are interested in from the second directory. Please note that generic names of medications are in normal typeset while trade names are in italics.
Frequently Used Pulmonary Medications – organized by Medication Class
- Corticosteroid Inhalers
- Leukotriene Modifiers Tablets
- Long-Acting Bronchodilators Inhaler (beta-agonist type)
- Non-steroidal Inhalers
- Oral Anticoagulants
- Oral Corticosteroid Tablets
- Short-Acting Bronchodilator Inhaler (anti-cholinergic type)
- Short-Acting Bronchodilator Inhalers (beta-agonist type)
- Theophylline Oral Tablets
Frequently Used Pulmonary Medications – organized by Medication Name
Intal (cromolyn sodium)
Tilade (nedocromil sodium)
- Alupent (metaproterenol)
- Brethaire (terbutaline)
- Maxair (pirbuterol)
- Metaprel (metaproterenol)
- Proventil (albuterol)
- Tornalate (bitolterol)
- Ventolin (albuterol)
- Xopenex (levalbuterol)
Inhaled short-acting bronchodilators are effective medications to help improve symptoms of bronchospasm (wheezing, shortness of breath, chest tightness, or cough) within 5 to 15 minutes and help control symptoms for 4 to 6 hours. These inhalers are sometimes prescribed to be used ten to twenty minutes prior to exercise to prevent exercise-induced asthma. There are many prescription strength inhaled short-acting bronchodilators on the market (see above). These have similar efficacy but a physician may have prescribing preferences tailored to individual patients. These medications are usually prescribed on an “as-needed” basis to be used every four hours but some physicians allow more regular or more frequent use during asthma flares. If you find your symptoms remain poorly controlled with regular use of these short-acting bronchodilators or that you are requiring increasingly frequent inhalations, you should consider contacting your physician or present to the emergency room for evaluation. Common side effects of these medications are shakiness, nervousness, difficulty with sleep, and chest flutters (palpitations); these symptoms all tend to improve over time.
- Atrovent (ipratropium)
Inhaled anticholinergic type bronchodilators help improve symptoms of bronchospasm (wheezing, shortness of breath, chest tightness, or cough) within 15 to 30 minutes and help control symptoms for 4 to 6 hours. They are mostly used in patients with chronic bronchitis and chronic obstructive pulmonary disease (COPD). They are commonly used four times a day. Occasional side effects include mild shakiness, nervousness, difficulty with sleep, chest flutters (palpitations), dryness of the mouth, sore throat discomfort, urinary retention (especially in men with enlarged prostate glands), and increased pressure inside the eye (especially in patients with glaucoma).
- Foradil (formoterol)
- Serevent (salmeterol)
Long-acting bronchodilators inhalers help improve symptoms of bronchospasm (wheezing, shortness of breath, chest tightness, or cough) within 15 to 30 minutes of use and should help control symptoms for approximately 12 hours. If, on occasion, these symptoms are not controlled for the full 12 hours, your physician may recommend that you use a short-acting beta agonist bronchodilator (above) in between your salmeterol doses. Common side effects of salmeterol are shakiness, nervousness, difficulty with sleep, and chest flutters (palpitations); these symptoms all tend to improve over time.
- AeroBid (flunisolide)
- Azmacort (triamcinolone)
- Beclovent (beclomethasone)
- Flovent (fluticasone)
- Pulmicort (budesonide)
- Vanceril (beclomethasone)
Corticosteroid inhalers are medications that when used regularly suppress and control the underlying inflammation that is the principle driving force in persistent asthma. These medications are preventative and are not to be used in urgent situations. Patients should not expect any immediate response – the effectiveness of these medicines is seen by better control of asthma symptoms over weeks to months. At the recommended doses, there are few side effects with these medicines. To avoid hoarseness or a yeast infection of the tongue and throat, patients should be sure to rinse out the mouth and throat with water or mouthwash after each use. The use of a spacer device makes these side effects less likely. It is very important for a patient to take medications in this class as instructed and to take care not to miss doses (even on days when feeling well).
- Intal (cromolyn sodium)
- Tilade (nedocromil sodium)
Medications in this group help with the long-term control of symptoms of bronchospasm (wheezing, shortness of breath, chest tightness, or cough). These medications are not bronchodilators, therefore patients should not expect immediate relief after use. They are sometimes used 15 to 30 minutes before exercise or allergy exposure to prevent bronchospasm. These medications are generally safe and free of significant side effects. To be effective, patients must take these medications regularly (including days when feeling well!).
- Singulair (montelukast)
- Accolate (zafirlukast)
- Zyflo (zileuton)
Medications in this group help prevent asthma or allergy symptoms by blocking the action of leukotrienes – natural substances found in humans that may be important mediators of asthma and other allergy-related disorders. Two of these agents (montelukast and zafirlukast) block the deleterious effects of leukotrienes in the body, whiled the third (zileuton) prevents formation of leukotrienes. These medications are considered “controller” agents for asthmatic and allergic disorders and are frequently used along with inhaled corticosteroids. Montelukast (Singulair) is usually given once daily (usually in the evening) and is relatively well tolerated. Zafirlukast (Accolate) is usually given twice daily and should be taken either one hour before or two hours after meals to allow complete absorption from the stomach. This drug may interact with other medications – possible interactions should be discussed with one’s physician or pharmacist. Zileuton (Zyflo) is taken four times a day and may interact with several drugs, most notably theophyllines or coumadin.
- Medrol (methylprednisolone)
Oral corticosteroids are potent anti-inflammatory agents that are used in the acute setting for moderate-to-severe flare ups of obstructive lung disease that are poorly responsive to bronchodilators or chronically for control of moderate-to-severe obstructive lung disease poorly controlled by the typical controller regimens (inhaled corticosteroids, leukotriene antagonists, and cromolyns). For moderate-to-severe acute exacerbations of obstructive lung disease, relative high doses are used in the first few days and then the dose of corticosteroid is gradually tapered, typically over five to fourteen days. For difficult to control chronic obstructive lung disease, corticosteroids may be used on a long-term basis. The physician will attempt to find the lowest dose possible to maintain acceptable control of bronchospasm. Long-term use of corticosteroids can contribute to hyperglycemia (high sugars) – especially in patients with a predisposition to diabetes mellitus, weight gain, high blood pressure, cataracts, loss of bone density, and increased susceptibility to infections.
- (Many trade names)
Oral theophyllines are tablets or capsules that are taken regularly as bronchodilators. They are slow to act – one must be on this group of drugs for several days before adequate blood levels are achieved, therefore, they are infrequently used in the outpatient setting for acute flare-ups of obstructive lung diseases. They are only useful when taken regularly. They are relatively “weak” compared with inhaled bronchodilators and are sometimes added to an inhaled bronchodilator regimen for difficult to control bronchospasm or nighttime bronchospasm. Blood levels are usually kept between 5 and 15 micrograms per milliliter and require occasional lab monitoring. If higher blood levels are achieved, side effects may occur. These include nausea, vomiting, jitteriness/tremulousness, insomnia, anxiety, palpitations (pounding or racing heart), heart irregularities, or seizures. Theophyllines may interact with other drugs – possible interactions should be discussed with one’s physician or pharmacist.
- Coumadin (Warfarin Sodium)
Oral anticoagulants such as warfarin are used to treat disorders of excessive blood clotting or to prevent abnormal blood clots from forming in high-risk patients. They are useful in several pulmonary conditions including pulmonary embolism and primary pulmonary hypertension. They are also frequently used in non-pulmonary conditions including chronic atrial fibrillation, congestive heart failure, artificial heart valves, and strokes. The dosage of warfarin needs to be closely adjusted based on results of a blood test called the prothrombin time. This test measures the amount of time the blood takes to clot in the laboratory. To standardize this test across many labs, the results may be reported as an “international normalized ratio” or INR. An INR of 1.0 is a normal value for a healthy person not on anticoagulation. The goal of anticoagulation therapy is to safely raise the INR to a higher value. This “target” value may be 2.0 to 2.5 for atrial fibrillation and pulmonary embolism or higher (for example, 3.0 – 3.5) for prosthetic heart valves. Choosing an appropriate target and adjusting the daily dose of warfarin should be done under close medical supervision.
It is important for a patient to be an active participant in their care while taking warfarin. It is advisable to take the medicine at the same time each day, frequently in the evening. Evening doses are sometimes preferred to give the health care provider a chance to change that day’s dose should the morning blood test (INR) warrant a dose adjustment. It is important to have your blood drawn on the schedule recommended by the health care provider – early on in the course of anticoagulation, the bloods may be drawn as frequently as every day or two, but later, perhaps once every week or even less frequently. The dose of warfarin required may change with medical illness, addition or deletion of other interacting medications, or significant change in diet. Warfarin works by inhibiting vitamin K, an important vitamin that helps with normal blood clotting. Vitamin K is found in leafy, green vegetables and some beans and peas. It is not desirable to avoid foods with vitamin K, rather, avoid large changes in the amount of these foods eaten on a day to day basis – keep a fairly steady diet! Cooking, freezing, or drying food probably does not change the vitamin K content significantly.
The principle side effects of warfarin are excessive bruising and bleeding and the risk to an unborn child if taken by a pregnant woman. Consider wearing a Medical Alert bracelet or carrying a warfarin patient identification card while on this medication. Tell any medical or dental care provider treating you as a patient that you are on warfarin. Do not take warfarin if pregnant or may become pregnant. Avoid alcohol consumption while on warfarin. Avoid any activity or sport that may result in a traumatic injury. Notify your healthcare provider right away if you have a serious fall, hit your head, any bleeding that does not stop, heavier than usual menstrual periods, unusual colored urine or stools (especially red or black), unexplained pain or swelling, unusual headache, dizziness, or feelings of severe weakness or fatigue. Beware – the effects of warfarin may persist for up to five days after warfarin in stopped or held.
It is strongly recommended that the patient keep a diary of their warfarin doses and protime/INR. This enables the patient to “follow along” with their health care provider. Occasionally the patient may notice correlations of their lab result (INR) with changes in their diet, health, or medications that may not be immediately obvious to the health care provider! A suggested format for this table follows.
Dose of warfarin/coumadin
Taken? (check when taken)