Azmacort Substitute (Page 13)

Azmacort has been taken off the market because of environmental concerns (they say). There really is NO substitute. All other steroids do not work. My wife could die because of it. No one seems to care. Do you?

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REPORT

I ask one of the top men at Abbott if they might make the Azmacort into a nebulizer medication and he said no they had no plans to do that. So I guess we are up the creek without a paddle. Seems nobody gives a kj87%f@#e.I guess I will give up on the idea.
blessings,

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I fell upon this website accidentally when doing research for a presentation and I can't help but comment. I am a pharmacist who specializes in asthma at a major academic center. I agree with you all that it is unfortunate that a medication you were stable on was removed from the market over something as silly as CFCs.

However.... there was nothing special about Azmacort other than it worked for you when you tried it. The biggest difference is that whatever drug gets to the stomach rather than the lungs is 23% absorbed - this can lead to more side effects. (As a comparison, Flovent is <1% absorbed) Other inhaled corticosteroids will work for you if you try them. You may have to go through one or two to see what works for you, but they all work similar and have the same side effects. Azmacort was a metered dose inhaler (MDI), so I would recommend trying other MDI's - Flovent, Alvesco, or QVar. Flovent is my personal favorite, and preferred on many insurance plans.

If you have more side effects, you should use it with a spacer. (really, you should be using a spacer anyways)Without a spacer you swallow a lot of the drug and it can increase your side effects. Rinse your mouth or brush your teeth after to decrease thrush. Smoking marijuana is NOT a treatment for asthma. Inhaling any form of smoke into your lungs can trigger an asthma attack. Remember, it takes 3-4 weeks to see the effects from starting an inhaled steroid. None of these drugs cause increased heart rate - thats likely from your albuterol, salmeterol, or even anxiety/panic attacks. Do not try to inhale topical triamcinolone, that will not treat your lungs properly. Triamcinolone nasal spray will try nasal allergy symptoms which can help with asthma, but will not substitute an inhaled steroids.

Advair is also not a direct substitute from Azmacort. It is a step up in therapy according to the national asthma guidelines. This is a good drug for many people, but it has additional safety concerns. It is only indicated for patients uncontrolled on an inhaled corticosteroid.

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To Pharm222 - Thank you for posting your perspective as a pharmacist! It's nice to hear from someone "in the profession". I will tell you, though, that I have tried MANY of the other inhaled steriods to no avail. I have had an infection, long-term laryngitis, respiratory issues, etc., from each of them. My pharmacist believes that my reaction to these other inhalers isn't due to the medications themselves, but rather to the new HFA inhalant. He believes there is something with this inhalant that my body won't tolerate. Since every inhaler is now produced using the HFA inhalant, I'm basically out of luck. Any suggestions?

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I have tried ALL the other inhalers and have just been taken off nebulizer budesinide and bravana because it made it HARDER for me to breathe. I can't take any of the other inhalers. If you have read the post here you will see I also used QVAR with VERY bad side effects, and it has a spacer. I tried all the other inhalers while they were made with the CFC's, so it's not the HFA's causing my problem. I hope you do a paper or a write up on this medication, or at least tell everyone what we are going through.Everyone just keeps saying try one of the other inhalers without paying attention to what I have just said . I'm allergic to them all. I really need AZMZCORT and I NEED IT NOW! Thanks for reading our post.Blessings,Margie

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I wanted to write you and let you know that AZMACORT is not a MDI like you started. One of the reasons that AZMACORT worked for me besides the medication being good was that I was able to take it after every nebulizer treatment.
I take a nebulizer treatment every 4 hours and with the other medications you use them twice a day and after that many nebulizer treatments I'm thinking it washes the medication out of your lungs, so with the AZMACORT it kept me on an even path and my lungs were stable that way. I also noticed that when AMACORT tried to advertize that their medication was one of the best because it had it's own spacer and worked better, the FDA refused to let them advertize it that way. They filed papers on them so they couldn't. So I think the FDA just wanted to get rid of the AZMACORT medication becaues it WORKS!!!
The FDA probably just wants us all to DIE!

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Pharm 222

If you are doing research for a presentation, here is a footnote for you. My wife has died.

Please listen to what these folks have to say. They are not laboratory guinea pigs. They are not esoteric academia discussions. They are not wild-eyed fanatics over a particular drug. They are not against ecology or the environment. They are real human beings with really serious problems and, for the most part, Azmacort worked for them as it did for my wife.

You may assume that, when facing death, a person so afflicted will find out as much as possible to prevent dying or a way to achieve a better quality of life; both, if possible. They ave tried ways not even recommended hoping for a serendipitous discovery. These folks are probably the best experts you will ever find; better than books written by people who have not nor do they even know anyone who has real experience in this.

To me, this whole area experience seems like medical water-boarding. The difference here is, these folks are verifiably innocent before the torture has even begun...

Jack

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I may have jumped in when I shouldn't have about the MDI. I was thinking of drugs like albuterol inhaler or Spiriva or one of theBBMHMZse drugs but . MDI's are metered dose Inhalers and even though I wasn't thiking about AZMACORT being one I guess you could call it an MDI because it let a metered amount each time. Sorry ,This whole thing about not being able to get the medicine we need is sooooooo frustrating, I end up crying every time I thing about it.
You could really do us a kind service if you could publish our frustration and sickness and anything else you could think of that might help us or at least become a voice for us. We all would appreciate it.
Blessings,
Margie

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Thank you so much Jack for posting this reply. You say everything so elegantly and so well that you speak for me when you write stuff. Thanks. The man who was working for the asthma center, must have read what I wrote but he still DIDN'T get it. I have tried ALL other medications and I DID use a spacer and it made no difference. They all make me sooooo sick. Yesterday the doctor took me off the other stuff he had me on.The nebulizer Budesonide and told me NOT to use the Bravana either. To just don't take anything and see what happens . Well, I know what will happen. I 'll bet you I never make it through the next winter. If I do it will be by GOD's grace.
Blessings, Margie

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Boy I wish some of these substitutes worked as well as Azmacort. I have reacted negatively to all HFA inhalers, so my choice is powdered inhaler-allergic to Flovent, Asmanex so Pulmicort flex is the only one left-does it work as well as Azmacort-no. Before the FDA makes these decisions they should use only the asthmatics working there as the guinea pigs-if you don't have it, you don't know-reading is a lot different than breathing.

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I have contacted a druggest about compounding a nebulizer medication from AZMACORT. Since Abbott Labs hasn't ever made one there probably isn't a recipe for making it. But the man who called me from Abbott suggested I do that so maybe there is hope we will see.The druggest said she would call me back as soon as she found out. Pray for us to have found something. Thank you Lord. I 'm finally going to get out of the house and go to see my mother for Mother's Day. I haven't been to see her since Nov. . May 8, mothers day will be my 49th wedding anniversary.
Blessings,
Margie

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HFAs do have different ingredients than the CFCs did, so thats an interesting theory. (but on that note, if Azmacort switched to HFA to stay in production, you would have the same problem) Do you have the same reaction to albuterol? That is HFA as well. I personally feel like the albuterol HFA doesn't work as well for me as the CFC - so I agree there are differences. Try a dry powder inhaler (such as budesonide or Advair diskus). If you have the same problem with those, it is not HFA that is the problem. Are you using a spacer with your inhaler? Without a spacer 9% goes to the lung, 81% stays in the mouth/throat, and the remainder in the stomach. With a spacer, 21% lungs, 17% mouth/throat, 56% stays in the spacer. Hope that helps!

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Since I haven't been able to get my AZMACORT and have had to use all the other inhalers and they make me sick, and I have listened to a lot of other people since then that I'm beginning to think that none of the others work either, that they just keep on prescribing them and NOT LISTENING to the patient LIKE ALWAYS. I don't think the others work that well either. AZMACORT worked I don't care what is said against it.They just don't want us to have anything that works.
Now I'm on antibiotics and then it will be large doses of steroids and then antibiotics and then large doses of steroids and my face is already getting puffy . I'm taking 5 mg steroid everyday and it does nothing to help.I'm still trying to find a compound pharmacy.
Blessings

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When Azmacort was pulled, my wife tried Flovent. It made her extremely dizzy and she decided not to discontinue maintenance, being that she felt fine and hadn't had to use a rescue inhaler in years. This week the allergens have been at record high levels and she succumbed to them. She probably only needed a cough suppressant and expectorant, but she does not do well with all the junk added to OTC meds. While not actually wheezing, she felt the need to use the Albuterol.

Thinking her MD would recommend she go back on maintenance, she discovered this discussion, and a light bulb went off when the pharmacist here (Pharm222) mentioned the necessity of a spacer. Azmacort used a delivery device that had a built-in spacer. The others inhalers did not and still do not. After seeing her MD tomorrow it's likely she'll try the Flovent again, using one of the Azmacort devices that we still have. That may be the answer to many people's problems. I'll report back on the results.

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Correction: I meant to type that she decided TO discontinue maintenance.

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I searched until I found a Compounding Pharmacy to make a nebulizer medicine from the same stuff as AZMACORT I found several. I had one of them send a fax to my doctor it has set on his desk for 3 weeks.I called the pharmacy and they fax the doctor again. I called the doctor and was told it is sitting on the doctors desk. So after finding someone I still do not have my medication. I guess because it isn't under the thumb of the FDA they do not want to mess with it. But guess what the AZMACORT WAS under the FDA's thumb and look where it has gotten us. This is so hopeless.I don't know what to do now. I have run out of ideas.

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Well as it turns out my wife had some sinusitis and bronchitis that was going around and after listening to her chest her physician did not feel it necessary for her to go back on a steroid asthma inhaler. So she did not get to try the Flovent with the Azmacort device. But I would encourage everyone to at least try using that device for their med--they all insert the same. Or if you don't still have yours, get a spacer and try using that. The spacer may be the reason that Azmacort was so much more effective and/or better tolerated than these other meds.

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Howard

Is your wife's doctor a pulmonologist?

Jack

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No. He's a GP. But she hasn't had to use a rescue inhaler in years and went off Azmacort in 12/2009 and hasn't had a problem since. He's well aware of all this and specifically did not feel it was necessary for her to return to steroids. And I trust him.

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The spacer probably was a good thing in the AZMACORT but that isn't the reason I couldn't use the other inhalers. The other inhalers MADE me sick.So my problem has to do with the steroid . I thought it might have been the preservative but after using Budesinide and it made it very hard for me to breathe.I don't think it was the preservatives any more because this was a nebulizer med and it didn't have prservatives in it.

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Howard:

I did not mean to ask the question in an accusatory way, but merely as a precaution to you. I think you are doing the correct thing for your wife. When your doctor is over his head, he will let you know I'm sure. Either that, or you will sense it.

Margie:

With your permission, I would like to bring your case up during our prayer time at church. I really feel for you - - - and I really miss my wife. It is almost a year now.

Jack

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