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Advised to take more medication than it's licenced for.

Hi. Just curious of other peoples experiences. To put a long story short, i have uncontrolled asthma, been to a and e had paramedics out etc. Tried lots of diff meds, Gp have no further help so I've seen a consultant. They are out of my area so getting the info to my gp then help back to me takes a while. The consultant said to up my dose of fostair, even tho its not licensed for that amount, as fostair is helping a bit. Im wary of basically over dosing on this everyday until they come up with a plan. Dont know how long this will be. Im on fostair 200/6, 2 puffs twice a day and 1 puff twice a day. So 50% over the maximum dose. Anyone else been instructed to do this either with fostair or anything else? Tia x

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I was on more than max dose of Symbicort for a while (400/6 3 puffs twice daily). It was supposed to be temporary but I found reducing would make me worse so I guess it was helping! Horrible palpitations from the long-acting reliever element though.

Cons then put me on a ridiculous regimen of Symbicort 200/6 plus Pulmicort - same amount of.steroid (over licenced max dose), less reliever, 6 puffs total morning and night. Fewer palpitations but as I had many many issues with this cons I quit seeing her. The new one, at a specialist centre, said my regime might have been a good.idea in 1995 with no other options, and changed me to Fostair Nexthaler which is fine particle so.you need less to get the same effective dose. I am on max.dose of that and it does work better partly because it's easier to inhale.

Maybe you could ask the consultant about any other inhaler options including one of the more modern ones which are easier to.use? I hadn't realised until I switched that it did make a difference not being able to.inhale Symbicort whenever I was struggling ans getting into a bit of a cycle. The first cons I mentioned wasn't really up on asthma (she thought she was) so didn't know about those but hopefully yur cons will. You could ask Asthma UK nurses about the options.

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Hi there,

Taking medication outside licensing amount is fairly common for those of us with uncontroll d asthma. Mine is fairly well controlled at present, but I take 1 drug not licensed for asthma and two others in ways that are off license. All prescribed by my consultant. If it works go with the flow.

R x

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Thanks guys. I guess I'll just wait and see. I suppose it's good I'm starting to feel better on it too.

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I'm on Symbicort, my dose is 150% over the recommended Symbicort dose. There are people over here, they are on high dose of Seretide (2000/200). It's a common practice, don't worry.

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It does seem to be common practice. I was v nervous about taking Fostair over & above what it’s licensed for, but I have faith in my consultant - if he says it’s ok then it’s ok!

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It is fairly common, I’m on fostair 200/6 2 puffs twice a day & qvar 100 4 puffs twice a day. Only thing I’ve noticed is other medical professionals questioning the dose. Until you tell them it’s consultant prescribed they seem to get it.

Hope it works for you!

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I am on symbicort 160/4.5. During recent flared-up I was advised to increase the number of puffs to maximum of 12 puffs/day. At most I just need 6 puffs/day for 2 weeks or less. Under normal condition I just need 2-3 puffs/day. If I am not mistaken the fostair is another version of symbicort though the one that you have is much more concentrated. Hence the safety margin is much less than mine. Consult your GP.

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Yes, I have a rare phenotype of asthma, and I’ve been intubated and mechanically ventilated many times.

I’m over the licensed dose of several drugs - it was benefit VS. Risk, and the benefit to me is ansolutely outweighing the risk.

I’d be wanting it to be a consultant respiratory doc making those decisions. There is an algorithm for treatment that is normally utilised prior to these other measures. X

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Hi the thing about medical professionals is that because they have the knowledge and experience they can prescribe different dosages of drugs than are advised. It's like if you have severe copd for example then they can give you oramorph even though it can make breathing issues worse coz the benefits outweight the dangers. This sounds like what your consultant is doing but trust him/her as they know what they are doing. x

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Hi Treed12

I asked the Asthma UK nurse team about this. They said Consultants do work 'off license' often. I think if this is the Consultant's advice then it should be followed but I would have hoped that the new instruction would be updated on your asthma action plan and correspondence to GP is vital so they can update their systems otherwise when you get your next repeat prescription form GP it may not be quite right. If you are unsure could you ring your team at the hospital, perhaps the asthma nurse there may ring you back to reassure you of exactly what the Consultant wanted you to do as per the notes.

Hope that helps,

Dita

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Thanks for all the replies. I will stick with it. I've just had a letter from the consultant requesting a skin prick test after findings from a blood allergy test. So perhaps its a temporary thing until she has all the answers. Its reassuring to know it seems to be the norm!

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As an aside, the constituents of Fostair are a major depleter of Potassium, a very important nutrient that - if in short supply - can have serious health consequences over time.

Although using Potassium Supplements to attempt to correct the imbalance caused by use of potassium depleting drugs is risky (no more than 100mg daily is considered safe), making a dietary correction (e.g. more Bananas, Orange Juice etc that yield dietary Potassium) is well worth considering, unless you have a known medical condition that requires special care where Potassium is concerned.

You will see from the Fostair Patient Information Leaflet that it admits to Potassium Depletion (at least it did when I last looked).

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Thank you for the information. I have been getting more cramp lately and have put it down to that. I must get some bananas as they usually do the trick.

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Hi, I have the fostair 100/6 with a normal dose of 2 sucks (it’s the Nexthaler) twice a day, but have been told I can increase the dose to 4 twice a day if required and had this confirmed by a pharmacist.

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Lo- salt has a good balance of potassium to sodium & but sea -salt or Himalayan salt with a glass of water is a quick fix for Asthma. Look at proteolytic & digestive enzymes & Probiotics for a long term solution. 74 years old Chronic Asthmatic for 45years + now totally free (touch wood).

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Hi

I was on Fostair Nexthaler 200/6 and at one point was advised to take 2 puffs 4x daily. It didn’t seem to give me much benefit but had mild side effects (headache etc). The recommended dose is usually the level the drug company finds everyone get maximum benefit from (and the least side effects). I think with Fostair it’s 800 (hence 4x200/6) but some people absorb more than others so it gets put up but consultants to see if it helps.

My main improvement came from switching preventor tho so 🤷‍♀️

Hope that helps to explain things a bit x

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