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Azmacort Substitute

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Jack Says:
 
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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1
Dale88 Says:
 
Jack, so sorry to hear about the impact that Abbott's decision is having on your wife. It is sad that companies can create products which help individuals (and make individuals rely on them) and then just make such a decision to withhold it on a whim. Surely something can be done about this. I'd start by contacting Abbott and/or consulting with an attorney to see what can be done. Has her doctor recommended any substitutes yet? I know you said that nothing else works for her, but I would be curious to know what the doctor is recommending be done. Good luck and keep me posted!

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2
Jack Says:
 
Dear Dale88:

I have contacted Abbott by phone and got a sympathetic ear from the bottom of the totem pole. I cannot seem to make contact with anyone making the decision to stop production. I suspect Abbott caved in for other reasons as well - like the drug, although expensive to the individual, was not all that profitable to the company.

I also called the National Jewish Hospital in Denver. They are supposed to have a new name but still answer to this one. They are regarded as the number one respiratory center in the US, and one of the best in the world. They gave me a list of alternative drugs to use -
* Asmanex® (mometasone)
* Alvesco® (ciclesonide)
* Flovent® (fluticasone)
* Pulmicort® (budesonide)
* Qvar® (beclomethasone HFA)
* Aerobid® (flunisolide)
* Azmacort® (triamcinolone)

Sounds good, doesn't it? I thought so too until I met with her doctor.

Her doctor is an absolutely superior diagnostician. She already knew about all the suggestions made by the Denver Hospital and had her reasons for choosing Azmacort. It would (and did) work for her. Apparently, the suggestions made by Denver are canned responses to the question of alternatives that most knowledgeable practitioners are trained to give.

I suppose a canned reply works in many cases where people can tolerate a range of options that my wife cannot. Her body rejects most medications.

In desperation, the doctor has my wife on Pulmicort but is rightly dubious. We have an appointment coming up and we will tell her that my wife is having a lot of trouble tolerating the drug - something we knew would happen. Sometimes she tries alternatives just to see if her body would get used to it or not. It never has.

Her doctor also had a comment about discontinuing the drug. She expressed disbelief that any company would unilaterally do such a thing. When I told her why they did it - to comply with the Montreal Accord reached on December 23, 2007, - her jaw dropped. There is no way that inhalers could possibly effect the ozone layer to such a degree that, if ceased, would make any difference at all. Even if it could, it would be so minuscule as to be non-existent.

We all suspect that the driving force behind it is politically driven. If they are successful, they stand to make a lot more money than Bill Gates ever could. Some of them have already made more than 1000 million! And it is still a hotly debated subject.

I found this out about CFC (chlorofluorocarbons) emissions: they were invented in the 1920's by Thomas Midgley for use in Air Conditioners (Freon). This man, along with the famous Charles Franklin Kettering, are the major (though dead) targets of the environmentalists. They are also credited with inventing leaded gas for cars and other disasters.

Our doctor does not think puffs on medical inhalers should factor into the case against CFC's. However, we do not have either the political clout nor the ear of those who are in power to make a difference.

Although we may disagree on some aspects of the work being done on CFC's, we can live with whatever the results may be - except where it concerns total elimination, and where it endangers the life of an individual.

What I am going to suggest in desperation is this:

Azmacort is generically called triamcinolone acetonide. It is a steroid that also comes in another form - a topically applied cream for various skin disorders. I wonder if it could be applied to the nostril and inhaled that way and, if so, how such a method could be regulated?

I told you, we are desperate. I love my wife and I want her to be able to live her full life. I do not want it to be cut short.

Jack



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3
Concerned Reader Says:
 
Hi Jack. I just got done reading this thread and hearing what you and your wife have been through. You have my sympathy and my frustrations that the powers that be make decisions without factoring in individual lives. They only care about the $$$.

Now I don't know what state you guys live in (as such am not familiar with local or state laws). And I don't know what your stance on certain issues are, but I will merely open a discussion about this and do with it what you will. I fully respect whatever viewpoint you decide to take, so please understand that I am simply trying to offer a creative solution and some hope (although I am sure you must have considered this before since you have already tried so many things).

Have you guys considered the use of medicinal Marijuana? There are countless studies that have reported asthma symptoms immediately alleviated after inhalation of marijuana smoke.

For example:
"I find that smoked marijuana provides better relief of asthma than prescription drugs for four reasons.

(1) Marijuana seems to produce faster symptomatic relief than Proventil , and speed is important when you’re having trouble breathing.

(2) Marijuana seems to increase lung capacity and produce deeper breathing than Proventil. (In fact, marijuana seems to enable me to take deeper breaths than I can take even when I’m not having an asthma attack.) There are a number of objective tests of lung capacity that could be used to test this hypothesis.

(3) Since it take more puffs of marijuana to get relief than puffs of Proventil, it is easier to titrate the dosage of marijuana. I find this to be true even though the strength of marijuana (and therefore the necessary dose) varies widely due to genetic and environmental variation.

(4) Even when I smoke more marijuana than I need to for asthma relief, it does not make my heart race, give me headaches, or produce excessive bronchial dilation. It does tend to make me sleepy, which actually makes it perfect for right before I go to bed, when I consistently need to use Proventil to prevent the asthma attack that inevitably starts as soon as I lie down." [1]

And some more information:

"After experimental induction of acute bronchospasm in 8 subjects with clinically stable bronchial asthma, effects of 500 mg of smoked marijuana (2.0 per cent Delta 9-tetrahydrodrocannabinol) on specific airway conductance and thoracic gas volume were compared with those of 500 mg of smoked placebo marijuana (0.0 per cent Delta 9-tetrahydrocannabinol), 0.25 ml of aerosolized saline, and 0.25 ml of aerosolized isoproterenol (1,250 ug). Bronchospasm was induced on 4 separate occasions, by inhalation of methacholine and, on four other occasions, by exercise on a bicycle ergometer or treadmill. Methacholine and exercise caused average decreases in specific airway conductance of 40 to 55 per cent and 30 to 39 per cent, respectively, and average increases in thoracic gas volume of 35 to 43 per cent and 25 to 35 per cent, respectively. After methacholine-induced bronchospasm, placebo marijuana and saline inhalation produced minimal changes in speci! fic airway conductance and thoracic gas volume, whereas 2.0 per cent marijuana and isoproterenol each caused a prompt correction of the bronchospasm and associated hyperinflation. After exercise-induced bronchospasm, placebo marijuana and saline were followed by gradual recovery during 30 to 60 min, whereas 2.0 per cent marijuana and isoproterenol caused an immediate reversal of exercise-induced asthma and hyperinflation." [2]

Once again, I am not trying to encourage any illegal activities or recommend specific treatments. I'm simply trying to offer any other knowledge or options which could make life easier for you guys. I wish you and your wife the best! The answers are out there. Don't give up!

References:

[1] Marihuana as Asthma by Lisa http:/­/­www.rxmarijuana.com/­lisa.htm

[2] Effects of Smoked Marijuana in Experimentally Induced Asthma http:/­/­www.druglibrary.org/­Schaffer/­hemp/­medical/­tashkin/­tashkin1.htm

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4
Verwon Says:
 
And in our case, here at this site, of course we care, however, this site does not manufacture nor have ties to the manufacturer of any medications. We are a information only website.

It is also doubtful that the cream that contains Triamcinolone would work in such a manner, since she would not inhale enough of it to make a significant difference.

That said, one thing I am still finding listed as available is Tri-Nasal, which contains the same ingredient, I am not a medical professional, so I have no idea whether or not it would be effective in ths manner.

Have you talked to your doctor about tryng another product with the same ingredient, rather than an alternative?

http:/­/­www.medschat.com/­wiki/­Azmacort/­



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5
realist Says:
 
I just got told that my Azmacort would not be refilled. After reading your website, my response to those who are blamking the drug companies is to look at the true cause for this.. big government, the greenies, the Al Gore types who use the ecological issues which have some real concerns to faust their political agendas on us. Welcome Wait til the government is making the rest of your medical choices...about doctors, procedures, etc. The drug companies are not perfect but they are being forced into many decisions not only for profit as the government would have us believe but also because they are afraid of fine, suits, and lawyers. There in eeds to be regulations but not the kind that has no basis in common sense weighing the benefits versus the risks.

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6
Jack Says:
 
Dear Concerned Reader:

I am terribly sorry I did not answer sooner. I just got my wife out of the hospital. I believe she had a reaction to the new inhaler she was using. She was so determined to make it work that she put her body under great stress by continuing to use it. She was hoping that she could force her body to get used to it. Her body revolted. It seemed to induce a sort of heart arrhythmia and extreme discomfort. I did not have a clue.

Now, all you guys out there will understand what I am about to say about wives; - - - -they never tell you anything until it gets so bad that, when she finally tells you, you go into an immediate panic mode. No waiting, just action.

That was me. I told her we were not even going to wait for an ambulance or call 911 unless she wanted me to. I drove her to the hospital and sweated all the way. I certainly got there before an ambulance could arrive at the house. They are good, but not that good.

It was late at night and I got immediate attention. They did tests. Someone decided to give her oxygen and it worked! We were both very impressed with that.

To make a long story short, she is home now and, oh boy, am I ever happy. But I do try to watch her. When she falls asleep while watching TV, I find myself constantly checking to see if she is still breathing.

A Pulmonolgist is putting her on a new medication - it is Advair HFA 115/21. It is an aerosol and not the dry powder that she cannot take. It was made available in various strengths in 2006. It is not the Advair discus. It is a combination of fluticasone propionate and salmeterol in a single inhaler. I think one of the side effects of salmeterol is death. She had to take it in a separate inhaler with the Azmacort, so she can probably tolerate it. But it this drug so expensive, our pharmacist suggested that we apply to the manufacturer for help. Mercifully, they do have a program for that sort of thing. We are now sweating out the application and hoping we qualify. We want to try it to see if she can tolerate it. Go here if you have a need for more information:

http:/­/­www.medicalnewstoday.com/­articles/­54393.php

Now, to answer your suggestion considering using medical marijuana for an asthma relief.

I am not sure if marijuana is legal in Florida or not, but it does not matter. Neither my wife nor I smoke anything or drink anything with alcohol in it. Both of us teach the Bible and we know we would be called drunks and our testimony shot if we did. If they said it about our Lord in Matthew 11:19 (The Son of Man came eating and drinking, and they say, 'Behold, a gluttonous man and a drunkard, a friend of tax collectors and sinners!' ), how could we expect to escape?

Yes, we believe the Bible does NOT say, "Thou shalt not drink booze." It says you must not get drunk with it (Ephesians 5:18). We also believe the wine Jesus made at the party in John 2 was the best wine ever made - and it says it was a lot better than the stuff they ran out of right in the passage. Nor do we believe the wine used in the communion service was mostly water.

But right now, I think one puff of marijuana would send us both to the morgue. A few years back I had one sip (possibly two) of punch at a family Christmas party. I did not know had alcohol in it. I was dizzy and sick for two hours. I sat in an inconspicuous place until I recovered. Yes, it surprised me too, because I used to drink like a fish before the Lord called me to Him.

I am not going to criticize the use of marijuana here except to say that, with all the technical abilities we have available, you would think the necessary ingredients that make marijuana valuable to some people could be made available for non-smokers. You would think that it could be synthesized and taken in pill or inhaler form.

We do thank you for your interest in our case and taking the time to offer a possible solution.

Jack

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7
Jack Says:
 
Dear Vernon:

Thank you very much for your interest.

We agree with you concerning the inhalation of triamcinolone not being an effective way to go. Our son suggests that we might make stronger it if we used an hydrolyser. I suppose he means to put a dollop of it in a pot of boiling water and inhale the fumes. Besides potentially killing the cats, we think she would have to do that too many times a day. She said is not going to do it unless physically forced.

And there is a very real danger to her. We do not know fully what is in the salve that is not a disclosed ingredient. One thing we do know about drugs; they all forcibly change something that is going on in the body - some of them are even controlled poisons. They are not for amateurs to fool with.

Your suggestion regarding Tri-Nasal (Nasacort AQ Nasal Spray) is interesting and I will mention it to her doctor. But, again, I do not think a nasal spray would be a good substitute for an inhaler. One is good for nasal allergies and the other for the more serious asthma condition in the lungs.

As I said, we will take your suggestion to the doctor. At this point, we rule out nothing.

Jack


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8
Jack Says:
 
Dear Realist:

You are correct. We mentioned the Montreal Accord reached in December 2007. Their target was air pollutants that destroy the ozone layer. We can understand their concern - but throwing the baby out with the bath water seemed a little over the top.

That said, it seemed to us that we do not have the power or the money to stop it or even to have them re-think their position. So, rather than futilely shaking our fist in the air, we are trying to find a way to live with the new political world that is being created against our will.

Being believers in the Word of God, we think the world will not end by cfc’s flying around. But, since this particular brand of environmentalist does not believe the Bible, we understand why they think this earth the way it is right now, is all there ever was or ever will be. The belief in evolution (uniformitarianism) and the failure to remember earth’s history was predicted long ago.

2 Peter 3 says this:
3 Know this first of all, that in the last days mockers will come with their mocking, following after their own lusts,
4 and saying, Where is the promise of His coming? For ever since the fathers fell asleep, all continues just as it was from the beginning of creation. (uniform changes over time)
5 For when they maintain this, it escapes their notice that by the word of God the heavens existed long ago and the earth was formed out of water and by water,
6 through which the world at that time was destroyed, being flooded with water. (the worldwide Flood)
7 But by His word the present heavens and earth are being reserved for fire, kept for the day of judgment and destruction of ungodly men.

Verse 7 says that one day, God will allow the protons to do what they do naturally - repel each other with a force that is about equal to you holding a 30-pound weight at arms length. That is a lot of force for a little proton to overcome. Scientists today have cobbled together a theory called a “strong force” that enables the subatomic structure to hold the way they see it. But when God lets go (Colossian 1:17), it will go with a very loud bang. Scientists have the “big bang” at the wrong end of earth’s history - but then, that is their belief (religious) system.

The environmentalists are mixed with concern and greed. They are trying to protect the status quo for as long as they can. Of course, there is a lot - I mean, a LOT - of money involved here. Years ago I said that any one who controls energy can rule the world. It’s funny - God gives it for free in other forms that can more easily be used.

But, to stick to the issue - it is hard to watch a loved one suffer even though we know everyone dies eventually. So, we are struggling just as hard on our end to live our lives peaceably and in good health

Jack


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9
Mary Hardy Says:
 
I truly understand your problem. I have been using Azmacort for over 20 years and now I am going to be a ginny pig for other treatments. I have tryed other things but Azmacort is the one I need. can understand unless their the one looking for air.Know one can understand unless their the one gasping for air. What can you do. Drug companys only care about the bottem line not the people they are making suffer.

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10
Jack Says:
 
Dear Mary Hardy:

What you say is true. It is, indeed, hard to find a corporation whose eyes cannot see the bottom line before they see the people they have affected with their policies.

Do not dispair. We just came from our doctor who seems to agree that the aerosol form of Advair HFA may be just the ticket for my wife. This doctor knows my wife a lot better than the Pulmanologist who came up with the drug. They are going to try out the strength 115/21 first and then go to another strength if necessary.

I suspect that you may have had to use two inhalers when you used Azmacort - one to give you Serevent as well. The Advair has the serevent in it already.

We will keep you posted as to how it works our. We are trying to get a money break on it right now.

Jack

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11
Concerned Reader Says:
 
Hi Jack - I'm glad you got back to me. What you have stated makes sense, and I've always adopted an attitude of "to each their own", as long as they are not harming others.

So yes I definitely respect your reasons for avoiding Marijuana and you and your wife have every right to pursue the treatment options which feel right for you.

I would not consider myself a huge Marijuana advocate, but I am certainly someone who questions the way things are a lot. First, to answer your question about synthesizing the active components of Marijuana - I believe they have done something like that, and the pill is called Marinol. It is a synthesized version of THC which is the active ingredient in Marijuana, mostly responsible for the psychoactive effects experienced.

I do believe, however, that Marijuana has an unnecessarily bad reputation, mostly as a result of social engineering by the powers-that-be.

For me, something which comes directly from nature and has been used for thousands of years by various cultures can not be as hard on the human body as chemicals synthesized in a laboratory. I do believe that western medicine has its place, but both Marijuana and western medicine have pros and cons. In other words, there are two sides to every coin.

Going back to your example of alcohol - it can either be consumed in moderation (i.e. taking wine with the holy sacrament or having a glass of red with dinner), or it can be misused and consumed in excess (such as drinking for the sake of getting intoxicated, or to dull out the senses).

I guess my point in all of this goes back to my questioning mentality of "why" .... why is Marijuana considered illegal when it has never been responsible for any deaths (whereas readily available alcoholic beverages have)? Why doesn't the FDA allow its use for medicinal purposes when it has far less side effects? Could it be this way because the pharmaceutical companies would stand to lose millions or billions if a natural product were offered which people could grown in their own back yards?

Anyways, I'm not trying to force you guys to consider a route which you are not comfortable with - I guess I just wanted to share my feelings and beliefs concerning how our medical system is structured today. Sometimes as an individual we can feel powerless, but we must remember that those in control rely on the status quo and keeping everyone fearful and powerless in order to retain their grips. The more we all collectively know, the more liberty we can all have in the end. Regardless, this human life is a short one, and being a good person should come first....

Wishing you and your wife the best!

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12
Carol Says:
 
I have been using Azmacort for over 20 years and now my doctor has put me on Qvar. I am finding that I cough a lot during the day. Will have to contact my doctor about some of the side effects I have been experiencing with the use of this inhaler. Why take something this good off the market??? It works for so many people and now we are all guinea pigs.

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13
Mary Says:
 
Hello! I am in the same boat as many of you. I've been using Azmacort successfully for the past 10 years or so, and I was completely devasted & distraught when I found out that it was being discontinued. To be honest, I still am. I still haven't found a suitable alternative. My resting heart rate is around 120 bpm due to a neurological condition, so I have to be very careful to find a preventive inhaler that does not speed up my heart. Azmacort really fit the bill for me.

I recently called the manufacturer of Azmacort, Abbott Lab, at #1-800-633-9110. I urged them to consider reintroducing this medication with a different mechanism of action that does not contain CFCs. It sounded as though, if they received enough feedback, that they might consider doing this. If this affects you, please call Abbott Lab and tell them you want them to bring Azmacort back in a CFC-free form. Maybe if enough of us flood their phonelines, they will take action? (There's always hope...).

Perhaps too, if Abbott loses enough market share to manufacturers of other asthma meds, that may be incentive for them to reintroduce a form of Azmacort (money speaks, afterall). On the other hand, I don't know which of the other inhalers on the market today are also manufactured by Abbott.

Best of luck to all of you!


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14
Jack Says:
 
Dear Carol:

The Qvar you are using is beclomethasone, one of the suggestions from the National Jewish Hospital in Denver. It is possible that, at this time of he year, the weather is at fault - along with pollen.

But, if it is caused by the Qvar, you might call Denver, (800) 222-5864 - and mention it. That is, unless your doctor has a better idea.

With regard to the fact that we are all guinea pigs - yes, we are. But I think part of that is a necessity. No matter how much experimentation is done on animals, no drug is truly safe until it has developed human history.

Jack

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15
Jack Says:
 
Mary:

I am sorry you are one of us. It seems, though, that we are speaking to the choir. Even though there are a lot of us, there are millions more who are unaffected by the decision made by Abbott. It is doubtful that they will listen or even care about the small loss they might experience in the great scheme of things. They will lose only thousands of dollars on us while they make megabucks elsewhere.

As you can see in a earlier posting, we have already called Abbott with little response. So, rather than try to break down their doors or their resolve, it may be more profitable for all of us to seek a substitute - but seek it while always remembering who caused you the problem

We may be on to something with Advair HFA Mary, so stick with us and, if we are successful, we will share it with you. Then you can ask your doctor or your Pulmonologist if your personal condition warrants giving it a try.

Meanwhile, if you and your doctor come up with something, you can share it with us. You may not be able to lead all of us to a solution to our needs, but you may help some; - - even one would be a victory.

Jack

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16
Carol Says:
 
Hi Jack,

My doctor took me off Qvar because I was having so many side effects. She told me that all the inhalers have the same side effects. She just said to go without to see how I feel. I feel much better, but my asthma is now starting to act up again. I have an appointment with a doctor that treats asthma, allergies and immunizes patients for allergies. I am hoping that he will have something more to help me out. Wish me luck!!!

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17
Jack Says:
 
Dear Carol:

While both my wife and I have reduced the kinds of pills we take down to a minimum, we do not suggest others do it without a doctor's knowledge. In our case, though, we have felt much, much better since. We found that they were fighting each other in our bodies. That is no place for medicine to fight.

But problems such as asthma are difficult to have without taking some kind of help to deal with it. As yet, we have not heard from the manufacturer regarding a supply of the Advair HFA. We have not forgotten our promise to let you know what happens when we do and when we try it.

You have our best wishes that the first blush you experienced without medication will continue. Keep dry and Keep as free of pollen as you can - and above all, keep your doctor informed.

Jack

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18
Carol Says:
 
John:

I went to my new asthma doctor and he set up a plan that has three levels. The first one is only use Albuterol as needed and not to use an inhaler unless I get sick. My tests turned out to be pretty good and thus the doctor told me to just use the inhalers that he gave me if I get in respiratory distress. One inhaler is called Pulmicort Flexhaler and the other is called Alvesco. The Pulmicort is a power inhaler which I'm not too crazy about. The Alvesco is an inhaler like the others that I have used in the past, but it doesn't start working until it gets into your lungs, so there are no side effects like the cough, hoarseness, sore throat, etc. that I was having. My insurance will pay pretty well on the Pulmicort, but the Alvesco is about $25.00 higher. I got a card from the doctor that cuts the copayment down to almost nothing. The last level it to use the Albuterol, one of the inhalers and the doc would prescribe Prednisone. That is if I get an upper respiratory infection like I am proned to. He also suggested that if I get sick as with a cold, I should use Zyrtec along with the inhaler. So I now have some options. I don't know if these will work for your wife. I went to a doctor that specializes in asthma patients. He also suggested that I use Flonase as my allergic rhinitis can contribute to the asthma.

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19
Carol Says:
 
Sorry, your name should be Jack... and it should be that the inhaler, Pulmicort Flexhaler is a powder!!!

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20
Jack Says:
 
Dear Carol:

Not to worry. My real name is John but I never use it for personal reasons.

I wrote earlier, but it didn't take, so I will try again. This time I will copy it so that if it doesn't take again I won't have to try to remember what I wrote.

We have just received notice today that our application for Advair HFA 115/21 has been approved. It is an aerosol version of the Advair discus. The discus, like your Pulmicort, is a powder that June cannot tolerate at all.

The Advair HFA has the advantage of having the Serevent already in it so that she can take her medication in a single puffer. And, like you, she has Albuterol to take if she must use something after an attack has already started. These others will have no effect when it does.

I believe the 115/21 refers to the strength and the amount of puffs in a container.

Our prayer now is, that she will be able to tolerate the drug safely. We have high hopes she will.

We will post the results after we know what they are so that others may be helped.

Jack

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