Respiratory and Asthma Medications
Guidance on Respiratory and Asthma Medications (applicable from 01 January 2012)
The following guide lists common Respiratory and Asthma Medications and whether they are permitted or prohibited by the World Anti-Doping Agency. Brand Names are examples, if the brand is not listed, please check www.eirpharm.com, MIMS Ireland or check with the Irish Sports Council.
Beta-2 agonists:
| Active Substance | Brand Names | Permitted/Prohibited |
|---|
| Inhaled salbutamol | Salamol CFC-Free Inhaler Salamol Easi-Breathe Inhaler Ventolin Diskus Inhaler Ventolin Evohaler Ventolin Nebules Combivent Nebules | Permitted at doses <1600 micrograms over 24 hours, higher doses >1600 micrograms over 24 hours -such as by nebuliser are Prohibited |
| Inhaled salmeterol | Seretide Evohaler/Diskus Inhaler Serevent Evohaler/Diskus Inhaler | Permitted at doses in accordance with the manufacturers’ recommended therapeutic regime Prohibited at doses in excess of the manufacturers’ recommended therapeutic regime |
| Inhaled formoterol | Symbicort Turbohaler Oxis Turbohaler Foradil Aerolizer | Permitted up to a maximum inhaled dose of 36 micrograms over 24 hours Prohibited at inhaled doses >36 micrograms over 24 hours If formoterol is delivered via an aerolizer, the amount inhaled is variable but even at 48 mcg/day in divided doses, this should not result in the athlete exceeding the urinary threshold of 30ng/mL. For Symbicort Turbohaler and Oxis Turbohaler only 75% of the dose in the Turbohaler device is delivered and inhaled into the lungs. For example: · Two puffs of Symbicort Turbohaler 400/12 inhaled twice daily over 24 hours provides equivalent to 36 micrograms of formoterol over 24 hours · Two puffs of Symbicort Turbohaler 200/6 or Symbicort Turbohaler 100/6 inhaled twice daily over 24 hours provides equivalent to 18 micrograms of formoterol over 24 hours |
| Salbutamol by routes other than Inhaled | Ventolin Injection Ventolin Tablets Ventolin Syrup | Prohibited |
| Inhaled indaceterol | Onbrez Breezhaler | Prohibited |
| Inhaled terbutaline | Bricanyl Turbohaler Bricanyl Injection | Prohibited |
Warning: All beta-2 agonists including formoterol, salbutamol or salmeterol by any other administration route other than inhaled are prohibited.
Of interest to prescribers is the WADA Document - Medical Information to Support the Decisions of TUECs - Asthma, Version 4.0, December 2011.
Emergency Treatment
Whenever a dosage of more than the threshold allowances outlined above are either prescribed, or used in an emergency situation to treat an asthma exacerbation, the Irish Sports Council should be contacted immediately for advice on either applying for a retroactive TUE immediately (for athletes on the Registered Testing Pool), or for advice on what records of the emergency treatment need to be included in an athletes Medical File.
Remember: The Certificate of Approval for a TUE Application is only valid for the substance(s) listed in your Certificate and should your treatment, dosage or situation change, you must contact the TUE Secretariat of the Irish Sports Council immediately as you may need to reapply for a new TUE for the change of treatment or change of dosage. Therefore in an emergency situation for asthma where you use a higher dosage of your medication that what is listed on your certificate, you must contact the Irish Sports Council immediately for further advice.
Other Respiratory medicines (mixed classes)
| Active Substance | Brand Names | Permitted/Prohibited |
|---|
| Theophylline | Nuelin SA Prolonged-Release Tablets Uniphyllin Continus Prolonged-Release Tablets | Permitted |
| Aminophylline | Phyllocontin Continus Prolonged-Release Tablets | Permitted |
| Sodium cromoglycate | Hay-Crom Aqueous Eye DropsNalcrom Hard Capsules Opticrom Antiallergic Eye Drops Vividrin Eye Drops | Permitted |
| Tiotropium bromide | Spiriva Inhaler Spiriva Respimat Inhaler | Permitted |
| Montelukast | Singulair | Permitted |
Inhaled Glucocorticosteroids:
| Active Substance | Brand Names | Permitted/Prohibited |
|---|
| Inhaled beclomethasone | Asmabec Clickhaler Beclazone CFC-Free Inhaler Beclazone Easi-Breathe Inhaler Becotide Evohaler | Permitted |
| Inhaled fluticasone | Flixotide Evohaler/Diskus Inhaler | Permitted |
| Inhaled budesonide | Pulmicort Turbohaler Pulmicort Respules | Permitted |
| Inhaled mometasone | Asmanex Twisthaler | Permitted |
| Inhaled ciclesonide | Alvesco Inhaler | Permitted |
Intramuscular Glucocorticosteroids:
If in doubt, contact the Irish Sports Council.
Remember athletes selected for doping control must remember to declare the use of all prescribed and over-the-counter medications and supplements taken in the last 14 days on the doping control form.
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