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(zah fur' luh kast)
Accolate Pregnancy Category B
Antasthmatic Leukotriene receptor antagonist
Selectively and competitively blocks receptor for leukotriene D4 and E4, components of SRS-A, thus blocking airway edema, smooth muscle constriction, and cellular activity associated with inflammatory process that contribute to signs and symptoms of asthma.
Prophylaxis and long-term treatment of bronchial asthma in adults and children > 5 yr Contraindicated with hypersensitivity to zafirlukast or any of its components; acute asthma attacks; status asthmaticus; pregnancy, lactation. Use cautiously with hepatic or renal impairment; as oral steroid use is decreased; patients who previously required corticosteroid therapy to control asthma.
Contraindications and cautions
Tablet—10, 20 mg
Dosages ADULTS AND CHILDREN > 12 YR
20 mg PO bid on an empty stomach.
PEDIATRIC PATIENTS 5–11 YR
10 mg PO bid on an empty stomach.
Route Oral Onset Rapid Peak 3 hr
Metabolism: Hepatic; T1/2: 10 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine and feces
CNS: Headache, dizziness, myalgia GI: Nausea, diarrhea, abdominal pain, vomiting, liver enzyme elevation
Other: Generalized pain, fever, accidental injury, infection; Churg-Strauss syndrome (eosinophilia, vasculitic rash, pulmonary and cardiac complications) when oral steroid dose is reduced
Drug-drug • Increased risk of bleeding with warfarin; these patients should have PT done regularly and warfarin dose decreased accordingly • Potential for increased effects and toxicity of calcium channel-blockers, cyclosporine • Decreased effectiveness with erythromycin, theophylline • Possible severe reaction when oral steroid dose is reduced while on zafirlukast; monitor patients very closely Drug-food • Bioavailability decreased markedly by presence of food; administer at least 1 hr before or 2 hr after meals
Nursing considerations Assessment
History: Hypersensitivity to zafirlukast; impaired renal or hepatic function; pregnancy, lactation; acute asthma or bronchospasm Physical: T; orientation, reflexes; R, adventitious sounds; GI evaluation; renal and liver function tests Administer on an empty stomach 1 hr before or 2 hr after meals. Ensure that drug is taken continually for optimal effect. Do not administer for acute asthma attack or acute bronchospasm. Take this drug on an empty stomach, 1 hr before or 2 hr after meals. Take this drug regularly as prescribed; do not stop taking it during symptom-free periods; do not stop taking it without consulting your health care provider. Do not take this drug for acute asthma attack or acute bronchospasm; this drug is not a bronchodilator; routine emergency procedures should be followed during acute attacks. Avoid use of over-the-counter medications while using this drug; many of them contain products that can interfere with drug or cause serious side effects. If you feel that you need one of these products, consult your nurse or physician. These side effects may occur: Dizziness (use caution when driving or performing activities that require alertness); nausea, vomiting (eat frequent small meals); headache (analgesics may be helpful). Report fever, acute asthma attacks, severe headache.
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Adverse effects in Italic are most common; those in Bold are life-threatening.