Clenil Modulite Problems…

Note, December 2 2008 – see also this page, which is more important.

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For those of you who don’t have COPD, this may seem a bit gross, as it discusses sputum quality in COPD.

I mentioned, previously, that I thought that Clenil Modulite increased sputum production, and I’m now certain it does. This is not a good thing.

I rely greatly on the taste of my sputum as an early warning of a developing infection, to which those of us with COPD are prone, as experience has shown that the earlier an infection is treated with antibiotics, the more effective the treatment is. This is particularly important since GPs, as a result of the paranoia surrounding the use of antibiotics, tend to prescribe inadequate quantities – 7 days worth frequently isn’t enough, once an infection has become well established. However, since CM is hideously sweet, that’s all I can taste. That’s not only unhelpful, it’s potentially dangerous .

For the record, CM, in addition to its active ingredient (Beclometasone dipropionate), also contains two forms of alcohol, ethanol and glycerol, the latter presumably responsible for its sweetness (Beclometasone has never been in need of sweetening before, and the propellant is widely used, so that doesn’t need sweetening, so what’s going on?). This prompts a question, as the alcohol contained in the drug pretty much goes straight into the blood stream, how much does it contribute to blood alcohol levels? Admittedly, the amount of ethanol is small (13%), though no information is given for the glycerol, but it must have some effect, no matter how slight, yet an assiduous search of Google, using several search parameters, came up blank. The information must surely be somewhere, though – I can’t believe it’s simply been ignored.

Footnote:-

Back on the subject of alcohol, I have a fondness for beer and, of late, I’ve been getting remarkably drunk without actually drinking any more then usual (normally, I would just get a little blurred around the edges). Yesterday, for example, the pub had a rather good, if quite weak, beer (I’m not one of those macho pillocks who only drinks strong beer – how it tastes is far more important), and yet I was extraordinarily drunk. Not dysfunctional in any way, but way drunker than I should have been. I’m either developing an intolerance to alcohol or it’s another factor, and the only thing that’s different is Clenil Modulite – I always take a dose when I’m out. Very strange.

Er, I was wromg about my inhaler – see comments…

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14 thoughts on “Clenil Modulite Problems…

  1. Hi,

    Recently diagnosed with asthma after hacking cough and general breathlessness over the last ten years.

    I’ve variously been told its stress/post nasal drip/all in the mind etc. etc.

    Finally my GP retired and the new chap is very firmly on the ball. Went to see him re cough. Aha, he said. Sounds a bit like Asthma or COPD.

    Lung function test revealed Asthma. Practice Asthma nurse horrified my symptoms had been missed for so long – particularly the almost passing out when I cough for too long.

    Anyway, thing is I had been searching Google myself to see link between Clenil and alcohol and only item online seems to be your rant.

    Out last night, had two gin and tonics, felt pissed. Waking up with return of the chronic fatigue I thought I’d left behind.

    See the leaflet talks about 9mg of alcohol in every puff and I’d taken my 12 hourly two puffs about an hour before going out – thinking to put off cough symptoms and not thinking about any link wif alcohol consumed.

    Will pursue the search. Let you know if anything turns up,

    Mo xx

    • Right, first up – there aren’t 9mg of alcohol in each puff of CM (the maximum drug in each puff of the most potent version is only a quarter of a milligram, so it can’t contain 9mg of anything). Where’s that info from? I have the inhaler’s leaflet in front of me, and it’s not there. I haven’t been able to pry it out of the manufacturer, either. The info will be in their patent application, but that’s not available online either (or if it is, it’s deeper in Google than I can be bothered with). Ah – just noticed on the side of the canister that there’s 13% ethanol in it. But 13% of what? The total propellant or the total contents? Doesn’t say. Either way, the amount is too tiny to worry about, and will probably evaporate from your lungs on the exhale before it can be absorbed into your blood stream.

      Just re-read my post – I’d forgotten what it was about – so I can see where you’re coming from with this, but no, I’m sure it’s not my inhaler causing my problems. The reason I was getting so plastered is that I feel so nauseous (a side-effect of several of my meds), I just wasn’t eating enough. If I make sure I have a decent meal while I’m out, I’m fine.

      I take 2 250mcg puffs every 6 hours – the microscopic amount of alcohol has zero effect – whatever the reason for being drunk on 2 G&Ts, it’s not your inhaler.

      Good luck with leaving ME/CFS behind – I’ve been trying for 24 years. If you can shake it off in the first 3-5 years, there’s a chance of a full recovery (the usual routine is carefully graduated exercise and lots of rest – and NEVER exercise to the point of exhaustion, or a setback is guaranteed); if not, broadly speaking, it’s yours for life. And alcohol makes it worse – often a lot worse. Doesn’t stop me drinking, but anyone with ME/CFS needs to know it’s a seriously bad idea, and decide whether to live with the consequences – it’s swings and roundabouts.

      Are you taking anything else apart from CM? You should be, you know. A steroid inhaler will reduce inflammation of the bronchi, but you also need a bronchodilator inhaler at the very least. Check this page out http://ronsrants.wordpress.com/2008/06/06/drugs-for-copd/ most of which are relevant to asthma as well, depending on the severity. By the way, if you’re prescribed a Salbutamol inhaler, check the pharmacies in your area to see if anyone dispenses Ventolin (the branded version), as while generic inhalers on the whole are OK, generic Salbutamol is crap. It’s a popular fake, too, which makes the branded version a lot more attractive.

      A standard GP-administered spiromentry test, incidentally, will tell you your lungs are crap, it won’t tell you why with much accuracy – your doctor needs to refer you to the Pulmonary Function Laboratory at your local hospital, for a full assessment and, just as important, access to decent meds (and to eliminate or confirm COPD, especially if you smoke), which can be more precisely tailored to your needs. Be aware that a PFL test can take 2 days, but it’s worth it.

      Almost forgot – it’s vital to take CM with a Volumatic spacer device, unless you find the idea of oral thrush and a voice that’s inaudible attractive! Available on prescription, but check the OTC price, it may be cheaper.

  2. Hi,

    Just read a bit of your blog about Clenil Modulite and seeing as you seem pretty clued up, wanted to ask you about some side effects I’ve been having – whether they’re actually linked to the CM or something else, and also wondered if anyone else was suffering these side effects.

    After a few weeks use of CM, I started to notice that I was growing a ‘tache’!!! OK it’s not thick dark hair, but it IS becoming more noticeable. My hair has thinned considerably, you can see the scalp in some places. And of course the usual sore throat depending on the amount of use.

    I’ve previously used other preventative inhalers with no side effects whatsoever. These symptons/conditions?? have only taken effect since the use of CM.

    Does anybody else get this?

    I have looked on the net for these side effect, without much help, which is how I came across your blog. It would be really good to see if you or anyone else has come across something similar. OK, you’re not female or have long hair (sorry! lol), but maybe someone else has been through the same thing.

    Would be REALLY grateful to hear your comments – as, of course, the docs don’t seem to want to give too much away!

    Cheers

    Leanne

    • Hi Leanne,

      OK, the easy answer first – use a Volumatic spacer and the sore throat will go away. Insist on a Volumatic – other spacers are too small to be really effective. It may be that you have candidiasis, which will need treatment then, with the spacer, it shouldn’t come back. If you already use a spacer, get candida checked out then gargle with a drop of warm water after using your steroid inhaler – that should help. And the real bummer – candidiasis can assume the status of a informal STD – it’s very easy to pass on to others, in areas where they really wouldn’t want it, he said, coyly. And even though it’s not serious, it makes you very unpopular.

      I can’t find any reference to hair – growth or loss – as it relates to CM, so I’d advise getting your thyroid function checked out. Hypothyroidism, from experience (my blog photo is from when I had a thyroid problem), mainly cause loss of facial, body and head hair). It’s unusual for one cause to give you hair loss in one place, and growth in another, so it may be worth looking at other hormones, not just thyroid. Head-hair loss can be due to stress, too.

      I’ve searched the Web, too, and come up blank – it does seem it’s not a known problem. It could still be CM, but my money would be on something else.

      I take 2 puffs of CM four times a day. It’s made me fat, but that’s all (well, actually, it’s quite enough!). High doses of inhaled steroids can give you the same side-effects as oral steroids,the biggest problem being weight gain. A lot of doctors don’t know that, and I had a stand-up row with mine about it, until he went away and checked for himself.

      the docs don’t seem to want to give too much away!

      Ha! I’ve mad it a point to know as much as my GP – and preferably more – about my respiratory problems and their treatment. It’s the “general” in GP that most people overlook. GP’s mostly know a little about a whole load of things, but only occasionally know a subject in fine detail – that’s what consultants are for, after all. So the more you know as a patient, the more you can engage with your GP on a level playing field.

      Ron.

  3. Hi after reading the post about the Lady with the extra hair growth i did remember something . This is a steriod based inhaler and one of the side effects of taking these is an increase in hair growth so that might well be your answer.

    • True, but we know it’s a steroid inhaler. And, as I said, having thoroughly investigated the subject, hair growth isn’t a known problem with CM. Or, at least, it wasn’t six months ago.

      You do get some systemic effects with very high doses – you’ll get fat, for example, as I know to my cost – but many of the problems associated with oral steroids – Cushing’s, hair growth/loss, etc, – shouldn’t occur with inhaled steroids. And yes, there are always exceptions, but other, potentially more serious, problems should never be overlooked, hence my advice.

      Hair problems resulting from steroid use aren’t serious, just undesirable – hair problems resulting from a malfunctioning thyroid, on the other hand – especially the loss of head hair – are a whole different ball game.

      Any changes should be investigated, and not just put down to steroid use – that’s potentially dangerous.

      Ron.

  4. Hi

    I have had astma for 29 years. I am 54. My probem is that my skin on my arms seems to be thinning because I easily get blood patches under my skin, after knocking my arm. Even my watch strap causes it. Could CM be the cause. I do not think it is sun damage because I do not sun bathe and live in the UK.

    Many Thanks

    • Hi,

      All steroids cause bruising, especially oral steroids. Actually, that not quite true, the cause of the bruise is the same as without steroids – a bump.The difference is that with steroids will give you a bruise for a bump you may not even notice – I was investigated for everything from scurvy to leukaemia before we figured it out.

      Oral steroids, though, shouldn’t a problem unless you’re taking a high dose – I take 2 250mcg puffs 4 times a day, and my arms, in particular, are covered in bruises. In addition, I think it also causes gastric bleeding, having just returned from a night in hospital with a gastric bleed that stopped the further away I got from my inhaled steroids. As of now I’m cutting the dose by half.

      Ron.

  5. I have noticed weight gain and dry skin and thin hair after using even on a low dose. It’s fine, but at least a dress size and I am worried if my does goes up it will get worse!
    Doctor unsympathetic- says inhaled steroids have no effect. Thinking of getting a private prescription because I want to try other brands.

    • Your doctor is an idiot! In 1987 I had a standup row with my GP over the fact that high-dose inhaled steroids cause the same systemic effects as oral steroids, and need the user to carry a steroid card. He stomped off to check and found I was right. It seems, 23 years on, GPs are still ignorant.

      Some people think that inhaled drugs stay in the lungs (and if those people are GPs, they’re in the wrong job!); they don’t, they pass through into the bloodstream, and cause systemic effects, to a greater or lesser degree. They all do, not just steroids.

      Really, though – depending on what you’re actually taking – 1 puff twice a day of one of the weaker versions is low, for example (CM inhalers start at 50mcg), compared to my 2 puffs 4 times a day of the 250mcg version (which has pushed me over 15stone on less than 1,000 kcals a day!), it probablyshouldn’t cause you much in the way of problems, and certainly not weight gain, but it does depend a lot on the individual. Some people are just more susceptible than others to the side effects. You simply can’t generalise and say that you won’t get side effects for a given dose.

      Forget a private prescription – you really shouldn’t experiment with steroids, as not all steroid inhalers are equal. Changing to a different brand could see you getting a higher or lower dose of a totally different product, none of which is good for you and – the bottom line – ALL steroids have the same side effects. The good news is that inhaled steroids, overall, cause fewer problems than oral steroids.

      By the way, get your thyroid function checked – those could be symptoms of thyroid problems.

      Ron.

  6. im on my first 200 clenil modulite inhaler and cant find the info leaflet. did i read that it can cause cramp? my problem is , i am on quinine for cramp, and the quinine does not appear tp be as efficint as it was last week, when i started using the c m .
    bill

    • I’ve been taking this drug – Beclometasone Dipropionate (250mcg, 2 puffs 4 times a day) – for over 30 years, and I’ve never known it to cause cramp.

      Depending on the dose the bulk of the drug should remain in the lungs and not affect the rest of your body. On high doses, like mine, you get the same systemic effects as oral steroids.

      No indication in the info leaflet that it causes cramps or interacts with quinine. Best check with your doc if you’re worried, though.

  7. Hi, My 9 year old child (girl) has been on CM 50 for the last year puff in the morning and puff in the evening, she was short for her age to start with and I feel she hasn’t grown at the same rate as the other girls in her class and is now significantly smaller( diet hadn’t changed) but she did look puffy around the face and neck as well. I stopped using it for a few weeks and the puffiness seemed to go away?

    Am going back to the doctors to ask more questions about this, what do you think?

    Jenny.

    • Hi Jenny,

      While I know that 2 puffs of CM250 4 times a day piles on weight in an adult (me!), I have no idea how a much lower dose would affect a child.

      The recommended dose for a child under 12 is 100-200mcg twice daily (source: British National Formulary, No. 61) so as your daughter is taking half the minimum dose, I wouldn’t, in theory at least, expect to see systemic side-effects with that low a dose, so that does need looking into.

      I do know, though, is that suddenly stopping any steroid therapy is a bad idea – it should always be tapered off. Talk to her docs ASAP.

      Ron.

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