II. Indications

III. Mechanism

  1. Cromolyn (Cromoglycate)
    1. Synthetic Mast Cell Stabilizer with anti-inflammatory activity used to prevent type 1 Allergic Reactions
    2. Blocks Antigen-mediated Calcium influx into Mast Cells (and other inflammatory cells)
    3. Prevents degranulation, the release of inflammatory mediators (e.g. Histamine, Leukotriene) from Mast Cells
      1. Also prevents degranulation from other inflammatory cells (e.g. Macrophages, PMNs, Eosinophils)
      2. Also inhibits Eosinophil chemotaxis
  2. Cromolyn Sodium (Sodium Cromoglycate)
    1. Sodium salt form of cromlyn typically used in inhaled and Topical Medications

IV. Medications

  1. Inhaled (Exercise-Induced Asthma)
    1. Cromolyn Sodium Inhaler (MDI)
    2. Nebulized Cromolyn Sodium Solution
  2. Oral Solution (Mastocytosis)
    1. Cromolyn Sodium Oral Solution
  3. Ocular Mast Cell Stabilizer (Allergic Conjunctivitis)
    1. See Cromolyn Sodium Ophthalmic
  4. Intranasal Mast Cell Stabilizer (Allergic Rhinitis)
    1. See Intranasal Cromolyn

V. Dosing: Asthma

  1. Exercise-Induced Asthma
    1. Approved for age 5 years and older
    2. Use two puffs via MDI (or 20 mg/2ml nebulized) 10 to 15 minutes before Exercise
  2. Chronic Asthma
    1. Not recommended in modern Asthma guidelines
    2. FDA approved MDI for use in age >=5 years, and nebulizer for use age >=2 years
    3. Use two puffs via MDI (or 20 mg/2ml nebulized) four times daily
      1. Adults may use up to 4 puffs at one time

VI. Dosing: Mastocytosis

  1. Dissolve oral concentrate (100 mg/5 ml) in water, strir and drink
  2. Take 30 minutes before meals and at bedtime
  3. Ages 2 to 12 years: 100 mg orally taken four times daily
  4. Age >12 years and Adults: 200 mg orally taken four times daily

VII. Efficacy

  1. Not recommended in modern Asthma guidelines due to low efficacy
  2. NOT effective in acute bronchospasm (e.g. rescue Inhaler)

VIII. Adverse Effects

IX. Safety

  1. Pregnancy Category B
  2. Unknown safety in Lactation

X. Pharmacokinetics

  1. Slow onset of action
  2. Effects may be delayed for weeks after starting and using regularly

XII. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2022) Comparison of Asthma Medications, Presc Lett, #381217

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Cost: Medications

cromolyn sodium (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CROMOLYN SODIUM NASAL SPRAY Generic OTC $0.26 per ml
cromolyn (on 6/21/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
CROMOLYN 100 MG/5 ML ORAL CONC Generic $0.27 per ml
CROMOLYN 20 MG/2 ML NEB SOLN Generic $1.50 per ml
CROMOLYN 4% EYE DROPS Generic $0.59 per ml