Priming

Metered Dose Inhalers (MDIs) require priming.

Priming of the inhaler is necessary for effective use of the MDI inhaler and to deliver a correct amount of dose into the lungs. Priming means to make your inhaler ready for use. Priming is done when the inhaler is being used for the first time or if it is used after a long interval of time.

Different MDI types have different priming instructions:

Proventil HFA® (MDI)

As with all aerosol medications, it is recommended to prime the inhaler before using for the first time and in cases where the inhaler has not been used for more than 2 weeks. Prime the inhaler by releasing four “test sprays” into the air and away from your face.

Source: http://www.merck.com/product/usa/pi_circulars/p/proventil_hfa/proventil_hfa_ppi.pdf

ProAir HFA®(MDI)

Your ProAir device must be primed before you use it for the first time or if your device has not been used for more than 14 days in a row. Do not prime your ProAir HFA device every day.

Step 1: Remove your ProAir HFA device from its package

Step 2: Remove the protective dust cap from the mouthpiece

Step 3: Shake the inhaler well, and spray it into the air away from your face

Step 4: Shake and spray the inhaler like this 2 more times to finish priming it. The dose counter on the actuator should display the number 200 after you prime the actuator for the first time

Source: http://www.proairhfa.com/library/docs/ProAirDoseCounter-Prescribing-Information-PA0512G-PE2557.pdf

Ventolin HFA® (MDI)

Prime Ventolin HFA before using for the first time, when the inhaler has not been used for more than 2 weeks, or when the inhaler has been dropped. To prime Ventolin HFA, release 4 sprays into the air away from the face, shaking well before each spray.

Step 1: Remove your Ventolin HFA inhaler from its packaging

Step 2: Throw away the pouch and the drying packet that comes inside the pouch

Step 3: Remove the protective cap from the mouthpiece

Step 4: Shake the inhaler well, and spray it into the air away from your face

Step 5: Shake and spray the inhaler like this 3 more times to finish priming it. After you prime the actuator for the first time, the dose counter in the window on the back of the actuator should show the number 200 or 60, depending on which size inhaler you have

Source: http://us.gsk.com/products/assets/us_ventolin_hfa.pdf#page=19

Xopenex HFA® (MDI)

It is recommended to prime the Xopenex HFA inhaler before using for the first time and in cases where the inhaler has not been used for more than 3 days by releasing 4 test sprays into the air, away from the face.

Step 1: To prime the inhaler, take the cap off the mouthpiece and shake the inhaler well

Step 2: Then spray the inhaler into the air away from your face. Avoid spraying in your eyes

Step 3: Shake and spray the inhaler like this 3 more times to finish priming it

Step 4: You must prime the inhaler again if you have not used it in more than 3 days

Source: http://www.xopenex.com/files/XOPENEX-HFA-Prescribing-Information.pdf

QVAR® (MDI)

Patients should prime QVAR by actuating into the air twice before using for the first time or if QVAR has not been used for over ten days. Avoid spraying in the eyes or face when priming QVAR. QVAR is a solution aerosol, which does not require shaking.

Source: http://www.qvar.com/library/docs/prescribing-information.pdf

Alvesco® (MDI)

Alvesco should be primed by actuating 3 times prior to using the first dose from a new canister or when the inhaler has not been used for more than 10 days. Avoid spraying in the eyes or face while priming Alvesco.

Step 1: Remove your Alvesco Inhalation Aerosol from its package

Step 2: Remove the plastic cap. Look at the dose indicator on top of the inhaler. Make sure that the dose indicator display window pointer is before the “60” inhalation mark before you use your ALVESCO Inhalation Aerosol for the first time

Step 3: Hold the actuator upright. Spray 3 times into the air away from the face, by pressing down fully onto the center of the dose indicator button

Step 4: Check the dose indicator display window after the priming sprays and before the first use to make sure it shows that there are 60 sprays left in your Alvesco Inhalation Aerosol unit. If there are not 60 sprays left in your Alvesco Inhalation Aerosol after the first use priming spray, return it to the pharmacy

Source: http://www.alvesco.us/AlvescoPI.pdf, http://www.drugs.com/alvesco.html

Flovent HFA® (MDI)

Step 1: Take the cap off the mouthpiece and shake the inhaler well for 5 seconds

Step 2: Then spray the inhaler into the air away from your face. Avoid spraying in eyes. Shake and spray the inhaler like this 3 more times to finish priming it. The counter should now read 120

Step 3: You must prime the inhaler again if you have not used it in more than 7 days or if you drop it. Take the cap off the mouthpiece and shake the inhaler well for 5 seconds. Then spray it 1 time into the air away from your face

Source: http://us.gsk.com/products/assets/us_flovent_hfa.pdf

Advair HFA (MDI)

Step 1: To prime the inhaler, take the cap off the mouthpiece and shake the inhaler well for 5 seconds

Step 2: Then spray the inhaler 1 time into the air away from your face. Avoid spraying in eyes. Shake and spray the inhaler like this 3 more times to finish priming it. The counter should now read 120, or 060 if you have a sample or institutional canister

Step 3: You must prime your inhaler again if you have not used it in more than 4 weeks or if you drop it. Take the cap off the mouthpiece, shake the inhaler well for 5 seconds. Then spray it into the air away from your face. Shake and spray the inhaler like this 1 more time to finish priming it

Source: http://www.advair.com/asthma/about-advair/if-you-are-taking-advair/using-advair-hfa.html, http://us.gsk.com/products/assets/us_advair_hfa.pdf

Symbicort HFA (MDI)

SYMBICORT (budesonide and formoterol fumarate dihydrate) should be primed before using for the first time by releasing two test sprays into the air away from the face, shaking well for 5 seconds before each spray. In cases where the inhaler has not been used for more than 7 days or when it has been dropped, prime the inhaler again by shaking well for 5 seconds before each spray and releasing two test sprays into the air away from the face.

Step 1: To prime the inhaler, hold it in upright position shake the inhaler well for 5 seconds

Step 2: Hold Your SYMBICORT inhaler facing away from you and then release a test spray. then shake it again for 5 seconds and release a second test spray. Your Symbicort inhaler is now primed and ready for use. After you have primed the SYMBICORT inhaler for the first time the counter will read either 120 or 60, depending on which size was provided to you

Step 3: You must prime your inhaler again if you have not used it in more than 4 weeks or if you drop it. Take the cap off the mouthpiece, shake the inhaler well for 5 seconds. Then spray it into the air away from your face. Shake and spray the inhaler like this 1 more time to finish priming it

Source: http://www.rxlist.com/symbicort-drug.htm, http://www1.astrazeneca-us.com/pi/symbicort.pdf

Azmacort® (MDI)

To prime, hold the inhaler upright, with the mouthpiece facing away from you. Shake the inhaler gently, then press the canister firmly and quickly. Repeat this procedure again so a total of 2 puffs are released. Your Azmacort Inhalation Aerosol is now ready for use.

Re-priming is only necessary when your inhaler has not been used for more than 3 days. To re-prime, shake the inhaler and release one puff. Repeat this procedure again so a total of two puffs are released.

Source: http://www.drugs.com/pro/azmacort.html