What is the typical dosing regimen for cromolyn sulfate (inhalation corticosteroid) in patients with asthma or allergic rhinitis?

Cromolyn Sodium Dosing

Cromolyn sodium is dosed at 20 mg (one capsule or ampule) four times daily via nebulizer or metered-dose inhaler for asthma, or one spray per nostril 3-6 times daily (every 4-6 hours) for allergic rhinitis. 1

Important Clarification on Drug Classification

Cromolyn sodium is not an inhaled corticosteroid—it is a mast cell stabilizer with an entirely different mechanism of action. 2 This is a critical distinction that affects prescribing decisions and patient counseling.

Asthma Dosing

Standard Maintenance Therapy

• Adults and children ≥5 years: 20 mg four times daily via nebulizer solution or 2 puffs (2 mg per puff) four times daily via metered-dose inhaler 1, 3
• Children 0-4 years: Nebulizer delivery is the preferred method in young children who cannot coordinate MDI use 1

Exercise-Induced Bronchospasm

• Single prophylactic dose: One dose 15-30 minutes before exercise or allergen exposure provides effective prophylaxis for 1-2 hours 1
• This is less effective than short-acting beta-agonists for exercise-induced bronchospasm 1

Clinical Role in Asthma Management

• Cromolyn is positioned as an alternative (not preferred) therapy for Step 2 mild persistent asthma in patients unable or unwilling to use inhaled corticosteroids 1
• The preferred Step 2 treatment remains low-dose inhaled corticosteroids 1
• A 4-6 week trial is required to determine maximum benefit, as onset of action is prolonged 1
• Once control is achieved, dosing frequency may be reduced 1

Allergic Rhinitis Dosing

Over-the-Counter Nasal Spray (4% Solution)

• Standard dosing: One spray in each nostril every 4-6 hours, maximum 6 times daily 4
• Begin use before allergen exposure for optimal prevention 4
• Treatment duration of at least 2 weeks is recommended for full assessment of efficacy 4, 5

Oral Formulation for Food-Induced Rhinitis

• Dosing: 200 mg orally four times daily, starting 3 days before anticipated food exposure and continuing 3 days after 6
• This formulation is effective for preventing immediate and late nasal responses to ingested foods 6

Critical Dosing Considerations

Delivery Device Matters

• MDI doses may be inadequate to affect bronchial hyperresponsiveness in some patients 1
• Nebulizer delivery provides more consistent dosing, particularly in young children and during acute symptoms 1
• Large volume spacer devices should be used with MDIs to enhance delivery 1

Timing and Frequency

• Four times daily dosing is essential for maintenance asthma therapy—less frequent dosing is inadequate 1, 3
• For rhinitis, the every 4-6 hours schedule must be maintained for symptom control 4
• Prophylactic use before known triggers is more effective than reactive treatment 1

Response Assessment Timeline

• Do not abandon therapy prematurely: 4-6 weeks of consistent use is required before concluding treatment failure 1
• In children 0-4 years, if no clear benefit is observed within 4-6 weeks, discontinue and consider alternative diagnoses 1

Common Pitfalls to Avoid

• Do not use cromolyn for acute symptom relief—it has no bronchodilator properties and is purely prophylactic 1, 2
• Do not substitute cromolyn for inhaled corticosteroids in patients with moderate-to-severe asthma—it is substantially less effective 1
• Do not expect immediate results—the prolonged onset of action means patients must continue therapy for weeks before assessing efficacy 1
• Do not underdose—four times daily administration is required for asthma; less frequent dosing will fail 1, 3

Safety Profile

Cromolyn has an extremely low frequency of adverse effects at standard doses, with toxicity being mild, short-lived, and without sequelae. 2 The most common side effects are headache and rhinitis, occurring at rates similar to placebo. 4