QVAR HFA Metered Dose Inhaler is Going off of the Market

With little if any notice to providers, TEVA has decided to stop selling the QVAR HFA Metered Dose inhaler in the US. They have replaced it with a QVAR RediHaler, which is a breath actuated inhaler that CANNOT be used with a spacer (valved holding chamber) device. Young children and disabled children who cannot take a deep breath in and hold it will not be able to use the RediHaler device.   Patients who are used to or prefer to use a spacer (valved holding chamber) may not wish to change to a breath actuated inhaler (a spacer decreases oropharyngeal and dental deposition of the medication) . Adolescent patients who do not like to use a spacer may prefer the breath actuated inhaler.

What this means for providers is that patients will not be able to get their QVAR HFA Metered Dose Inhalers refilled. Providers will need to change them to either an alternative inhaled corticosteroid metered dose inhaler (if they require or prefer a product that can be used with a spacer/valved holding chamber) or to the QVAR Redihaler (if a breath actuated inhaler that cannot be used with a spacer is preferred). Either way the patient will need to be instructed on the medication change.

Flovent HFA (FLUTICASONE PROPIONATE) will now be the only inhaled corticosteroid metered dose inhaler on the Texas Medicaid Preferred Drug List[1] that can be used with a spacer/valved holding chamber device.

In converting children from QVAR to Flovent:

QVAR HFA 40 mcg is approximately equivalent to Flovent HFA 44 mcg

QVAR HFA 80 mcg is approximately equivalent to Flovent HFA 110 mcg

Similar to the QVAR product, the Flovent HFA inhaler has a dose counter, 120 doses are in each canister.

Note that although some have commented on smaller particle size distribution as a theoretical advantage of the QVAR product, and inactivation of any swallowed drug as a theoretical advantage of the Flovent product, there is no research to date to show that these theoretical differences are clinically important.

Harold J. Farber, MD, MSPH, FAAP
Associate Professor of Pediatrics, Pulmonary Section
Baylor College of Medicine and Texas Children’s Hospital
Associate Medical Director, Texas Children’s Health Plan

[1] Although Alvesco HFA (ciclesonide) metered dose inhaler is still on the market in the US, it is NOT on the Texas Medicaid VDP Preferred Drug List.