Budesonide Formoterol

Budesonide Formoterol Brand Name

Symbicort

What is Budesonide Formoterol

Budesonide formoterol is a combination of an inhaled corticosteroid (ICS), budesonide, and a long-acting beta-2 agonist (LABA), formoterol.

It is administered by oral inhalation twice daily. The combination is indicated for the maintenance treatment of asthma in adult and pediatric patients 6 years and older.

Budesonide formoterol is also indicated for the maintenance treatment of COPD in adults and to reduce the risk of exacerbations of COPD.

Budesonide formoterol is not recommended for acute bronchospasm or acute asthmatic attacks; a short-acting beta-2 agonist (SABA) should still be available for acute bronchospasm.

LABAs should not be first-line agents in the treatment of asthma and are used only if other drugs do not control asthma.

The use of LABAs alone to treat asthma, without an inhaled corticosteroid (ICS) to treat lung inflammation, is associated with an increased risk of asthma-related death; therefore, LABAs are contraindicated in patients with asthma without the use of an asthma controller medication (i.e., an ICS).

Clinical trials have demonstrated the beneficial effects of the concurrent use of budesonide; formoterol on lung function and the subsequent reduction of asthma symptoms.

Orally inhaled corticosteroids (ICSs) such as budesonide are considered a preferred pharmacologic treatment in the long-term management of persistent asthma of various severities according to the Expert Panel of the National Asthma Education and Prevention Program (NAEPP); NAEPP concluded that ICSs are the most potent and consistently effective class of medications for the long-term control of asthma in both adults and children.

LABAs such as formoterol are an acceptable adjunct maintenance treatment with an ICS for persistent asthma inadequately controlled with a low-dose ICS (step 3 care).

NAEPP recommends that equal consideration be given to increasing the ICS dose versus adding an LABA for insufficient control of asthma symptoms. The preferred treatments in steps 4 to 6 care include the combined use of an LABA and ICS.

According to the Global Initiative for Chronic Lung Disease (GOLD) guidelines for chronic obstructive lung disease (COPD), budesonide; formoterol may be used as initial therapy in group D (those with a high risk of exacerbation).

Combination of a LABA with an ICS has the greatest likelihood of reducing exacerbations in patients with blood eosinophil counts of 200 cells/microliter and higher.

An ICS combined with a LABA is more effective than the individual components in improving lung function and health status and reducing exacerbations in patients with exacerbations and moderate to very severe COPD; however clinical trials failed to demonstrate a statistically significant effect on survival.

At follow-up, if the patient is still experiencing dyspnea, consider switching inhaler device and investigate for other causes of dyspnea. If the patient has COPD exacerbations, consider triple therapy with a long-acting muscarinic antagonists (LAMA), a LABA, and ICS.

Budesonide formoterol inhalation was first FDA-approved in 2006.

Indications

  1. asthma
  2. chronic bronchitis
  3. chronic obstructive pulmonary disease (COPD)
  4. emphysema

Side Effects

  1. adrenocortical insufficiency
  2. agitation
  3. anaphylactoid reactions
  4. angina
  5. angioedema
  6. arrhythmia exacerbation
  7. asthma-related death
  8. atrial tachycardia
  9. back pain
  10. bronchospasm
  11. candidiasis
  12. cataracts
  13. cough
  14. depression
  15. dizziness
  16. ecchymosis
  17. growth inhibition
  18. headache
  19. hyperglycemia
  20. hypertension
  21. hypokalemia
  22. hypotension
  23. hypothalamic-pituitary-adrenal (HPA) suppression
  24. increased intracranial pressure
  25. infection
  26. influenza
  27. muscle cramps
  28. nasal congestion
  29. nausea
  30. ocular hypertension
  31. osteopenia
  32. osteoporosis
  33. palpitations
  34. pharyngitis
  35. QT prolongation
  36. restlessness
  37. rhinitis
  38. sinus tachycardia
  39. sinusitis
  40. tremor
  41. urticaria
  42. ventricular tachycardia
  43. vomiting
  44. wheezing

Monitoring Parameters

  • blood glucose
  • pulmonary function tests (PFTs)
  • serum potassium

Contraindications

  • acute bronchospasm
  • alcoholism
  • asthma-related death
  • bradycardia
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cataracts
  • children
  • coronary artery disease
  • corticosteroid hypersensitivity
  • corticosteroid therapy
  • diabetes mellitus
  • females
  • fungal infection
  • geriatric
  • glaucoma
  • growth inhibition
  • heart failure
  • hepatic disease
  • herpes infection
  • hypertension
  • hyperthyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothalamic-pituitary-adrenal (HPA) suppression
  • increased intracranial pressure
  • increased intraocular pressure
  • infants
  • infection
  • labor
  • long QT syndrome
  • malnutrition
  • MAOI therapy
  • measles
  • myocardial infarction
  • neonates
  • osteoporosis
  • paradoxical bronchospasm
  • pheochromocytoma
  • pregnancy
  • QT prolongation
  • respiratory insufficiency
  • seizure disorder
  • seizures
  • status asthmaticus
  • tachycardia
  • thyroid disease
  • thyrotoxicosis
  • tuberculosis
  • varicella
  • viral infection

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  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Telaprevir
  • Telavancin
  • Telbivudine
  • Telithromycin
  • Telotristat Ethyl
  • Temsirolimus
  • Testosterone
  • Tetrabenazine
  • Tezacaftor; Ivacaftor
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Thiazolidinediones
  • Thioridazine
  • Thyroid hormones
  • Timolol
  • Tiotropium; Olodaterol
  • Tobramycin
  • Tolazamide
  • Tolbutamide
  • Tolterodine
  • Toremifene
  • Torsemide
  • Tositumomab
  • Trandolapril; Verapamil
  • Tranexamic Acid
  • Tranylcypromine
  • Trazodone
  • Tretinoin, ATRA
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Tuberculin Purified Protein Derivative, PPD
  • Tubocurarine
  • Umeclidinium; Vilanterol
  • Vancomycin
  • Vandetanib
  • Vardenafil
  • Vecuronium
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Vigabatrin
  • Vinblastine
  • Vincristine Liposomal
  • Voriconazole
  • Vorinostat
  • Warfarin
  • Zafirlukast
  • Zileuton
  • Ziprasidone
  • Zonisamide
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