View source for Budesonide/Formoterol

==Administration==
*Type: [[Inhaled corticosteroid]]
*Dosage Forms: 80/4.5, 160/4.5 mcg/spray MDI
*Routes of Administration: Inhaled
*Common Trade Names: Symbicort

==Adult Dosing==
*[[Asthma]], maintenance
**2 puffs inhaled BID
***Start: Dependent on severity of asthma
***Max: 640 mcg/18 mcg/day
***May increase to 160 mcg/4.5 mcg/day per spray after 1-2 weeks if started at 80 mcg/4.5 mcg/spray.
***Taper to lowest effective dose.
*[[COPD]], maintenance
**2 puffs (160 mcg/4.5 mcg/ spray) inhaled BID
***Max: 640 mcg/18 mcg/day

==Pediatric Dosing==
*5-11 yo
**2 puffs inhaled BID
***Start: Dependent on severity of asthma
***Max: 320 mcg/18 mcg/day
***Taper to lowest effective dose. Use shortest effective treatment duration.
*12+ yo
**2 puffs inhaled BID
***Start: Dependent on severity of asthma
***Max: 640 mcg/18 mcg/day
***Taper to lowest effective dose. Use shortest effect treatment duration.

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C; Possible risk of delayed ossification based on animal data at 80x MRHD and risk with uterine contractility.
*[[Lactation risk categories|Lactation risk]]: L3; Safety unknown

===Renal Dosing===
*Adult: Not defined
*Pediatric: Not defined

===Hepatic Dosing===
*Adult: Not defined. Caution in severe hepatic impairment.
*Pediatric: Not defined. Caution in severe hepatic impairment

==Contraindications==
*Allergy to class/drug
*[[Asthma]], acute
*Bronchospasm, acute
*[[COPD]], acute deteriorating

==Adverse Reactions==
===Serious===
*Bronchospasm, paradoxial
*[[Asthma]] exacerbation
*Death, asthma-related
*[[Pneumonia]]
*Hypersensitivity Reaction
*[[Anaphylaxis]]
*[[Hypertension]]
*[[Angina]]
*[[Hypotension]]
*[[Cardiac arrest]]
*[[Arrhythmia]]
*[[Hypokalemia]]
*[[Hyperglycemia]]
*[[Glaucoma]] in long-term use
*Cataracts in long-term use
*Osteoporosis in long-term use
*Growth suppression in peds pts
*Hypercorticism
*Adrenal suppression
*Behavioral distrubance

===Common===
*Nasopharyngitis
*[[Headache]]
*[[URI]]
*Pharyngolaryngeal pain
*[[Sinusitis]]
*[[Influenza]]
*Back pain
*Nasal congestion
*[[Dyspepsia]]
*[[Nausea]]
*[[Vomiting]]
*[[Candidiasis]], oral
*BP changes
*[[Chest pain]]
*[[Palpitations]]
*[[Tachycardia]]
*Muscle cramps
*Tremor
*Nervousness
*[[Insomnia]]
*[[Cough]]
*[[Bronchitis]]
*Respiratory infection

==Pharmacology==
*Half-life: Budesonide: 2.3 hr, Formoterol: 10 hr.
*Metabolism: Budesonide: Liver, CYP450: 3A4 substreate. Formoterol: Liver extensively, CYP450: 2A6, 2C9/19, 2D6 substrate.
*Excretion: Budesonide: Urine 60%, feces. Formoterol: Urine 59-62% (10% unchanged), feces 32-24%.

==Mechanism of Action==
*Budesonide: Inhibits multiple inflammatory cytokine sand produces multiple glucocorticoid and mineralcorticoid effects. Exact mechanism unknown.
*Formoterol: Selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle.

==Comments==
Black Box Warning: Long acting beta-2 adrenergic agonists (LABA) increase risk of asthma-related death. LABA use may increase risk of asthma-related hospitalization in pediatric and adolescent patients. Do not use corticosteroid/LABA combo if asthma adequately controlled on low-or medium-dose inhaled corticosteroids.

==See Also==

==References==
<references/>
[[Category:Pharmacology]] [[Category:Pulmonology]]