Budesonide-Formoterol Fumarate

The typical dosage of Symbicort varies depending on the condition being treated:

For Asthma (Adults and Children 12 years and older):

• Starting Dose: 2 inhalations twice daily (morning and evening) of either the 80/4.5 mcg or 160/4.5 mcg strength.

For COPD (Adults):

• Recommended Dose: 2 inhalations twice daily (morning and evening) of the 160/4.5 mcg strength.

Symbicort is contraindicated in patients with:

• Hypersensitivity to budesonide, formoterol fumarate, or any other component of the product.
• Acute episodes of asthma or COPD exacerbations, as it is not intended for use as a rescue inhaler.

Patients using Symbicort should be advised to:

• Use the inhaler exactly as prescribed and not as a rescue inhaler for sudden breathing problems. A separate rescue inhaler (e.g., albuterol) should be used for acute symptoms.
• Rinse their mouth with water and spit it out after each use to reduce the risk of oral thrush (a fungal infection in the mouth).
• Be aware of potential side effects, such as increased heart rate, headache, or dry mouth, and report any severe or persistent side effects to their healthcare provider.
• Store the inhaler at room temperature and protect it from light and moisture. Keep the inhaler clean and dry, and replace it according to the manufacturer's instructions.

• Sore throat
• Cough
• Hoarseness
• Headache
• Increased heart rate
• Tremor

• Pneumonia: Increased risk of pneumonia in patients with COPD.
• Paradoxical Bronchospasm: Worsening of breathing immediately after using the inhaler, which requires immediate medical attention.
• Hypokalemia: Low potassium levels, which can cause muscle weakness, cramps, or irregular heartbeats.
• Hyperglycemia: Increased blood sugar levels, particularly in patients with diabetes.

Patients should seek immediate medical attention if they experience signs of serious side effects, such as difficulty breathing, chest pain, or swelling of the face, lips, or tongue.

• Increased Risk of Asthma-Related Death: LABAs, such as formoterol, have been associated with an increased risk of asthma-related death. Symbicort should be used only for patients who require both a corticosteroid and a LABA and not as monotherapy.
• Pneumonia Risk in COPD: Patients with COPD using inhaled corticosteroids like budesonide may be at an increased risk of developing pneumonia. Patients should be monitored for signs and symptoms of pneumonia, such as fever, chills, and increased sputum production.
• Cardiovascular Effects: The LABA component (formoterol) can increase heart rate and blood pressure, which may be problematic for patients with cardiovascular conditions. Patients should be monitored for signs of cardiovascular effects.

Symbicort may interact with other medications, including:

• Beta-Blockers: Can reduce the effectiveness of formoterol and may worsen breathing problems.
• Diuretics: May increase the risk of low potassium levels (hypokalemia) when used with formoterol.
• MAO Inhibitors or Tricyclic Antidepressants: May increase the risk of cardiovascular side effects when used with formoterol.

Other Inhaled Medications: Using multiple inhaled medications can increase the risk of side effects and interactions. Patients should inform their healthcare provider of all medications they are taking.

Alternative treatments for asthma and COPD include:

• Other Combination Inhalers: Such as Advair (fluticasone/salmeterol) or Breo Ellipta (fluticasone/vilanterol), which combine different bronchodilators and corticosteroids.
• Single-Ingredient Inhalers: Such as Spiriva (tiotropium) or Pulmicort (budesonide), which may be used alone or in combination with other therapies.
• Nebulized Treatments: Such as albuterol or ipratropium, for patients who have difficulty using inhalers.
• Biologics: For patients with severe asthma, medications like Xolair (omalizumab) or Dupixent (dupilumab) may be considered.

The choice of treatment depends on the severity of the condition, the patient's response to previous treatments, and overall health status.