Home Drug Guide Budesonide; Formoterol Fumarate

Drug Guide

Generic Name

Budesonide; Formoterol Fumarate

Brand Names Symbicort Aerosphere

Classification

Therapeutic: Asthma and COPD maintenance therapy

Pharmacological: Combo inhaled corticosteroid and long-acting beta2-agonist

FDA Approved Indications

Maintenance treatment of airflow obstruction in patients with asthma and COPD

Mechanism of Action

Budesonide is an inhaled corticosteroid that suppresses airway inflammation. Formoterol is a long-acting beta2-adrenergic agonist that relaxes bronchial smooth muscle, leading to bronchodilation.

Dosage and Administration

Adult: 2 inhalations twice daily, as prescribed by healthcare provider

Pediatric: Typically for children aged 6 years and older, dosage adjusted by healthcare provider

Geriatric: Adjust dose based on patient response and tolerability; no specific age-related contraindications, but caution advised

Renal Impairment: No specific dose adjustment required; use with caution

Hepatic Impairment: Use with caution; no specific dose adjustment established

Pharmacokinetics

Absorption: Rapid absorption from the lungs; systemic absorption minimal for local effects

Distribution: Selective distribution to the lungs; systemic binding of corticosteroid and beta2-agonist is limited

Metabolism: Budesonide undergoes extensive first-pass metabolism in the liver; formoterol metabolized via COMT and CYP pathways

Excretion: Renal and fecal routes

Half Life: Budesonide ~2-4 hours; Formoterol ~12 hours

Contraindications

Hypersensitivity to budesonide, formoterol, or other corticosteroids/beta2-agonists

Precautions

History of hypersensitivity reactions, cardiovascular disorders, hyperthyroidism, diabetes, osteoporosis, glaucoma, or infections like tuberculosis

Adverse Reactions - Common

Throat irritation (Common)
Hoarseness (Common)
Headache (Common)

Adverse Reactions - Serious

Worsening of asthma or COPD exacerbation (Uncommon)
Cardiac arrhythmias or tachycardia (Uncommon)
Oral candidiasis (Less common)

Drug-Drug Interactions

Other beta2-agonists, MAO inhibitors, tricyclic antidepressants, beta-blockers, CYP3A4 inhibitors like ketoconazole

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor respiratory status, breath sounds, and for signs of allergic reactions or infections

Diagnoses:

Ineffective airway clearance
Risk for infection
Impaired gas exchange

Implementation: Administer via inhaler as prescribed; educate patient on inhaler technique; monitor for adverse effects

Evaluation: Assess improvement in symptoms, lung function tests, and adherence to therapy

Patient/Family Teaching

Use inhaler correctly to ensure medication delivery
Rinse mouth after inhalation to prevent thrush
Report worsening symptoms or adverse effects
Do not stop medication abruptly

Special Considerations

Black Box Warnings:

Potential for severe asthma episodes if used improperly

Genetic Factors: Genetic variations in CYP2D6 and CYP3A4 can affect metabolism of formoterol

Lab Test Interference: None noted

Overdose Management

Signs/Symptoms: Severe nausea, vomiting, tremors, tachycardia, hypokalemia, hyperglycemia

Treatment: Supportive care,Monitor vital signs, Manage symptoms; activated charcoal if ingestion occurred recently; seek emergency care

Storage and Handling

Storage: Store at room temperature, away from moisture and heat

Stability: Stable up to manufacture's expiration date when stored properly