budesonide + formoterol: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
budesonide + formoterol: clinical details
Prescribing considerations
- Confirm that an inhaled corticosteroid–long-acting beta2 agonist combination is appropriate.
- Do not initiate during an acute severe exacerbation or rapidly deteriorating asthma.
- Ensure the patient can use the dry-powder device correctly.
- Review increasing reliever use, poor response or worsening control promptly.
- Consider adrenal risk when transferring from prolonged systemic corticosteroids.
Contraindications and cautions
- Hypersensitivity to budesonide, formoterol or an excipient.
- Hypersensitivity to milk proteins: the selected powder contains lactose with small amounts of milk protein.
- Use caution with significant cardiovascular disease, prolonged QTc, thyrotoxicosis, phaeochromocytoma, diabetes, untreated hypokalaemia and active or quiescent respiratory infections.
Monitoring
- Asthma control, exacerbations and reliever use.
- Inhaler technique and adherence.
- Oropharyngeal candidiasis and dysphonia.
- Height in children receiving prolonged inhaled corticosteroid treatment.
- Potassium, glucose, cardiovascular effects or adrenal function when risk factors warrant.
- Visual symptoms; consider ophthalmic assessment for persistent blurred vision.
Clinical pharmacology
Budesonide is an inhaled glucocorticosteroid with local airway anti-inflammatory activity. Formoterol is a selective beta2-adrenoceptor agonist producing rapid, sustained bronchial smooth-muscle relaxation. Both are mainly cleared through hepatic metabolism; potent CYP3A4 inhibition particularly increases budesonide exposure.
Formulation and product differences
- The selected product is an inspiratory flow-driven multidose dry-powder inhaler.
- It contains lactose monohydrate with small amounts of milk protein.
- It requires a forceful, deep inhalation and is not used with a spacer.
- Other budesonide–formoterol inhalers may have different devices, licences and instructions and should not be assumed interchangeable.
budesonide + formoterol preparations and strengths
Inhaled preparation
Route: Inhaled
Strengths: 100 micrograms + 3 micrograms/actuation, 160 micrograms + 4.5 micrograms, 200 micrograms + 6 micrograms/actuation, 320 micrograms + 9 micrograms
budesonide + formoterol interactions
Tell the prescriber or pharmacist about all medicines, including eye drops and non-prescription products. Important examples include:
Potent CYP3A4 inhibitors, including itraconazole, ketoconazole, ritonavir and cobicistat
These can substantially increase budesonide exposure and the risk of corticosteroid adverse effects.
Beta blockers, including beta-blocker eye drops
These may reduce or block formoterol's bronchodilator effect and worsen bronchospasm.
Medicines that prolong the QT interval
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.