Can arformoterol (Brovana) and budesonide be mixed in one nebulizer?

From the Guidelines

Yes, Brovana (arformoterol) and budesonide can be mixed together in one nebulizer treatment, as budesonide suspension is compatible with other nebulizer solutions, including bronchodilators like Brovana, in the same nebulizer 1. When considering the combination of these medications, it's essential to prioritize the patient's response to therapy and adjust the dose accordingly, as the most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy 1. Some key points to consider when mixing these medications include:

• Using only jet nebulizers, as ultrasonic nebulizers are ineffective for suspensions like budesonide 1
• Adding both medications to the nebulizer cup and proceeding with the normal nebulization routine
• Typical dosing for Brovana is 15 mcg (one 2 mL vial) twice daily, while budesonide dosing varies from 0.25 mg to 1 mg depending on the prescription
• The combination of Brovana and budesonide works well because the medications have complementary actions - Brovana opens the airways while budesonide reduces inflammation and swelling in the lungs However, it's crucial to confirm this practice with a healthcare provider before mixing any medications, as individual health conditions may affect recommendations, and they may prefer using these medications separately in some cases. Additionally, the choice of an appropriate nebulizer system is essential for the quality of the aerosol produced and the drug output, and careful attention to technical detail is applicable in applications such as nebulized medications 1.

From the FDA Drug Label

Do not mix budesonide inhalation suspension with other nebulizer medicines The drug compatibility (physical and chemical), efficacy, and safety of arformoterol tartrate inhalation solution when mixed with other drugs in a nebulizer have not been established.

The FDA drug label does not answer the question.

From the Research

Compatibility of Brovana and Budesonide

• The compatibility of arformoterol tartrate inhalation solution (Brovana) with budesonide was assessed in a study published in 2007 2.
• The study found that arformoterol was chemically and physically compatible with commercially available nebulized formulations of budesonide.
• The admixtures of arformoterol and budesonide remained clear and colorless, with no visible signs of change, and the pH values were within the acceptable range.
• Another study published in 2008 3 also evaluated the compatibility of formoterol fumarate (a similar medication to arformoterol) with budesonide and found that the admixtures were physically and chemically compatible.

Aerosol Characteristics

• The study published in 2008 3 also assessed the aerosol characteristics of the admixtures and found that the respirable fraction and delivered dose increased significantly when formoterol and budesonide were mixed together.
• However, the fine particle fraction and mass median aerodynamic diameter generally remained unchanged.

Clinical Implications

• While the studies provide evidence for the compatibility of Brovana and budesonide, the clinical implications of mixing these medications in a nebulizer are not well established.
• Further studies are needed to determine the safety and efficacy of mixing Brovana and budesonide in clinical practice.
• It is essential to consult with a healthcare professional before mixing any medications in a nebulizer.