Symbicort (Budesonide/Formoterol) Dosage Recommendations
The recommended dosage of Symbicort varies based on asthma severity, with typical dosing being 160/4.5 mcg (two inhalations twice daily) for moderate to severe persistent asthma or 80/4.5 mcg (two inhalations twice daily) for mild to moderate persistent asthma. 1
Dosage Options by Age and Condition
Adolescents and Adults (≥12 years)
- Mild to moderate persistent asthma: Budesonide/formoterol 80/4.5 mcg × 2 inhalations (160/9 mcg) twice daily 1
- Moderate to severe persistent asthma: Budesonide/formoterol 160/4.5 mcg × 2 inhalations (320/9 mcg) twice daily 1
- Severe COPD: Budesonide/formoterol 160/4.5 mcg × 2 inhalations twice daily 2
Children (5-11 years)
- Dosing depends on level of severity or control 3
- Currently approved for use in youths 12 years and older in the US 3
Adjustable Maintenance Dosing
For patients with established asthma control, an adjustable dosing regimen may be considered:
- Start with standard twice-daily dosing for 4 weeks to establish control 4
- Step down to one inhalation twice daily if symptoms are well-controlled 4
- Step up to four inhalations twice daily for 1-2 weeks during symptom worsening 4
- This approach has been shown to reduce exacerbations compared to fixed dosing (6.2% vs 9.5%) 4
- Adjustable dosing requires fewer daily inhalations (2.35 vs 3.95) and reduces costs 4
Administration Considerations
- Symbicort is available as a pressurized metered-dose inhaler (pMDI) or as a dry powder inhaler (Turbuhaler) 1, 5
- The medication should be administered at consistent times each day for optimal effect 1
- Patients should be instructed on proper inhaler technique to ensure adequate drug delivery 1
- Symbicort should not be used for acute symptom relief or exacerbations 3
Clinical Benefits
- Combination therapy provides greater efficacy than either component alone 1
- Rapid onset of effect (apparent within 1 minute of treatment) due to formoterol properties 6
- Significantly more patients achieve ≥15% improvement in FEV1 within 15 minutes compared to fluticasone/salmeterol 1
- Reduces exacerbations and improves lung function, symptoms, and quality of life 1, 5
Safety Considerations
- Common side effects include pharyngitis, epistaxis, and cough 3
- Long-acting beta-agonists (LABAs) may cause tachycardia, skeletal muscle tremor, and hypokalemia 3
- LABAs should always be administered in combination with inhaled corticosteroids 3
- Potential risk of uncommon severe life-threatening or fatal exacerbation with LABAs 3
- Safety profile is similar to that of budesonide alone, with no unexpected pattern of abnormalities even at higher doses 1
Special Populations
- For patients with COPD: Budesonide/formoterol 160/4.5 mcg (two inhalations twice daily) has demonstrated benefits for severe and very severe COPD 2
- Inheritance of the Gly16Arg polymorphism of the beta2-adrenergic receptor does not appear to affect clinical outcomes 1
Remember that Symbicort combines an inhaled corticosteroid (budesonide) with a long-acting beta2-agonist (formoterol) and should only be used for maintenance treatment of asthma, not for rescue therapy during acute symptoms.