Symbicort Dosing: Low and Medium Dose Regimens
For Symbicort (budesonide/formoterol), low dose is typically 2 puffs once daily, while medium dose is 2 puffs twice daily.
Symbicort Dosing Specifications
Low Dose
- Low dose Symbicort is defined as 2 puffs once daily (160/4.5 mcg per puff) 1
- This provides a total daily dose of 320 mcg budesonide and 9 mcg formoterol 2
- Low dose is appropriate for patients with mild persistent asthma who were previously on inhaled corticosteroids alone 3
Medium Dose
- Medium dose Symbicort is defined as 2 puffs twice daily (160/4.5 mcg per puff) 4
- This provides a total daily dose of 640 mcg budesonide and 18 mcg formoterol 2
- Medium dose is appropriate for patients with moderate persistent asthma 3
Age-Specific Considerations
Adults and Adolescents (≥12 years)
- Standard Symbicort formulation contains 160 mcg budesonide and 4.5 mcg formoterol per puff 3
- Dosing ranges from 2 puffs once daily (low dose) to 2 puffs twice daily (medium dose) 2
- Maximum recommended dose is 4 puffs twice daily for severe persistent asthma 4
Children (6-11 years)
- Pediatric Symbicort formulation contains 80 mcg budesonide and 4.5 mcg formoterol per puff 4
- Dosing should be adjusted accordingly for this age group 4
Clinical Considerations
- Symbicort combines an inhaled corticosteroid (budesonide) with a long-acting beta-agonist (formoterol) in a single inhaler 5
- The combination has been shown to be more effective than inhaled corticosteroids alone 5
- Adjustable maintenance dosing with Symbicort may allow for lower overall drug exposure while maintaining asthma control 2
- Once daily dosing (low dose) may be sufficient for some patients with mild persistent asthma 2
- Twice daily dosing (medium dose) provides better symptom control for patients with moderate persistent asthma 4
Common Pitfalls and Caveats
- Symbicort should not be used for acute symptom relief or exacerbations 2
- A separate rescue inhaler (typically a short-acting beta-agonist) should be prescribed for quick relief of symptoms 1
- Starting with too low a dose in patients with moderate to severe asthma may result in inadequate control 4
- Starting with too high a dose unnecessarily increases medication exposure and potential side effects 2
- Monitor for potential side effects including oral candidiasis, dysphonia, and cough 6
Monitoring and Follow-up
- Assess symptom control, exacerbation frequency, and lung function to determine if dose adjustment is needed 1
- Consider stepping down to a lower dose once asthma control has been maintained for at least 3 months 2
- In children, monitor growth as suppression of growth velocity has been observed with inhaled corticosteroid use 6