Maximum Dose of Symbicort for Bronchial Asthma
The maximum dose of Symbicort for bronchial asthma in patients 12 years and older is 8 puffs per day (4 puffs twice daily), which delivers 640 mcg budesonide/18 mcg formoterol daily. 1
Standard Maintenance Dosing
- For moderate to severe persistent asthma: The typical dose is 2 inhalations of budesonide/formoterol 160/4.5 mcg twice daily (320/9 mcg total daily dose) 1
- For mild to moderate persistent asthma: The dose is 2 inhalations of budesonide/formoterol 80/4.5 mcg twice daily (160/9 mcg total daily dose) 1
- The usual dosing range fluctuates between 2 inhalations once daily up to 4 inhalations twice daily (8 puffs total per day) 2
Maximum Dose Evidence
A 52-week tolerability study specifically evaluated Symbicort at up to double the maximum dose (640/18 mcg twice daily), which equals 8 puffs per day of the 80/4.5 mcg strength or 4 puffs per day of the 160/4.5 mcg strength 1. This study demonstrated a safety profile similar to budesonide monotherapy with no unexpected adverse events 1.
SMART Regimen (Maintenance and Reliever Therapy)
- For patients using the adjustable maintenance dosing approach, Symbicort can be used both as maintenance therapy (2 inhalations twice daily) and as needed for symptom relief 3
- The maximum total daily maintenance and rescue dose is 12 puffs (54 mcg formoterol) when using the SMART regimen 4
- Patients can step up to 4 inhalations twice daily if asthma worsens, for a maximum of 14 days, then step back down when symptoms are controlled 5
Important Clinical Considerations
Symbicort should never be used as monotherapy—it must be part of a comprehensive asthma management plan that includes an inhaled corticosteroid component 6. The combination provides both anti-inflammatory (budesonide) and bronchodilatory (formoterol) effects 2.
Increasing use of rescue medication beyond 2 days per week generally indicates inadequate asthma control and signals the need to step up maintenance therapy rather than simply increasing the dose 4, 6.