From the Guidelines
The equivalent dose of Miflonide 400 (budesonide 400 mcg) to Symbicort would be Symbicort 200/6, which contains budesonide 200 mcg and formoterol 6 mcg per inhalation, taken as two inhalations twice daily. This provides a total daily budesonide dose of 800 mcg, which matches the Miflonide 400 mcg taken twice daily (800 mcg total) 1. The key difference is that Symbicort is a combination inhaler that also contains formoterol, a long-acting beta-agonist bronchodilator, while Miflonide contains only budesonide, an inhaled corticosteroid. When switching between these medications, it's essential to maintain the same daily steroid dose to ensure continued control of airway inflammation. However, the addition of formoterol in Symbicort may provide better symptom control through bronchodilation. Some key points to consider when using these medications include:
- The most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy 1.
- Preparations are not interchangeable on a mcg or per-puff basis 1.
- Patients should be monitored for potential side effects when switching, including possible increased heart rate or tremor from the formoterol component.
- The transition should be supervised by a healthcare provider who can adjust the dosage if needed.
- Budesonide nebulizer suspension is the only ICS with FDA-approved labeling for children <4 years of age 1.
- For children <4 years of age, the safety and efficacy of ICSs in children <1 year has not been established 1.
- Children <4 years of age generally require delivery of ICS (budesonide and fluticasone HFA) through a face mask that should fit snugly over nose and mouth and avoid nebulizing in the eyes 1.
- Corticosteroid side effects can be minimized by washing the face after each treatment to prevent local side effects 1.
- For budesonide, the dose may be administered 2 times daily 1.
- Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 1.
- Use only jet nebulizers because ultrasonic nebulizers are ineffective for suspensions 1.
- For fluticasone HFA, the dose should be divided 2 times daily; the low dose for children <4 years of age is higher than for children 5-11 years of age because of lower dose delivered with face mask and data on efficacy in young children 1.
From the Research
Recommended Dose Equivalent
The recommended dose equivalent to miflonide 400 equivalent to Symbicort is not directly stated in the provided studies. However, we can look at the doses of budesonide and formoterol in Symbicort:
Comparison of Inhalers
Some studies compared the efficacy of budesonide/formoterol with salmeterol/fluticasone propionate:
- Budesonide/formoterol 320/9 μg per day vs salmeterol/fluticasone propionate 100/500 μg per day 2
- Budesonide/formoterol 9/320 μg bid vs salmeterol/fluticasone combination 50/250 μg bid 3
Key Findings
Some key findings from the studies include:
- Budesonide/formoterol maintenance and reliever therapy prolonged time to first severe exacerbation versus budesonide/formoterol and salmeterol/fluticasone propionate fixed maintenance dose 2
- Switching from salmeterol/fluticasone to formoterol/budesonide combinations improved peripheral airway/alveolar inflammation in asthma 3
- Mometasone furoate/formoterol improved pulmonary function and asthma control similar to fluticasone propionate/salmeterol with a superior onset of action 4
Dose Equivalence
While the exact dose equivalent to miflonide 400 is not provided, the studies suggest that budesonide/formoterol and salmeterol/fluticasone propionate are commonly used in the treatment of asthma, with various doses and combinations: