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Airsupra
albuterol/ budesonide inhaled
Adult Dosing .
Dosage forms: MDI: 90 mcg/80 mcg per actuation
asthma, prn tx
- [2 puffs inhaled prn]
- Max: 12 puffs/24h; Info: search 'asthma' for epocrates Asthma Long-Term Management NIH/NHLBI decision tools
renal dosing
- [see below]
- renal impairment: not defined; Info: caution advised if high-dose use
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: hypersensitivity to corticosteroids
- caution: MAO inhibitor use within 14 days
- caution: TCA use within 14 days
- caution: electrolyte abnormalities
- caution: long QT syndrome, congenital
- caution: QT prolongation
- caution: QT prolongation family history
- caution: torsades de pointes history
- caution: arrhythmia
- caution: bradycardia
- caution: MI, recent
- caution: CHF
- caution: cardiovascular disease
- caution: patients unusually responsive to sympathomimetic amines
- caution: hyperthyroidism
- caution: diabetes mellitus
- caution: ketoacidosis
- caution: seizure disorder
- caution: labor and delivery
- caution: renal impairment (high-dose use)
- caution: hepatic impairment
- caution: long-term systemic corticosteroid use, recent
- caution: immunosuppressed patients
- caution: infection, active
- caution: TB infection, active
- caution: TB infection, latent
- caution: measles exposure
- caution: varicella exposure
- caution: osteoporosis
- caution: osteoporosis risk
- caution: cataract
- caution: glaucoma
- caution: glaucoma risk
- caution: ocular HSV
Drug Interactions .
Overview
albuterol inhaled
beta-2 agonist
- hypertensive effects
- hypokalemia
- prolongs QT interval (conditional)
- tachycardia
budesonide inhaled
corticosteroid inhaled
- CYP3A4 substrate
- immunomodulatory effects
- interferes w/ ACTH analog test
Contraindicated
Avoid/Use Alternative
Monitor/Modify Tx
Caution Advised
Adverse Reactions .
Serious Reactions
- bronchospasm, paradoxical
- hypersensitivity reaction
- anaphylaxis
- angioedema
- HTN
- angina
- arrhythmia
- hypokalemia
- hyperglycemia
- metabolic acidosis
- eosinophilia
- Churg-Strauss syndrome
- adrenal suppression (long-term use)
- hypercorticism (long-term use)
- immunosuppression (long-term use)
- glaucoma (long-term use)
- cataracts (long-term use)
- osteoporosis (long-term use)
Common Reactions
- headache
- candidiasis, oral
Safety/Monitoring .
Monitoring Parameters
BMD at baseline if osteoporosis risk factors, then periodically; oral cavity exam periodically; consider ophthalmic exam if long-term use, change in vision, IOP/glaucoma/cataracts history
Pregnancy/Lactation .
Pregnancy
Clinical Summary
albuterol inhaled: may use during pregnancy; drug of choice for asthma use during pregnancy; weigh risk/benefit during labor and delivery; risk of fetal harm low based on human data; risk of interference with uterine contractility based on drug's mechanism of action
budesonide inhaled: may use during pregnancy; drug of choice for asthma use during pregnancy; risk of teratogenicity low based on human data
Pregnancy Registry
enroll patients or encourage patients to enroll in MotherToBaby Pregnancy Studies at 1-877-311-8972 or at www.mothertobaby.org/asthma/
Lactation
Clinical Summary
albuterol inhaled: may use while breastfeeding; no human data available, though risk of infant harm and adverse effects on milk production not expected based on minimal systemic absorption in breastfeeding patients
budesonide inhaled: may use while breastfeeding; no known risk of infant harm based on human data and minimal drug excretion into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for albuterol: GI tract; CYP450: unknown; for budesonide: liver extensively; CYP450: 3A4 substrate
Excretion: for albuterol: urine 80-100%, feces <20%; Half-life: 7.1h; for budesonide: urine 60% (none unchanged), feces; Half-life: 4.1h
Subclass: Beta-2 Agonists, Inhaled Short-Acting (SABAs) ; Corticosteroids, Inhaled
Mechanism of Action
for albuterol: selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle; for budesonide: exact mechanism of anti-inflammatory action unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects
Formulary .
No Formulary Selected
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