Which medicine is more dangerous beclazone or symbicort. Symbicort analogues, their comparison and reviews. Contraindications for use

Pulmicort- a synthetic glucocorticosteroid drug that is prescribed for bronchial asthma, as well as. Pulmicort is produced in Sweden.

This drug is available in the form of a suspension, which is used for inhalation. There are also other dosage forms. For procedures with Pulmicort, it is recommended to use a compressor nebulizer with a mouthpiece and a special mask, with which inhalations will be most effective. Consider whether it is possible to replace Pulmicort for inhalation with something, but first we will get acquainted with the composition of the drug and find out how it affects the body.

The active ingredient of the drug is the substance budesonide. Auxiliary ingredients in the composition of the suspension: sodium chloride, sodium citrate, disodium edetate, citric acid, polysorbate 80, prepared water.

Budesonide is a local glucocorticoid, which, when administered by inhalation, is quickly and easily absorbed from the lungs (the maximum concentration in the blood is observed 15–45 minutes after the procedure). The substance has a powerful anti-inflammatory and anti-allergic effect, directly affecting cells and glucocorticosteroid receptors and regulating the synthesis of various substances. The drug contributes to:

• reduction of swelling of the mucous membranes of the bronchi;
• reduction of mucus secretion;
• reduction of airway hyperreactivity;
• reducing the severity of manifestations and the frequency of exacerbations of the disease.

The practice of using Pulmicort has shown that it is well tolerated during long-term treatment, does not affect water and electrolyte metabolism. Due to the selectivity of exposure, side effects in the treatment of the drug occur only in rare cases. The drug is excreted in the urine and bile.

Pulmicort analogues for inhalation

There are a number of preparations based on the same active ingredient as Pulmicort and intended for inhalation:

• Budesonide (Spain);
• Benakort (Russia);
• Tafen Novolizer (Slovenia);
• Novopulmon E Novolizer (Germany);
• Symbicort Turbuhaler (Sweden).

The listed drugs are substitutes for Pulmicort and can be used for the same indications with the permission of the attending physician. Dosages are selected individually in each case.

The cheapest analogue of Pulmicort from the above list is a domestic drug - Benacort. This medicine for inhalation is available in several forms: capsules with powder for inhalation, powder, solution, suspension.

You can also select several drugs, the active ingredient of which is also budesonide. However, these drugs are available in other dosage forms, and indications for their appointment may differ from those of Pulmicort. These are tools such as:

• Buderin (nasal spray);
• Budecort (aerosol);
• Benarin (drops in the nose);
• Budenofalk (capsules for oral administration), etc.

Berodual or Pulmicort?

Berodual is a drug that in some cases is prescribed for use in parallel with Pulmicort. It's combined a drug whose action is based on two active compounds - ipratropium bromide and fenoterol hydrobromide. Basically, Berodual is prescribed for bronchospastic syndromes, accompanied by obstructive pulmonary disease.

Review comments

You're right. I suffered for 7 years, I was dying, my breathing was up to -30%, if only there were no hormones. In the beginning, I was saved by neophilin + Diet, fasting for 10 days, but only the child brought the flu from school, asthma worsened worse and worse. I have been using it for 2 years, the minimum dose is 1 r. per day, with an exacerbation of the flu 2 times. If you stick to proper nutrition, then the attacks are much less. That is, asthma reacts to air (dirty, cold, damp, flowering, mites in pillows, SARS) Only then can you come to the minimum dose. Everything must be done gradually.

In this article, you can read the instructions for using the drug Symbicort. Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Symbicort in their practice are presented. A big request to actively add your reviews about the drug: did the medicine help or not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Symbicort analogues in the presence of existing structural analogues. Use for the treatment of bronchial asthma and chronic obstructive pulmonary disease (COPD) in adults, children, as well as during pregnancy and lactation. The composition of the drug.

Symbicort- a combined drug for the treatment of bronchial asthma. Contains formoterol and budesonide, which have different mechanisms of action and show an additive effect in reducing the frequency of asthma exacerbations. The special properties of budesonide and formoterol make it possible to use their combination simultaneously as maintenance therapy and for the relief of attacks, or as maintenance therapy for bronchial asthma.

Budesonide is a glucocorticosteroid (GCS), after inhalation, it has a rapid (within several hours) and dose-dependent anti-inflammatory effect on the respiratory tract, reducing the severity of symptoms and the frequency of exacerbations of bronchial asthma. When prescribing budesonide in the form of inhalation, there is a lower incidence of serious adverse effects than when using systemic corticosteroids. Reduces the severity of edema of the bronchial mucosa, mucus production, sputum production and airway hyperreactivity. The exact mechanism of the anti-inflammatory action of GCS is unknown.

Formoterol is a selective beta2-adrenergic agonist. After inhalation, it causes a rapid and prolonged relaxation of the smooth muscles of the bronchi in patients with reversible airway obstruction. The bronchodilator effect is dose-dependent, occurs within 1-3 minutes after inhalation and persists for at least 12 hours after taking a single dose.

Symbicort Turbuhaler: budesonide + formoterol

Bronchial asthma

Clinical efficacy of Symbicort as maintenance therapy

With the combined use of formoterol and budesonide, the severity of symptoms of bronchial asthma decreases, lung function improves and the frequency of exacerbations of the disease decreases.

The effect of Symbicort Turbuhaler on lung function is comparable to that of the combination of budesonide and formoterol alone and exceeds that of budesonide alone. In all cases, a short-acting beta2-adrenergic stimulant was used to relieve seizures. There was no decrease in the anti-asthma effect over time. The drug is characterized by good tolerance.

While taking Symbicort Turbuhaler as maintenance therapy for 12 weeks in children aged 6 to 11 years (two inhalations of 80/4.5 mcg / inhalation 2 times a day), lung function improved and the drug was well tolerated, compared with appropriate dose of budesonide Turbuhaler.

Clinical efficacy of Symbicort as a maintenance therapy and for the relief of seizures

In a follow-up of 4447 patients treated with Symbicort as maintenance therapy and for the relief of attacks for 6 to 12 months, there was a statistically and clinically significant decrease in the number of severe exacerbations, an increase in the period to the onset of the first exacerbation compared with the combination of Symbicort or budesonide as maintenance therapy and beta2-agonist for relief of seizures. There was also an effective control over the symptoms of the disease, pulmonary function and a decrease in the frequency of inhalation prescriptions for relief of seizures. There was no development of tolerance to the prescribed therapy. In patients who sought medical help in connection with the development of an acute attack of bronchial asthma, after inhalation of Symbicort, the relief of symptoms (removal of bronchospasm) occurred as quickly and effectively as after the appointment of salbutamol and formoterol.

COPD

In patients with severe COPD (FEV1 = 36% before treatment with Symbicort) while taking the drug Symbicort Turbuhaler, there was a significant reduction in the frequency of exacerbations of the disease compared with patients who received only formoterol or placebo as therapy (mean frequency of exacerbations 1.4 compared with 1.8- 1.9 in the placebo/formoterol group). There was no difference between taking Symbicort Turbuhaler and formoterol in terms of FEV1 values.

Compound

Budesonide micronized + Formoterol fumarate dihydrate + excipients.

Pharmacokinetics

Symbicort Turbuhaler is bioequivalent to the respective mono-drugs (budesonide and formoterol) in terms of their systemic action. Despite this, there was a slight increase in cortisol suppression after taking Symbicort Turbuhaler compared with monotherapy. This difference does not affect clinical safety. There is no evidence of a pharmacokinetic interaction between budesonide and formoterol. The pharmacokinetic parameters of budesonide and formoterol were comparable after their administration in the form of monodrugs and as part of Symbicort Turbuhaler.

When using the combined drug, the AUC of budesonide was slightly higher, the absorption of the drug was faster and the Cmax was higher; Cmax formoterol coincided with that for a single drug. Inhaled budesonide is rapidly absorbed and reaches Cmax after 30 minutes. The average dose of budesonide that enters the lungs after inhalation through a turbuhaler is 32-44% of the delivered dose. Systemic bioavailability is approximately 49% of the delivered dose. In children aged 6 to 16 years, the average dose of budesonide that has entered the lungs after inhalation through a turbuhaler does not differ from that in adult patients (the final concentration of the drug in blood plasma was not determined).

Inhaled formoterol is rapidly absorbed and reaches Cmax 10 minutes after inhalation. Studies have shown that the average dose of formoterol that enters the lungs after inhalation through a turbuhaler is 28-49% of the delivered dose. Systemic bioavailability is about 61% of the delivered dose.

Plasma protein binding of budesonide is approximately 90%, formoterol is 50%.

Budesonide undergoes intensive biotransformation (about 90%) during the "first pass" through the liver with the formation of metabolites with low glucocorticoid activity. The metabolism of budesonide is carried out mainly with the participation of the CYP3A4 enzyme. Glucocorticoid activity of the main metabolites - 6-beta-hydroxybudesonide and 16-alpha-hydroxyprednisolone - does not exceed 1% of the similar activity of budesonide.

Formoterol is metabolized mainly in the liver by conjugation to form active O-demethylated metabolites, mainly in the form of inactivated conjugates.

There is no evidence of metabolite interactions or substitution reactions between budesonide and formoterol.

Budesonide is excreted in the urine as metabolites or in the form of conjugates, and only in a small amount - unchanged. Budesonide has a high systemic clearance (approximately 1.2 l/min).

After inhalation, 8-13% of the delivered dose of formoterol is excreted unchanged in the urine. Formoterol has a high systemic clearance (approximately 1.4 l / min); T1 / 2 averages 17 hours.

The pharmacokinetics of formoterol in children and in patients with renal insufficiency has not been studied.

Plasma concentrations of budesonide and formoterol may be increased in patients with liver disease.

Indications

• bronchial asthma (not adequately controlled by the use of inhaled glucocorticosteroids (GCS) and short-acting beta2-agonists as on-demand therapy, or adequately controlled by inhaled corticosteroids and long-acting beta2-agonists). Symbicort Turbuhaler 80/4.5 mcg/dose and 160/4.5 mcg/dose can be used as maintenance therapy and for the relief of seizures;
• COPD (symptomatic therapy in patients with severe COPD (FEV less than 50% of the estimated calculated level) and with a history of recurrent exacerbations in the presence of severe symptoms of the disease, despite therapy with long-acting bronchodilators).

Release form

Powder for inhalation dosed turbuhaler 80 mcg + 4.5 mcg (60 doses and 120 doses), 160 mcg + 4.5 mcg (60 doses and 120 doses), 320 mcg + 9 mcg (60 doses).

There are no other dosage forms, whether tablets, drops or solution.

Instructions for use and dosage

Symbicort Turbuhaler is not intended for the initial treatment of intermittent and mild persistent asthma.

The selection of the dose of the drugs that make up Symbicort Turbuhaler is carried out individually and depending on the severity of the disease. This must be taken into account not only when starting treatment with combined drugs, but also when changing the dose of the drug.

In the event that individual patients require a different combination of doses of active substances than in the preparation of Symbicort Turbuhaler, beta2-agonists and / or GCS should be prescribed separately in separate inhalers.

Bronchial asthma

Symbicort Turbuhaler 80/4.5 mcg/dose and 160/4.5 mcg/dose

Patients should be under constant medical supervision for adequate dose selection of Symbicort Turbuhaler. The dose should be reduced to the lowest dose that maintains optimal control of asthma symptoms. When complete control over the symptoms of bronchial asthma is achieved against the background of the minimum recommended dose of the drug, at the next stage, you can try the appointment of monotherapy with inhaled corticosteroids.

There are two approaches to prescribing therapy with Symbicort Turbuhaler:

• as a maintenance therapy, Symbicort Turbuhaler is prescribed for continuous maintenance therapy in combination with a separate short-acting beta2-adrenergic stimulant for the relief of seizures;
• as a maintenance therapy and for the relief of attacks, Symbicort Turbuhaler is prescribed both for continuous maintenance therapy and on demand when symptoms appear.

As maintenance therapy

The patient must always carry a separate inhaler with a short-acting beta2-adrenergic stimulant to stop attacks.

Adults (18 years and older) are prescribed Symbicort Turbuhaler 80/4.5 mcg/dose and 160/4.5 mcg/dose, 1-2 inhalations 2 times a day. If necessary, it is possible to increase the dose to 4 inhalations 2 times a day.

Adolescents (12-17 years old) are prescribed Symbicort Turbuhaler 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose, 1-2 inhalations 2 times a day.

Children over 6 years of age are prescribed Symbicort Turbuhaler 80 / 4.5 mcg / dose, 1-2 inhalations 2 times a day.

After achieving optimal control of asthma symptoms while taking the drug 2 times a day, it is recommended to titrate the dose to the lowest effective dose, up to 1 time per day, in cases where, in the opinion of the doctor, the patient requires maintenance therapy in combination with long-acting bronchodilators.

An increase in the frequency of use of short-acting beta2-adrenergic stimulants is an indicator of a deterioration in overall disease control and requires a review of anti-asthma therapy.

As maintenance therapy and for the relief of seizures

The patient must always have Symbicort Turbuhaler with him to stop attacks.

In this case, the drug is especially indicated for patients with insufficient control over bronchial asthma and the need for frequent use of drugs to stop attacks; with indications in the anamnesis of exacerbations of bronchial asthma that required medical intervention.

It is necessary to carefully monitor the occurrence of dose-dependent side effects in patients using a large number of inhalations to relieve seizures.

Adults (18 years and older) are given Symbicort Turbuhaler 80/4.5 mcg/dose and 160/4.5 mcg/dose; the recommended dose is 2 inhalations per day: 1 inhalation in the morning and evening, or 2 inhalations 1 time per day only in the morning or only in the evening. Some patients may be given a maintenance dose of Symbicort Turbuhaler 160/4.5 mcg/dose 2 inhalations twice daily. If symptoms occur, 1 additional inhalation is necessary. With a further increase in symptoms within a few minutes, another 1 additional inhalation is prescribed, but not more than 6 inhalations to stop 1 attack.

Usually no more than 8 inhalations per day are required, but you can increase the number of inhalations to 12 per day for a short time. In patients who use more than 8 inhalations per day, a revision of therapy is recommended.

Symbicort Turbuhaler 80/4.5 mcg/dose and 160/4.5 mcg/dose as maintenance therapy and for the relief of seizures is not recommended in children and adolescents under 18 years of age.

Symbicort Turbuhaler 320/9 mcg/dose

For adults (18 years and older), the drug is prescribed 1 inhalation 2 times a day. If necessary, it is possible to increase the dose to 2 inhalations 2 times a day. After achieving optimal control of asthma symptoms while taking the drug 2 times a day, it is recommended to titrate the dose to the lowest effective dose, up to 1 time per day.

Adolescents aged 12-17 years are prescribed 1 inhalation 2 times a day.

Patients should regularly visit a doctor to control the optimal dose of the drug. The dose should be reduced to the lowest dose that maintains optimal control of asthma symptoms. After achieving optimal control of asthma symptoms while taking the drug 2 times a day, it is recommended to titrate the dose to the lowest effective dose, up to 1 time per day, in cases where, in the opinion of the doctor, the patient requires maintenance therapy in combination with long-acting bronchodilators.

COPD

Adults are prescribed Symbicort Turbuhaler 160/4.5 mcg/dose 2 inhalations 2 times a day or Symbicort Turbuhaler 320/9 mcg/dose 1 inhalation 2 times a day.

There is no need for a special selection of the dose of the drug for elderly patients.

There are no data on the use of Symbicort Turbuhaler in patients with renal or hepatic insufficiency. Because Since budesonide and formoterol are eliminated primarily through hepatic metabolism, a slower elimination rate can be expected in patients with severe cirrhosis.

Rules for using a turbuhaler

The mechanism of action of the turbuhaler is such that when the patient inhales through the mouthpiece, air currents carry the medicinal substance with them into the respiratory tract.

The patient should be instructed:

• carefully study the "Instructions for Use" of the turbuhaler;
• inhale strongly and deeply through the mouthpiece to ensure that the optimal dose of the drug enters the lungs;
• never exhale through the mouthpiece;
• in order to minimize the possibility of developing a fungal infection of the oropharynx, rinse your mouth with water after each inhalation. It is also necessary to rinse your mouth with water after inhalation to relieve symptoms and in case of development of candidiasis of the oral mucosa and pharynx.

The patient may not taste or feel the drug after using the turbuhaler due to the small amount of substance delivered.

Instructions for using the turbuhaler

Turbuhaler is a multi-dose inhaler that allows you to dose and inhale the drug in very small doses. When inhaling, the powder from the turbuhaler is delivered to the lungs, so it is important that the patient inhales forcefully and deeply through the mouthpiece.

Before using the turbuhaler for the first time, it is necessary to prepare for work:

1. Unscrew and remove the cap.
2. Hold the inhaler vertically with the red dispenser down. Do not hold the inhaler by the mouthpiece while turning the dispenser. Turn the dispenser until it stops in one direction, and then also until it stops in the opposite direction. Carry out the described procedure twice.

Now the inhaler is ready for use, it is not required to repeat this procedure for preparing the turbuhaler before each use.

To receive a single dose, the patient must perform the following procedure:

1. Unscrew and remove the cap.
2. Hold the inhaler vertically with the red dispenser down. Do not hold the inhaler by the mouthpiece while turning the dispenser. In order to measure the dose, turn the dispenser all the way in one direction, and then also all the way in the opposite direction. A click will be heard during this procedure.
3. Exhale. Do not exhale through the mouthpiece.
4. Gently place the mouthpiece between your teeth, purse your lips and inhale strongly and deeply through your mouth. Do not chew or squeeze the mouthpiece with your teeth.
5. Remove the inhaler from your mouth before exhaling.
6. If inhalation of more than one dose is required, repeat steps 2-5.
7. Close the inhaler with a cap, check that the inhaler cap is carefully screwed on.
8. Rinse mouth with water without swallowing.

You can not remove the mouthpiece, because. it is attached to the inhaler and cannot be removed. The mouthpiece of the turbuhaler rotates but should not be rotated unnecessarily.

Since the amount of inhaled powder is very small, you may not feel the taste of the powder after inhalation.

However, absolutely precise compliance with the instructions ensures inhalation (inhalation) of the required dose of the drug.

If before taking the drug, the procedure for loading the inhaler was mistakenly repeated more than once, then when inhaling, patients will still receive one dose of the drug. The dose indicator will then show the total number of doses dispensed.

The sound that is heard when the inhaler is shaken is produced by the drying agent and not by the drug.

The need to replace the inhaler

The dose indicator shows the approximate number of doses remaining in the inhaler, the dose count for filling the turbuhaler starts from the 60th or 120th dose (depending on the total number of doses of the purchased turbuhaler). The indicator shows an interval of 10 doses, so it does not show every metered (loaded) dose.

Turbuhaler delivers the required dose of the drug, even if no change is visible in the dose indicator window.

The appearance of a red background in the dose indicator window means that 10 doses of the drug remain in the turbuhaler. When the number 0 appears on a red background in the middle of the dose window, the inhaler should be discarded.

Please note that even when the indicator window shows the number 0, the dispenser continues to rotate. However, the dose indicator stops recording the number of doses (stops moving) and the number 0 remains in the dose window of the inhaler.

cleaning

Clean the outside of the mouthpiece regularly (once a week) with a dry cloth. Do not use water or other liquids to clean the mouthpiece.

Disposal

Care should be taken when handling a used inhaler and be aware that some medication may remain inside the inhaler.

Side effect

• headache;
• psychomotor agitation;
• anxiety;
• nausea;
• dizziness;
• sleep disorders;
• depression;
• behavioral disorders (mainly in children);
• taste disorders;
• feeling of heartbeat;
• tachycardia;
• atrial fibrillation;
• supraventricular tachycardia;
• extrasystole;
• angina;
• fluctuations in blood pressure;
• tremor;
• candidiasis of the mucous membrane of the oral cavity and pharynx;
• slight irritation in the throat;
• cough;
• hoarseness;
• bronchospasm
• bruising;
• dermatitis;
• hives;
• angioedema;
• anaphylactic reactions;
• hypokalemia;
• symptoms of systemic action of corticosteroids (including adrenal hypofunction).

The systemic effect of inhaled corticosteroids can be observed when taking the drug in high doses for a long time.

Contraindications

• children's age up to 6 years (for all dosage forms);
• children under 12 years of age (for a dosage form containing budesonide 320 mcg + formoterol 9 mcg);
• hypersensitivity to budesonide, formoterol or inhaled lactose.

Use during pregnancy and lactation

There are no clinical data on the use of Symbicort Turbuhaler or the combined use of budesonide and formoterol during pregnancy.

During pregnancy, Symbicort should only be used when the expected benefit to the mother outweighs the potential risk to the fetus. Budesonide should be used at the lowest effective dose required to maintain adequate control of asthma symptoms.

It is not known whether budesonide and formoterol are excreted in human breast milk. Symbicort Turbuhaler may be given to breastfeeding women if the expected benefit to the mother outweighs the potential risk to the baby.

Use in children

Contraindicated in children under 6 years of age (for all dosage forms); in children under 12 years of age (for a dosage form containing budesonide 320 mcg + formoterol 9 mcg).

Symbicort Turbuhaler 80/4.5 mcg/dose and 320/9 mcg/dose is not indicated for the treatment of patients with severe asthma.

Symbicort Turbuhaler is not intended for the initial selection of therapy in the early stages of the treatment of bronchial asthma.

If the therapy is not effective enough or the maximum recommended doses of Symbicort are exceeded, it is necessary to reconsider the treatment tactics. Sudden and progressive worsening of asthma or COPD symptom control is a potentially life-threatening condition and requires urgent medical attention. In this situation, the possibility of increasing the dose of GCS should be considered, i.e. prescribing a course of oral corticosteroids or antibiotic treatment in case of infection.

Patients are advised to carry emergency medications at all times, or Symbicort Turbuhaler (for asthma patients using Symbicort Turbuhaler for maintenance and relief of attacks), short-acting beta2-agonists (for all patients using Symbicort Turbuhaler for maintenance therapy only) .

The patient's attention should be drawn to the need for a regular maintenance dose of Symbicort in accordance with the selected therapy, even in cases of the absence of symptoms of the disease. Inhalations of Symbicort Turbuhaler for the relief of seizures should be carried out only when symptoms occur, but the use of the drug is not indicated for regular prophylactic use, i.e. before physical activity. In such cases, the use of a separate short-acting bronchodilator is indicated.

If asthma symptoms are controlled, the dose of Symbicort Turbuhaler can be gradually reduced, and it is important to constantly monitor the condition of patients. Symbicort Turbuhaler should be given at the lowest effective dose.

Treatment with Symbicort should not be initiated during an exacerbation or significant worsening of asthma.

During therapy with Symbicort Turbuhaler, exacerbations and the development of serious adverse reactions associated with bronchial asthma may be noted. Patients should continue treatment, but seek medical attention if their asthma symptoms are not controlled or if the condition worsens after starting therapy.

As with any other inhalation therapy, paradoxical bronchospasm may occur with an immediate increase in wheezing after a dose of the drug. In this connection, treatment with Symbicort Turbuhaler should be discontinued, treatment tactics should be reviewed and, if necessary, alternative therapy should be prescribed.

A systemic effect may occur when taking any inhaled corticosteroids, especially when taking high doses of drugs for a long period of time. The manifestation of systemic action is less likely during inhalation therapy than with oral corticosteroids. Possible systemic effects include adrenal suppression, growth retardation in children and adolescents, decreased bone mineral density, cataracts and glaucoma.

It is recommended to regularly monitor the growth of children receiving inhaled corticosteroids for a long time. In the case of established growth retardation, therapy should be reviewed in order to reduce the dose of inhaled corticosteroids. It is necessary to carefully evaluate the ratio of the benefits of corticosteroid therapy to the possible risk of growth retardation. When choosing therapy, it is recommended to consult a pediatric pulmonologist.

Based on limited research data on long-term use of corticosteroids, it can be assumed that most children and adolescents receiving therapy with inhaled budesonide will eventually achieve normal adult growth rates. However, a slight (about 1 cm), short-term growth retardation was reported, mainly in the first year of treatment.

Due to the potential effect of inhaled corticosteroids on bone mineral density, special attention should be paid to patients taking the drug in high doses for a long time with risk factors for osteoporosis. Studies of long-term use of inhaled budesonide in children at an average daily dose of 400 mcg (metered dose) or in adults at an average daily dose of 800 mcg (metered dose) did not show a noticeable effect on bone mineral density. There are no data on the effect of the drug in high doses on bone mineral density.

If there is reason to believe that adrenal function was impaired during previous systemic corticosteroid therapy, precautions should be taken when transferring patients to treatment with Symbicort Turbuhaler.

The benefits of inhaled budesonide therapy generally minimize the need for oral corticosteroids, but patients who discontinue oral corticosteroid therapy may remain in adrenal insufficiency for a long time. Patients who in the past needed urgent high-dose corticosteroids, received long-term treatment with high-dose inhaled corticosteroids, may also be at this risk group. It is necessary to provide for the additional appointment of GCS during a period of stress or surgery. It is recommended to instruct the patient about the need to rinse the mouth with water after inhalation in order to prevent the development of candidiasis of the oral mucosa. It is also necessary to rinse your mouth with water after inhalation to relieve symptoms in case of development of candidiasis of the oral mucosa and pharynx.

Formoterol may cause QT interval prolongation, so the drug should be used with caution in patients with an extended QT interval.

The need for the use and dose of inhaled corticosteroids in patients with active or inactive forms of pulmonary tuberculosis, fungal, viral or bacterial infections of the respiratory system should be reconsidered.

Special precautions should be taken in patients with unstable bronchial asthma who use short-acting bronchodilators to relieve attacks during exacerbation of severe bronchial asthma, because. the risk of developing hypokalemia increases against the background of hypoxia and in other conditions, when the likelihood of developing symptoms of a hypokalemic effect increases. In such cases, it is recommended to control the content of potassium in the serum.

Reception by patients with acute bronchial obstruction of formoterol at a dose of 90 mcg for 3 hours is safe.

During treatment, the concentration of glucose in the blood should be monitored in patients with diabetes mellitus.

Symbicort Turbuhaler contains lactose (less than 1 mg/dose). Usually this amount does not cause adverse reactions in patients with lactose intolerance.

Influence on the ability to drive vehicles and control mechanisms

Symbicort Turbuhaler does not affect the ability to drive vehicles and control mechanisms. May affect the ability to drive vehicles and control mechanisms with the development of side effects.

drug interaction

With simultaneous ingestion of ketoconazole at a dose of 200 mg 1 time per day and budesonide at a dose of 3 mg, the plasma concentration of budesonide increases by an average of 6 times. When taking ketoconazole 12 hours after taking budesonide, the concentration of the latter in plasma increases by an average of 3 times. There is no information on such an interaction with budesonide when inhaled, but a noticeable increase in the concentration of the drug in the blood plasma should be expected. As data are not currently available for dose recommendations, this drug combination should be avoided. If this is not possible, then the intervals between taking ketoconazole and budesonide should be maximized. You should also consider reducing the dose of budesonide. Other potent inhibitors of CYP3A4 are also likely to significantly increase plasma levels of budesonide. Symbicort Turbuhaler is not recommended for maintenance therapy and for the relief of seizures in patients receiving potent inhibitors of CYP3A4.

Beta-adrenergic blockers may weaken or inhibit the action of formoterol. Symbicort Turbuhaler should not be co-administered with beta-blockers (including eye drops) unless absolutely necessary.

With the simultaneous use of Symbicort Turbuhaler and quinidine, disopyramide, procainamide, phenothiazines, antihistamines (terfenadine), MAO inhibitors and tricyclic antidepressants, it is possible to prolong the QTc interval and increase the risk of ventricular arrhythmias.

In addition, levodopa, levothyroxine, oxytocin and ethanol (alcohol) can reduce the tolerance of the heart muscle to beta2-agonists.

With the simultaneous appointment of MAO inhibitors, as well as drugs with similar properties (furazolidone, procarbazine), an increase in blood pressure is possible.

There is an increased risk of developing arrhythmias in patients undergoing general anesthesia with halogenated hydrocarbon preparations while using Symbicort Turbuhaler.

With the simultaneous administration of Symbicort Turbuhaler and other beta-adrenergic agonists, the side effects of formoterol may increase.

The hypokalemic effect of beta2-agonists can be enhanced with the simultaneous administration of xanthine derivatives, mineral derivatives of corticosteroids and diuretics. Hypokalemia increases the susceptibility to the development of arrhythmias in patients taking cardiac glycosides.

There was no interaction of budesonide with other drugs that are used to treat bronchial asthma.

Analogues of the drug Symbicort

Structural analogues for the active substance:

• Symbicort Turbuhaler.

Analogues for the therapeutic effect (drugs for the treatment of asthma):

• Asthmopent;
• Atrovent;
• Athonilum;
• Beclason;
• Beclomet Easyhaler;
• Benacort;
• Berlikort;
• Berodual;
• Berotek;
• Bricanil;
• Bronchosan;
• Budesonide;
• Ventolin;
• Hydrocortisone;
• Dexamethasone;
• Diprospan;
• Intal;
• Ifiral;
• Clenbuterol;
• Cortisone;
• Cromogen;
• Cromoglin;
• Xidiphon;
• Metipred;
• Montelar;
• Oxys Turbuhaler;
• Pentamine;
• Platifillin;
• Pliebecot;
• Polyoxidonium;
• Polcortolon;
• Prednisolone;
• Pulmicort;
• Pulmicort Turbuhaler;
• Retafil;
• Salamol;
• Salbuvent;
• Salbutamol;
• Salgim;
• Salmecort;
• Salmeter;
• Serevent;
• Seretide;
• Seretide Multidisk;
• Syngulex;
• Spofillin retard;
• Theotard;
• Theophylline;
• Triamcinolone;
• Flixotide;
• Celeston;
• Erespal;
• Eufillin;
• Euphylong.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases that the corresponding drug helps with and see the available analogues for the therapeutic effect.

An asthma attack is a medical emergency. As a rule, patients suffering from this disease have in their arsenal means for stopping an attack. However, a more formidable pathology is the development of croup or an infection-mediated inflammatory process of the upper respiratory tract in children. Due to the peculiarities of the anatomical structure and functioning, the friability of the submucosal layer and rich vascularization, the inflammatory process develops edema of the submucosal layer, which blocks the child's airways. Developed laryngospasm is a condition requiring emergency medical care. "Pulmicort" is a drug used to reduce swelling and facilitate breathing in this group of patients. Let's consider not only the drug itself, but also the analogue of "Pulmicort" for inhalation.

Pharmacological characteristics

Pulmicort is the trade name for a drug with a main active ingredient called budesonide. This is a glucocorticosteroid agent that exhibits a pronounced anti-inflammatory effect when applied topically.

Due to inhalation, budesonide penetrates both the initial and more distant areas, helping to reduce the swelling of the submucosal layer. When applied topically, budesonide does not have a systemic effect, which significantly reduces the frequency and severity of adverse reactions.

Indications for use

"Pulmicort" is used for a category of patients for whom the use of spraying the drug with compressed air or as a powder is unacceptable.

In addition, "Pulmicort" is used to stop croup in childhood (starting from 6 months) with further hospitalization in a medical institution.

Mode of application

Given that "Pulmicort" is a suspension for inhalation, the drug is administered using nebulizers, and the final effective dose that has an effect may vary depending on the device used.

In the case when an analogue of Pulmicort is used for inhalation in the form of a special inhaler, an effective dose for children can be provided by injecting two to three doses of the drug into an inhalation mask. The latter can be made from a plastic bottle by cutting it off from one end. The resulting edge must be sealed with adhesive tape and cotton wool, and an inhaler should be inserted into the second. Thus, without using Pulmicort, analogues for children can be inhaled by small children through such a mask.

Side effects

The drug "Pulmicort", despite the local effect, is able to have a resorptive effect, and cause side effects characteristic of glucocorticosteroids. Of course, the frequency and severity of these effects with inhalation use is much less than with systemic use. Among such systemic effects, one can note a delay in the growth and development of children, a decrease in bone density and its mineralization. In addition, clouding of the lens, decreased visual acuity and increased intraocular pressure are likely.

Conducted randomized studies indicate that "Pulmicort" with a high frequency causes hoarseness or cough with irritation of the mucous membrane of the throat.

Due to the immunosuppressive effect and the deposition of the drug on the surface of the oropharyngeal mucosa, the development of candidiasis is noted. For prophylactic purposes, it is necessary to rinse the mouth after each inhalation.

With a much lower frequency, Pulmicort is capable of causing disorders of the nervous system, which are manifested by nervousness, anxiety, depressive and behavioral disorders.

Allergic reactions are single, manifested by skin rash, dermatitis. Very rarely, angioedema and shock may occur.

Contraindications

The use of the drug is contraindicated in case of hypersensitivity, the occurrence of paradoxical bronchospasm. It is not recommended for use as an inhalation agent "Pulmicort" in patients with an open form of pulmonary tuberculosis, with fungal infections of the respiratory tract.

"Pulmicort" - analogues for children

To date, a large number of analogues of the drug "Pulmicort" are presented on the pharmaceutical market. Among them are Apulein, Benakap, Benacort, Benarin, Budesonide, Bunoster and many other drugs representing the Russian analogue of Pulmicort and containing glucocorticoid hormones.

But what if you do not want to use inhaled hormone-based drugs? You can use selective adrenomimetics, which are analogues (cheap) of Pulmicort. Refusal of hormonal drugs is often due to poor patient awareness of the drug or its high cost.

Among non-hormonal drugs that are an analogue of Pulmicort for inhalation, beta-adrenergic agonists can be recommended: Salbutomol, Ventlin. This group of drugs, due to the peculiarities of the mechanism of action, does not contribute to the removal of puffiness, however, it helps to increase the lumen of the bronchial tree by expanding the smooth muscles of the bronchi.

Seretide can be recommended as a combined drug that can be used as an analogue of Pulmicort for inhalation. In its composition, this drug contains the beta-adrenergic agonist salmeterol, as well as the inhaled glucocorticosteroid fluticasone propionate. The effectiveness of the use of this tool is achieved by expanding the lumen of the bronchial tree, as well as by providing a local anti-inflammatory effect on the bronchial tree. It is worth saying that Seretide is not a liquid for inhalation, it is a powder with a special inhaler. This requires careful attention to the procedure, however, this drug may well act as an analogue of "Pulmicort" for inhalation to a child of 4 years old.

The cost of "Pulmicort" and its analogues

Would you like to purchase medicines in which the active ingredient is budesonide - "Pulmicort", analogues? The price of the original drug is about 1000 rubles for 20 doses of 2 ml containing 0.25 mg/ml budesonide, and about 1400 rubles for 20 similar doses containing 0.5 mg/ml budesonide.

The price of drugs that have a different mechanism of action can vary significantly. For example, an aerosol for inhalation "Salbutamol" will cost only 95-100 rubles, and a combined "Seretide" in the form of an aerosol for inhalation will cost a little more than 2000 rubles.

Conclusion

With the help of the above medicines, the removal of an attack of bronchial asthma or croup in children at home becomes not such a complicated procedure. It is important to remember that croup is a direct indication for hospitalization in a medical institution.

If, after two or three inhalations of medicines, the baby does not breathe easier, be sure to call an ambulance and inform your doctor. And the last - if it is not possible to purchase a nebulizer, or it simply was not at hand at the right time, buy analogues (cheap) of Pulmicort.

In order to stop an asthma attack using an inhaler, it is necessary to choose the most appropriate and effective medication. Below you will learn about two similar drugs, their uses and side effects. After studying the composition and contraindications, you can stop at the most suitable for you. Be careful and always read the instructions for the drugs.

Characteristics of the drug "Symbicort"

Symbicort Turbuhaler is a combined drug for inhalation use against bronchodilator and inflammatory effects. This tool is available in the form of a powder, it is a small round granules of white or close to white. They include micronized budesonide and formoterol fumarate dihydrate, and also its auxiliary component is lactose monohydrate.

Symbicort is used in cases of bronchial asthma as a preventive measure for attacks, as well as for further maintenance therapy. In addition, this remedy is applicable in chronic obstructive pulmonary disease ( COPD) - the drug copes well with severe symptoms of this disease.

The following dosages of the Symbicort inhaler are available:

• Micronized budesonide - 80 mcg and 160 mcg / 4.5 mcg formoterol fumarate dihydrate.
• 320 mcg / 9 mcg respectively.

Frequent side effects: candidiasis of the mucous membrane, as well as the entire oral cavity, hoarseness with cough, slight irritation in the throat, a strong heartbeat, headaches, tremors, and bruising are noticed.

Characteristics of the drug "Pulmicort"

Pulmicort Turbuhaler is an inhaled glucocorticosteroid ( GKS) as a white powder for topical use. This powder breaks easily when pressed. It contains only one component - budesonide. This remedy has a good anti-inflammatory effect. The sooner a patient is prescribed treatment for chronic bronchial asthma with budesonide, the more improvement in the condition of his lungs is expected.

Pulmicort is also applicable in the case of bronchial asthma and COPD. This medication gives a preventive effect on bronchial asthma, but does not have a real treatment for the acute manifestations of this disease. Turbuhaler is a reusable inhaler that allows the patient to take small doses of the powder.

Pulmicort is available in the following dosages of budesonide:

• 200 doses of 100 mcg.
• 100 doses of 200 mcg.
• 200 doses of 200 mcg.

Frequent side effects are: irritation of the mucous membranes and oral cavity, oropharyngeal candidiasis, hoarseness in the voice and a strong cough.

Similarities between drugs

Both of these drugs, despite a long list of side effects and contraindications, have proven themselves in the pharmaceutical market on the positive side of many adults and even children. They cope well with bronchial asthma, obstructive diseases of the respiratory system and laryngotracheitis.

In addition, they relieve swelling well and perfectly restore breathing in diseases such as allergic rhinitis, hay fever and various infectious diseases of the respiratory tract. The main substance in both medicines is the glucocorticosteroid budesonide, with its help, edema is reduced and mucus is secreted, cough and various hoarseness completely disappear.

As for Symbicort, it also includes an additional chemical element - formoterol, which instantly affects the smooth muscles of the bronchi and quickly reduces the high severity of the symptoms of existing diseases.

The two drugs have identical absolute contraindications, namely: they cannot be used by a person under the age of 6 and if the patient has hypersensitivity to any of the substances of the drug.

Obvious drug differences

The difference between Symbicort and Pulmicort lies primarily in the forms of their release and methods of administration:

1. Symbicort is available only as a white powder, which is intended for inhalation use, but is not used in nebulizers.
2. Pulmicort is also available as a white powder, but it also comes in a liquid form. It must be used in a certain proportion with sodium chloride and used only in nebulizer inhalers.

The first drug has many more relative contraindications to its use, it is not recommended or should be used with extreme caution in people who are sick with: severe arterial hypertension, diabetes mellitus, thyrotoxicosis, aneurysms of any location, uncontrolled hypokalemia, pheochromocytoma. And also for those who suffer from idiopathic hypertrophic subaortic stenosis, long interval QT, severe heart failure, coronary heart disease and tachyarrhythmia.

Before using this or that remedy, seek the advice of a specialist.

Which of the medicines is better and what to choose

The use of the compared preparations is unacceptable for children who have not reached the age of 6 years. When prescribing a particular medication, check with your doctor whether the prescribed dosage is right for you. Since there are no pictures in the instructions for medicines for the correct use of the inhaler, you should ask your doctor to explain to you how to use it.

Since both medicines contain the same element, it makes no sense to use both drugs together. But many people being treated find it convenient to use them in turn, for example, at home it is more convenient for them to do inhalations with Pulmicort, and they use Symbicort Turbuhaler as a pocket inhaler.

These drugs are equally good, but Symbicort has many more contraindications, and Pulmicort is undesirable for use during pregnancy. Symbicort is often referred to as an expensive analogue of Pulmicort. This is a stronger drug, before using it, you must thoroughly study the instructions and side effects. Since this drug contains a considerable dose, doctors usually prescribe it when Pulmicort is ineffective. The price of this rather expensive analogue varies within 1300–2500 rubles, while the first medicine will cost you 3-4 times cheaper.

It is also worth noting that, according to studies by experts and pulmonologists, Symbicort, namely budesonide and formoterol, is much faster and more effective in stopping asthma attacks, and it also reduces the occurrence of all possible risks associated with the appearance of new unwanted exacerbations. That is why it is prescribed by professional doctors when the patient does not notice an improvement in the condition when using Pulmicort.