budesonide/formoterol/glycopyrrolate (Breztri Aerosphere)
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Indications
- maintenance treatment of COPD
- predominantly benefits patients with elevated blood eosinophil count (> 300 x 10E6/L)[3]
Contraindications
- not indicated for relief of acute bronchospasm or for treatment of asthma
Dosage
- 2 inhalations of twice daily
Inhalation: budesonide (160 ug), glycopyrrolate (9 ug), & formoterol fumarate (4.8 ug) per inhalation
Adverse effects
- > 2%
- upper respiratory tract infection
- pneumonia
- back pain
- oral candidiasis
- influenza
- muscle spasm
- urinary tract infection (2.6% vs 2.3% with placebo)
- cough (4.0% vs 2.7% with placebo)
- sinusitis
- diarrhea
- due to budesonide
- due glycopyrrolate
Drug interactions
- strong cytochrome P450 3A4 inhibitors (ritonavir) may result in systemic glucocorticoid (dexamethasone) effects
- other adrenergic drugs may potentiate effect
- diuretics, xanthine derivatives or steroids may potentiate hypokalemia or ECG changes
- monoamine oxidase inhibitors & tricyclic antidepressants
- beta-blockers may block bronchodilatory effects of beta-agonists & result in bronchospasm
- anticholinergics may interact additively with glycopyrrolate
Laboratory
- complete blood count
- eosinophil count: > 300 x 10E6/L[3]
Mechanism of action
- glucocorticoid/long-acting beta-2 agonist/long-acting muscarinic antagonist combination (triple therapy)
- both 160 & 320 ug of budesonide reduce rates of moderate to severe COPD exacerbations relative to dual therapy[1]
- only 320 ug dose of budesonide reduces mortality[1]
Notes
- marketed by Atra-Zeneca
More general terms
Components
- budesonide (Rhinocort, Pulmicort, Turbuhaler, Flexhaler, Entocort EC, Uceris, Cortiment, Eohilia)
- formoterol (Foradil, Perforomist)
- glycopyrrolate (Robinul, Cuvposa, Qbrexza)
References
- ↑ 1.0 1.1 1.2 Boyles S Triple Treatment Reduces COPD Exacerbations. Also a suggestion of reduced mortality with one dose level, large multicenter ETHOS trial finds. MedPage Today June 25, 2021 https://www.medpagetoday.com/meetingcoverage/ats/87261
- ↑ Rabe KF, Martinez FJ, Ferguson GT et al Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD. N Engl J Med 2020; 383:35-48 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32579807 https://www.nejm.org/doi/full/10.1056/NEJMoa1916046
- ↑ 3.0 3.1 3.2 Labaki WW, Rosenberg SR. Chronic obstructive pulmonary disease. Ann Intern Med 2020 Aug 4; 173:ITC17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32745458
Agusti A, Celli BR, Criner GJ et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD executive summary. Am J Respir Crit Care Med. 2023 Apr 1;207(7):819-837. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36856433 PMCID: PMC10111975 Free PMC article https://www.atsjournals.org/doi/10.1164/rccm.202301-0106PP - ↑ HIGHLIGHTS OF PRESCRIBING INFORMATION BREZTRI AEROSPHERE<TM> (budesonide, glycopyrrolate, &formoterol fumarate) inhalation aerosol, for oral inhalation use https://den8dhaj6zs0e.cloudfront.net/50fd68b9-106b-4550-b5d0-12b045f8b184/9d44f9af-438a-448b-bb5c-dae506e17e49/9d44f9af-438a-448b-bb5c-dae506e17e49_viewable_rendition__v.pdf