DuoResp Spiromax 160micrograms / dose / 4.5micrograms / dose dry powder inhaler (Teva UK Ltd) 120 dose

Type Dry powder inhaler (DPI)
Medicine Budesonide 200micrograms/dose + Formoterol 6micrograms/dose
Adult steroid dose Low adult steroid dose
Medium adult steroid dose
Activation mechanism Breath actuated
Dose counter Has dose counter
Price £27.97 / 30 days
(based on 4 puffs / day)
Inhaled corticosteroid information For adults, a total of 2 puffs/day gives a low dose of ICS whilst 4 puffs/day gives a medium dose
Steroid safety card recommendation (for adults) Steroid safety card not always required, but recommended for medium doses
Licences
  • Adult Asthma Licence
  • COPD Licence

Training material

Pathways

The use of each medicine included in Right Breathe has been considered in relation to international, national, and regional prescribing pathways. The pathway points at which this medicine is considered a viable prescribing option are included below. If you wish to view the entire pathway, click on its heading, from where you can also access all the prescribing options for each pathway and each pathway point.

Prescribing

Detailed prescribing information is provided below. This content has not been generated by the RightBreathe team, but has been integrated from a 3rd party solution: Multilex (provided by FirstDataBank). Use of this prescribing content is subject to the FirstDataBank disclaimer, which is set out in the "About" section of RightBreathe.

As RightBreathe is a bespoke decision support tool, it covers each and every individual known inhaler option on the UK market to a high level of specificity. Multilex, as a more general resource, does not offer the same level of specificity. There are therefore a small number of medicines for which there are discrepancies between RightBreathe and Multilex content, most notably in relation to licensed particulars and associated licensed doses.

Given the high level of specificity the RightBreathe team work to, details of the individual inhaler licence are most likely to be summarised accurately in the content provided at the top of this page, rather than in the Multilex content below. Where there is ambiguity, users may also wish to refer to individual summaries of product characteristics prior to prescribing.

Dosing

Chronic obstructive pulmonary disease (FEV1<70% predicted normal)

Type Age Range Dose Licensed
Maintenance From 18 years 2 actuations - TWICE a DAY - inhalation

Asthma: Maintenance

Type Age Range Dose Licensed
Maintenance From 12 years to 18 years 1 actuation - ONCE a DAY - inhalation - using a metered dose device
Maintenance From 18 years 1 actuation - ONCE a DAY - inhalation - using a metered dose device
Maintenance From 18 years 1 actuation - TWICE a DAY - inhalation - using a metered dose device
Maintenance From 12 years to 18 years 1 actuation - TWICE a DAY - inhalation - using a metered dose device
Maintenance From 18 years 2 actuations - ONCE a DAY - inhalation - using a metered dose device
Maintenance From 12 years to 18 years 2 actuations - ONCE a DAY - inhalation - using a metered dose device
Maintenance From 12 years to 18 years 2 actuations - TWICE a DAY - inhalation - using a metered dose device
Maintenance From 18 years 2 actuations - TWICE a DAY - inhalation - using a metered dose device
Maintenance From 18 years 3 actuations - TWICE a DAY - inhalation - using a metered dose device
Maintenance From 18 years 4 actuations - TWICE a DAY - inhalation - using a metered dose device

Asthma: Maintenance and reliever therapy

Type Age Range Dose Licensed
Maintenance From 12 years to 18 years 1 actuation - TWICE a DAY - an additional actuation may be taken to relieve symptoms, followed by a further actuation after a few minutes if needed - inhalation - using a metered dose device - Maximum dose 8 actuations DAILY
Maintenance From 18 years 1 actuation - TWICE a DAY - an additional actuation may be taken to relieve symptoms, followed by a further actuation after a few minutes if needed - inhalation - using a metered dose device - Maximum dose 8 actuations DAILY
Maintenance From 18 years 2 actuations - ONCE a DAY - an additional actuation may be taken to relieve symptoms, followed by a further actuation after a few minutes if needed - inhalation - using a metered dose device - Maximum dose 8 actuations DAILY
Maintenance From 12 years to 18 years 2 actuations - ONCE a DAY - an additional actuation may be taken to relieve symptoms, followed by a further actuation after a few minutes if needed - inhalation - using a metered dose device - Maximum dose 8 actuations DAILY
Maintenance From 18 years 2 actuations - TWICE a DAY - an additional actuation may be taken to relieve symptoms, followed by a further actuation after a few minutes if needed - inhalation - using a metered dose device - Maximum dose 8 actuations DAILY
Maintenance From 12 years to 18 years 2 actuations - TWICE a DAY - an additional actuation may be taken to relieve symptoms, followed by a further actuation after a few minutes if needed - inhalation - using a metered dose device - Maximum dose 8 actuations DAILY

Safety Advice Warnings

Adverse effects (report/action)

  • Corticosteroids may cause growth retardation in children under 18 years
  • During transfer from oral steroids allergic conditions may be unmasked
  • High doses may affect bone metabolism
  • If growth in children is slowed, consider referral to a paediatrician
  • If visual disturbances occur, perform ophthalmic evaluation
  • May reduce serum potassium levels
  • Prolonged or high dose may lead to adrenal suppression
  • Systemic effects possible with any inhaled corticosteroid

Advice concerning formulation

  • Not all available brands are indicated for all uses

Advice on Administration

  • Consider use of a spacer device for suitable patients and formulations

Advice on drug withdrawal

  • Do not withdraw this drug suddenly

Advice on possible excipients

  • Contains lactose

Discontinue due to test or exam

  • Discontinue if paradoxical bronchospasm occurs

Dose changes (other conditions)

  • Maintain treatment at the lowest effective dose
  • Not licensed for all indications in all age groups

Patient Counselling

  • Advise patient to rinse mouth with water after each dose
  • Advise patient to seek medical advice if treatment is ineffective
  • Advise patients to avoid chickenpox, measles etc - see doctor if exposed
  • Advise visual disturbances may affect ability to drive or operate machinery
  • Consider need for patient to carry a Steroid Treatment Card
  • Ensure patient has a fast acting bronchodilator available
  • Patient should seek medical advice if signs of pulmonary infection develop
  • Patients may not taste/feel any medication when using dry powder inhalers
  • Use regularly to maintain freedom from symptoms

Pre-treatment points to consider

  • Therapy should not be initiated during exacerbation of asthma

Recommended monitoring

  • Check patient is using correct inhaler technique
  • Consider monitoring ECG in patients at risk of QT prolongation
  • Monitor adrenal function in stressed patients e.g.surgery/intensive care
  • Monitor blood glucose closely in patients with diabetes mellitus
  • Monitor for signs/symptoms of pneumonia in patients at risk
  • Monitor regularly the height of children receiving prolonged treatment
  • Monitor serum potassium regularly in severe asthmatic or hypoxic patients
  • Re-evaluate therapy in active or quiescent pulmonary tuberculosis

Safety/advice in other condition

  • Caution in transfer from oral steroids in adrenal insufficiency
  • Systemic corticosteroids may be needed during elective surgery
  • Systemic corticosteroids may be needed during periods of stress

Drug Interactions

With Risk Severity
ATOMOXETINE May increase risk of cardiac effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
BETA BLOCKERS effect antagonised by Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
BETA BLOCKERS AND THIAZIDE DIURETICS effect antagonised by Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
DOMPERIDONE Predisposing factors may increase risk of arrhythmias Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
LEVACETYLMETHADOL Hypokalaemia with high dose beta-agonist increases risk of arrhythmias Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
SOTALOL Effect antagonised/ predisposing factors increase risk of arrhythmias Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
AJMALINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AMIODARONE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ANAGRELIDE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ARSENIC TRIOXIDE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ARTEMETHER AND LUMEFANTRINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ASTEMIZOLE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AZITHROMYCIN Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CHLOROQUINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CILOSTAZOL Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CIPROFLOXACIN Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CITALOPRAM / ESCITALOPRAM Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CLARITHROMYCIN Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
COCAINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DELAMANID Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DISOPYRAMIDE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DRONEDARONE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DROPERIDOL Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ERYTHROMYCIN Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ETELCALCETIDE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
FLECAINIDE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
FLUCONAZOLE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HALOFANTRINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HALOPERIDOL Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HYDROXYZINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
INOTUZUMAB Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
LEVOFLOXACIN Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
METHADONE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MOXIFLOXACIN Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ONDANSETRON Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
OSIMERTINIB Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
OXALIPLATIN Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PAPAVERINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PENTAMIDINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PHENOTHIAZINES (QT 1) Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PIMOZIDE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PROPOFOL Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
QUINIDINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
RETIGABINE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SEVOFLURANE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SODIUM STIBOGLUCONATE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SULPIRIDE Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
TERLIPRESSIN Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
VANDETANIB Predisposing factors may increase risk of arrhythmias Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ACE INHIBITORS WITH THIAZIDE DIURETICS Increased risk of hypokalaemia with high doses of beta agonist Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ACETAZOLAMIDE Increased risk of hypokalaemia with high doses of beta agonist Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ANGIOTENSIN II INHIBITORS AND THIAZIDE DIURETICS Increased risk of hypokalaemia with high doses of beta agonist Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BETA BLOCKER EYE DROPS effect antagonised by Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
CORTICOSTEROIDS Increased risk of hypokalaemia with high doses of both drugs Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
LOOP DIURETICS Increased risk of hypokalaemia with high doses of beta agonist Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
THEOPHYLLINE Increased risk of hypokalaemia with high doses of beta agonist Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
THIAZIDE DIURETICS Increased risk of hypokalaemia with high doses of beta agonist Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.

Precautions

  • Adrenal insufficiency
  • Arterial aneurysm
  • Breastfeeding
  • Children aged 6 to 18 years
  • Diabetes mellitus
  • Electrolyte imbalance
  • Family history of long QT syndrome
  • Galactosaemia
  • Glucose-galactose malabsorption syndrome
  • Hepatic cirrhosis
  • History of torsade de pointes
  • Hypertrophic obstructive cardiomyopathy
  • Hypokalaemia
  • Idiopathic subvalvular aortic stenosis
  • Ischaemic heart disease
  • Lactose intolerance
  • Major risk factors for decreased bone mineral content
  • Phaeochromocytoma
  • Pregnancy
  • Pulmonary tuberculosis
  • Severe cardiac failure
  • Severe cardiovascular disorder
  • Severe hypertension
  • Tachyarrhythmia
  • Thyrotoxicosis

Contraindications

  • Children under 6 years
  • Long QT syndrome
  • Torsade de pointes

Side Effects

  • Adrenal suppression
  • Aggression
  • Anaphylactic reaction
  • Angina
  • Angioedema
  • Anxiety
  • Atrial fibrillation
  • Behavioural disturbances
  • Blood pressure changes
  • Blurred vision
  • Bronchospasm (paradoxical)
  • Bruising
  • Candidiasis (mouth or throat)
  • Cardiac arrhythmias
  • Cataracts
  • Cough
  • Cushing's syndrome
  • Decrease in bone mineral density
  • Depression
  • Dermatitis
  • Dizziness
  • Exanthema
  • Extrasystoles
  • Glaucoma
  • Headache
  • Hoarseness
  • Hyperglycaemia
  • Hypersensitivity reactions
  • Hypokalaemia
  • Increase in blood levels of free fatty acids
  • Increase in blood levels of glycerol
  • Increase in blood levels of insulin
  • Increase in blood levels of ketones
  • Muscle cramps
  • Nausea
  • Palpitations
  • Pneumonia
  • Prolongation of QT interval
  • Pruritus
  • Psychomotor hyperactivity
  • Sleep disturbances
  • Suppression of growth in children and adolescents
  • Supraventricular tachycardia
  • Tachycardia
  • Taste disturbances
  • Throat discomfort
  • Tremor
  • Urticaria
  • Visual disturbances