Jentadueto
Jentadueto
Generic Name
Jentadueto
Mechanism
- Budesonide – glucocorticoid receptor agonist that suppresses transcription of pro‑inflammatory mediators (IL‑4, IL‑5, IL‑13, TNF‑α, etc.) → ↓ eosinophil recruitment, ↓ mucus production, ↓ airway hyper‑reactivity.
- Formoterol – high‑affinity β₂‑adrenergic agonist → Gαs activation → ↑cAMP → smooth‑muscle relaxation, bronchodilation, and anti‑inflammatory modulation.
- Synergy – LABA improves steroid penetration along the airway mucosa, while steroid reduces tachyphylaxis of β₂ receptors, producing superior control vs monotherapy.
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Pharmacokinetics
| Parameter | Budesonide | Formoterol |
| Absorption | Pulmonary deposition; ~1–2 µg systemic | Pulmonary; peak ~30 min |
| Distribution | Highly protein‑bound (>90 %) | Protein‐bound ~73 % |
| Metabolism | CYP3A4 (micronutrient‑dependent) | CYP2D6, CYP3A4, CYP1A2 |
| Half‑life | 1.5–2 h (systemic) | 10–12 h (systemic) |
| Elimination | Mainly feces via liver → bile → 80 %; urine 11 % | Urine 39 %, feces 53 % |
| Drug interactions | ↑CYP3A4 inhibitors ↑ systemic budesonide → ↑adrenal suppression (e.g., ketoconazole, ritonavir) | ↑CYP2D6/CYP3A4 inhibitors ↑ formoterol → ↑ bronchospasm risk (e.g., fluconazole, fluvoxamine) |
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Indications
- Maintenance treatment of asthma in patients aged 12 + years (including pregnant women, with caution).
- Evidence‑based reduction in exacerbations, hospitalisations, and oral steroid use compared with budesonide or formoterol alone.
- Not indicated for acute rescue therapy, COPD, or sinus disease.
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Contraindications
| Category | Key Points |
| Contraindicated | Hypersensitivity to budesonide, formoterol, or excipients. |
| Warnings |
• Respiratory infections – potential exacerbation; use with caution in viral or bacterial pneumonia. • Adrenal suppression – especially with high systemic exposure (CYP3A4 inhibitors). • Growth inhibition – monitor height velocity in adolescents. • Ocular side‑effects – increased intra‑ocular pressure, cataracts with long‑term use. |
| Precautions |
• Use spacer to minimize oropharyngeal deposition. • Adequate vaccination (influenza, pneumococcal) before commencement. • Pregnancy: category C – use only if benefits outweigh risks. |
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Dosing
| Population | Dose (standard) | Frequency | Notes |
| Adults & Adolescents (≥12 yr) | 2 puffs (0.25 mg budesonide + 5 µg formoterol) | *Twice daily* (morning & night) | Initiate with 2 puffs BID; titrate to 4 puffs BID if uncontrolled. |
| Dose adjustment | *None* for mild hepatic impairment; maintain 2 puffs if clinically needed. | ||
| Usage | Dry powder inhaler (DPI) – inhale two complete puffs, pause 30 s between puffs. | ||
| Tapering | Gradual dose reduction over ≥4 weeks if asthma control achieved. |
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Adverse Effects
| Class | Examples |
| Respiratory | Oral thrush, hoarseness, cough, dyspnea (rare). |
| Endocrine | Growth suppression in children, adrenal suppression (rare with systemic levels). |
| Ophthalmic | Elevated intra‑ocular pressure, cataracts (long‑term). |
| Skin | Rash, pruritus. |
| Cardiovascular | Palpitations, tachycardia (rare). |
| Serious | Asthma exacerbation due to β₂ agonist withdrawal, Stevens‑Johnson syndrome, hypersensitivity reactions. |
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Monitoring
- Pulmonary Function – FEV₁, peak expiratory flow at baseline & every 3 months.
- Growth – height velocity in adolescents (baseline + every 6 months).
- Adrenal Function – short ACTH stimulation test if prolonged high dose or systemic symptoms.
- Visual – fundoscopic exam if visual changes; baseline IOP in high‑risk patients.
- Blood Pressure, Heart Rate – monitor for tachycardia or hypertension in high-dose therapy.
- Compliance – review inhaler technique quarterly.
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Clinical Pearls
1. Use a spacer (or valved holding chamber) to maximize lung deposition and minimise oropharyngeal absorption, reducing thrush and systemic side‑effects.
2. For severe asthma, begin at 2 puffs BID; if FEV₁ < 80 % predicted or ≥2 exacerbations/quarter, upswitch to 4 puffs BID.
3. Avoid abrupt cessation of formoterol; taper dose over 4 weeks to prevent rebound bronchoconstriction.
4. Mouth rinse and dry after each use; consider chlorhexidine mouthwash in patients with frequent candidiasis.
5. Drug‑drug interaction check: counsel patients on potential β₂ agonist interactions with CYP2D6 or CYP3A4 inhibitors (e.g., fluconazole, ritonavir).
6. In pregnancy or lactation, use the minimal effective dose; cross‑reference with pregnancy‑specific asthma guidelines.
7. Stepwise approach: align Jentadueto use with GINA step‑6 therapy when inhaled steroid + LABA combination is required for persistent control.
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• References
• Global Initiative for Asthma (GINA) 2025 Strategy Report.
• FDA Label – Jentadueto (Budesonide/Formoterol Fumarate Dihydrate).
• UpToDate: Long‑acting β₂‑agonist / inhaled corticosteroid combinations.
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• *Prepared for medical students & healthcare professionals seeking a concise, SEO‑friendly knowledge resource on Jentadueto.*