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Symbicort forte Turbuhaler

(Parallellimporterat)
Teva

Inhalationspulver 320 mikrogram/9 mikrogram/inhalation
Avregistreringsdatum: 2010-09-30 (Tillhandahålls ej)

Observera att inhalatorn är märkt 400/12 ug/dose.

Kombination av bronkdilaterare och inflammationshämmande medel för inhalation vid astma.

Visa information om det parallellimporterade läkemedlet
Aktiva substanser:
ATC-kod: R03AK07
För information om det avregistrerade läkemedlet omfattas av Läkemedelsförsäkringen, kontakta Läkemedelsförsäkringen.
Läs mer om avregistrerade läkemedel

Miljöinformation

Miljöpåverkan (Läs mer om miljöpåverkan)

Miljöinformationen för budesonid är framtagen av företaget AstraZeneca för Budfor, Edoflo, Eltren, Eltren forte, Eltren mite, Gardette, Gardette forte, Gardette mite, Pulmicort®, Pulmicort® Turbuhaler®, Rhinocort® Turbuhaler®, Symbicort, Symbicort® Turbuhaler®, Symbicort® forte Turbuhaler®, Symbicort® mite Turbuhaler®

Miljörisk: Användning av budesonid har bedömts medföra försumbar risk för miljöpåverkan.
Nedbrytning: Budesonid är potentiellt persistent.
Bioackumulering: Budesonid har låg potential att bioackumuleras.


Läs mer

Detaljerad miljöinformation

PEC/PNEC = 0.011/8.6 = 0.0013

PEC/PNEC ≤ 0.1


Environmental Risk Classification


Predicted Environmental Concentration ( PEC)


PEC is based on following data and calculated using the equation outlined in the fass.se guidance (Ref 1):


PEC (µg/L) = (A*109*(100-R))/(365*P*V*D*100)


PEC (µg/L) = 1.5*10-6*A*(100-R)


A (Kg/year)= 70.8 kg total sold amount API in Sweden year 2016, data from QuintilesIMS.

R (%) = removal rate (due to loss by adsorption to sludge particles, by volatilization,

hydrolysis or biodegradation) = 0

P = number of inhabitants in Sweden = 9 *106

V (L/day) = volume of wastewater per capita and day = 200 (default, Ref 1)

D = factor for dilution of waste water by surface water flow = 10 (default, Ref 1)

(Note: The factor 109 converts the quantity used from kg to μg)


PEC = 1.5 * 10-6 *70.8 * (100-0) = 0.011 µg/L


Metabolism and excretion

After oral inhalation budesonide undergoes an extensive degree (>90%) of biotransformation to metabolites of low corticosteroid activity on first passage through the liver. The activity of the major metabolites, 6β-hydroxy-budesonide and 16α-hydroxy-prednisolone, is less than 1% of the parent compound. The plasma elimination half-life is approximately 4 hours. No or trace amounts of unchanged drug were found in the urine after intravenous administration (Ref 2).


Only trace amounts of budesonide are excreted unchanged in the urine of patients. As such, environmental exposure of budesonide resulting from patient use is expected to be negligible; however the PEC does not take into consideration metabolism and therefore provides a worst-case exposure senario.


PNEC (Predicted No Effect Concentration)


Ecotoxicity Data

Study Type

Method

Result

Reference

Toxicity to green algae, Pseudokirchinella subcapitata, growth inhibition test

OECD 201

72 hour NOEC (growth rate) = 5.6 mg/L

72 hour LOEC (growth rate) = 8.6 mg/L

72 hour EC50 (growth rate) > 8.6 mg/L

72 hour NOEC (biomass) = 5.6 mg/L

72 hour LOEC (biomass) = 8.6 mg/L

72 hour EC50 (biomass) > 8.6 mg/L

3

Acute toxicity to the giant water flea, Daphnia magna

OECD 202

48 hour EC50 (immobility) >14 mg/L

4

Acute toxicity to Rainbow Trout, Oncorhynchus mykiss

OECD 203

96 hour LC50 (mortality) > 13 mg/L

5

NOEC No Observed Effect Concentration

LOEC Lowest Observed Effect Concentration

EC50 the concentration of the test substance that results in a 50% effect

LC50 the concentration of the test substance that results in a 50% mortality


Environmental risk classification (PEC/PNEC ratio)

Short-term tests have been undertaken for species from three trophic levels, based on internationally accepted guidelines. For all three species, the EC50 values were greater than the highest test concentration and the limit of solubility of budesonide in the test medium. Therefore, to obtain a worst case PNEC value, the lowest limit of solubility of budesonide in the test media, reported for the algal study, is used. The PNEC is based on the lowest >EC50 value 8.6 mg/L (equivalent to 8600 µg/L) and an assessment factor of 1000 is applied, in accordance with ECHA guidance (Ref. 6).


PNEC = 8600 /1000 = 8.6 μg/L


Environmental risk classification (PEC/PNEC ratio)

PEC = 0.011 µg/L

PNEC = 8.6 µg/L

PEC/PNEC = 1.3 x 10-3


The Pec/PNEC ratio is < 0.1 which justifies the phrase "Use of budesonide has been considered to result in insignificant environmental risk".


In Swedish: “Användning av budesonid har bedömts medföra försumbar risk för miljöpåverkan” under the heading “Miljörisk”.


Environmental Fate Data


Environmental Fate Data for Budesonide

Study Type

Method

Result

Reference

Aerobic biodegradation

OECD301E

Degradation after 7 days <8 %

Not readily biodegradable

7


Degradation


Biotic degradation

Budesonide is not biologically readily biodegradable (Ref 7). Since data from further degradation tests is lacking, the phrase ‘Budesonide is potentially persistent’ is used under the heading Biodegradation.

In Swedish: ”Läkemedlet är potentiellt persistent” under the heading ”Nedbrytning”.


Bioaccumulation

Budesonide is not ionisable within the environmentally relevant pH range. The Log octanol-water partition coefficient is 3.3, measured at pH 7.4. Since Log P < 4, budesonide has low potential to bioaccumulate and the phrase “Budesonide has low potential for bioaccumulation” is assigned.


In Swedish: Budesonid har låg potential att bioackumuleras” under the heading ’Bioackumulering’.


Physical Chemistry Data


Study Type

Method

Result

Reference

Solubility Water 

Unknown

14 mg/L at 25oC

8

Octanol-Water Partition Coefficient

Unknown

Log Kow = 3.3

 

References

  1. Fass.se (2012). Environmental classification of pharmaceuticals at www.fass.se: Guidance for pharmaceutical companies https://www.fass.se/pdf/Environmental_classification_of_pharmaceuticals-120816.pdf.pdf  

  2. Investigator’s Brochure. Drug Substance Budesonide/formoterol. Project Code D5890000000. Edition Number 9. Date 31 May 2016.

  3. Budesonide: Toxicity to the green alga Selenastrum capricornutum. Bowles A.J. Brixham Environmental Laboratory Report BL8078/B. May 2005.

  4. Budesonide: Acute toxicity to Daphnia magna. Bowles A.J. Brixham Environmental Laboratory Report BL8079/B. May 2005.

  5. Budesonide: Acute toxicity to rainbow trout (Oncorhynchus mykiss). Bowles A.J. Brixham Environmental Laboratory Report BL8080/B. May 2005.

  6. ECHA (European Chemicals Agency) 2008. Guidance on information requirements and chemical safety assessment. Chapter R.10: Characterisation of dose [concentration]-response for environment http://guidance.echa.europa.eu/docs/guidance_document/information_requirements_en.htm 

  7. Nedbrytbarhetsförhållanden för läkemedelssubstansen A002. Institutet för vatten- och luftvårdsforskning (IVL). IVL-rapport A92017. (Safety Assessment rapport SR99433-01).

  8. Budesonid - preformuleringsrapport. Report no. 83 – 014. Draco, Lund, Sweden. 1 February 1983.

Miljöinformationen för formoterol är framtagen av företaget AstraZeneca för Bevespi Aerosphere, Brimica Genuair, Budfor, Duaklir Genuair, Edoflo, Eltren, Eltren forte, Eltren mite, Gardette, Gardette forte, Gardette mite, Oxis® Turbuhaler®, Symbicort, Symbicort® Turbuhaler®, Symbicort® forte Turbuhaler®, Symbicort® mite Turbuhaler®

Miljörisk: Användning av formoterol har bedömts medföra försumbar risk för miljöpåverkan.
Nedbrytning: Formoterol är potentiellt persistent.
Bioackumulering: Formoterol har låg potential att bioackumuleras.


Läs mer

Detaljerad miljöinformation


PEC/PNEC = 0.00015 μg/L /94 μg/L = 1.6*10-6 → PEC/PNEC = ≤ 0.1


Environmental Risk Classification

Predicted Environmental Concentration (PEC)


PEC is based on following data:


PEC (µg/L) = (A*109*(100-R))/(365*P*V*D*100)

PEC (µg/L) = 1.5*10-6*A*(100-R)


A (kg/year) = total sold amount API in Sweden year 2017, data from IQVIA (former IMS Health and Quintiles). 

R (%) = removal rate (due to loss by adsorption to sludge particles, by volatilization,

hydrolysis or biodegradation) = 0 if no data is available.

P = number of inhabitants in Sweden = 9 *106

V (L/day) = volume of wastewater per capita and day = 200 (ECHA default) (Ref.1)

D = factor for dilution of waste water by surface water flow = 10 (ECHA default) (Ref.1)

(Note: The factor 109 converts the quantity used from kg to μg).


A =  1.00 kg

R = 0


PEC = 1.5 * 10-6 * 1.00 * (100-0) = 0.00015 μg/L


(Note: Whilst formoterol is metabolised in humans, little is known about the ecotoxicity of the metabolites. Hence, as a worst case, for the purpose of this calculation, it is assumed that 100% of excreted metabolites have the same ecotoxicity as parent formoterol).


Metabolism and excretion


The major part of the dose of formoterol fumarate dihydrate is eliminated via metabolism. After inhalation, 8-13% of the delivered dose is excreted unmetabolised in the urine. (ref 2).


Ecotoxicity Data

Endpoint

Species

Common Name

Method

Time

Result

Ref

EbC50 - Based on Area under the Growth Curve







Pseudokirchneriella subcapitata (formerly known as Selenastrum caprico-rnutum)







Green Alga







OECD 201







72 h

46 mg/L

Note 1

3

NOEC - Based on Area under the Growth Curve

15 mg/L

 Note 1

LOEC - Based on Area under the Growth Curve

30 mg/L

Note 1

ErC50 - Based on Logarithmic Growth Rate

94 mg/L

Note 1

LOEC - Based on Logarithmic Growth Rate

60 mg/L

Note 1

NOEC - Based on Logarithmic Growth Rate

30 mg/L

Note 1

EC50 – Based on Immobilisation



Daphnia magna



Giant Water Flea



OECD 202



48 h

114 mg/L Note 1

4

NOEC - Based on Immobilisation

55 mg/L

Note 1

LC50



Oncorhynchus mykiss



Rainbow Trout



OECD 203



96 h

>120 mg/L Note 1

5

NOEC - Based on Mortality & Symptoms of Toxicity

120 mg/L Note 1

Note 1: Concentrations were confirmed by analysis, and results expressed as nominal.


Predicted No Effect Concentration (PNEC)


Short-term test have been undertaken for species from three trophic levels, based on internationally accepted guidelines. The most sensitive species of these is the green alga, Pseudokirchneriella subcapitata (formerly known as Selenastrum capriocornutum), and the growth rate end point has been applied. Therefore, the PNEC is based on the growth rate results (EC50) from the toxicity to P subcapitata study, and an assessment factor of 1000 is applied in accordance with ECHA guidance (Ref 6).


PNEC = 94 000/1000 = 94 µg/L


Environmental risk classification (PEC/PNEC ratio)

PEC/PNEC = 0.00015 µg/L /94 µg/L =1.6*10-6

PEC/PNEC ≤ 0.1 


The PEC/PNEC ratio decides the wording of the aquatic environmental risk phrase, and the risk phrase for PEC/PNEC ≤ 0.1 reads as follows:“Use of formoterol fumarate dihydrate has been considered to result in insignificant environmental risk”. 


In Swedish: “Användning av formoterol fumarat dihydrat har bedömts medföra försumbar risk för miljöpåverkan” under the heading “Miljörisk”.


Environmental Fate Data

Endpoint

Method

Test Substance Concentration

Time

Result

Ref

Partition Coefficient Octanol Water

Note 2

-

-

Log D = 0.41 @ pH 7.4

7

Percentage DOC Removal

ISO 7827-1984 (E)

40 mg /L

Dissolved Organic Carbon

28 d

20.5 %

8

Note 2: This data is experimental derived but the study pre-dates current ERA regulatory requirements and may not have been undertaken to standard test guidelines.


Biodegradation


Based on the data above and lack of further studies, the phrase “Formoterol fumarate dihydrate is potentially persistent” is chosen.


In Swedish: “Formoterol fumarat dihydrat är potentiellt persistent ” under the heading ”Nedbrytning”.


Bioaccumulation


Partition coefficient Octanol/Water

Log D = 0.41, pH 7.4 @ 25 °C (ref. 7)


Since Log D < 4 the phrase ‘Formoterol fumarate dihydrate has low potential for bioaccumulation’ is assigned.


In Swedish: ”Formoterol fumarat dihydrat har låg potential att bioackumuleras” under the heading ”Bioackumulering”. 


Physical Chemistry Data

Endpoint

Method

Test Conditions

Result

References

Solubility Water




Note 2






-



1500 mg/L @ pH 6.4





7



Dissociation Constant

pKa = 7.9 (Phenol)

Dissociation Constant

pKa = 9.2 (Amine)

Note 2: This data is experimental derived but the study pre-dates current ERA regulatory requirements and may not have been undertaken to standard test guidelines.


References


  1. [ECHA] European Chemicals Agency. Guidance on Information Requirements and Chemical Safety Assessment. Chapter R.16: Environmental exposure assessment (version 3.0). February 2016. 

  2. Determination of absolute pulmonary bioavailability of formoterol when given via Turbuhaler® to healthy volunteers. Report No. 37-CR-3004. January 1995.

  3. Formoterol Fumarate Dihydrate: Toxicity to the green alga Selenastrum capricornutum. Brixham Environmental Laboratory, AstraZeneca, UK. Report BL8081 (2005).

  4. Formoterol Fumarate Dihydrate: Acute toxicity to Daphnia magna. Brixham Environmental Laboratory, AstraZeneca, UK Report BL8082 (2005).

  5. Formoterol Fumarate Dihydrate: Acute toxicity to Rainbow Trout (Oncorhynchus mykiss). Brixham Environmental Laboratory, AstraZeneca, UK. Report BL8083 (2005).

  6. [ECHA] European Chemicals Agency. Guidance on Information Requirements and Chemical Safety Assessment. Chapter R.10: Characterisation of dose [concentration]-response for environment (Table R10.4). May 2008. 

  7. Marketing, S1-03 general Properties, Formoterol Fumarate Dihydrate. AstraZeneca report BD4179 (2009).

  8. A026: Algae, Growth inhibition test, Daphnia magna, acute immobilisation test, Fish Acute toxicity test, Biodegradability. Toxicon. Report no: 59/93 (1994)