Symbicort Inhaler
Symbicort Inhaler
Budesonide, Formoterol Fumarate
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Symbicort (Budesonide)

What is Symbicort?

Symbicort is a long-term, combination inhaler used to treat conditions such as asthma and chronic obstructive pulmonary disease (COPD). Symbicort is a combination of 2 medications, a corticosteroid and a bronchodilator. In combination, these drugs allow for easier breathing and can help control and prevent symptoms such as shortness of breath and wheezing.

How does Symbicort work?

The first component of Symbicort, Budesonide, is a corticosteroid that reduces inflammation in the lungs. The second component, Formoterol, is a bronchodilator or LABA (long-acting beta 2 agonist) that relaxes the airway muscles, making it easier for air to pass through. Symbicort is a “controller” inhaler, NOT a rescue inhaler, and should be used every day. When used regularly, Symbicort has shown a reduction in the number of episodes of shortness of breath.

Dosage

Symbicort comes in either 160/4.5 mcg or 80/4.5 mcg inhalers. Do not administer Symbicort more frequently than prescribed.

COPD

  • 2 inhalations of 160/4.5 mcg BID

Asthma (12 years and older)

  • Less severe asthma – 2 inhalations of 80/4.5 mcg BID
  • More severe asthma – 2 inhalations of 160/4.5 mcg BID
    (If no effect noted after 1-2 weeks of use at 80/4.5 mcg, the dose may be increased to 160/4.5 mcg for increased control)

Asthma (6-12 years old)

  • 2 inhalations of 80/4.5 mcg BID

Side Effects

If you experience signs or symptoms of an allergic reaction, such as hives, rash, itching, difficulty breathing, or swelling of the face, mouth, or throat, seek immediate medical attention.

The most common side effects include:

  • Sore throat
  • Cough
  • Headache
  • Back pain
  • Upset stomach
  • Vomiting
  • Upper respiratory infection
  • Nasal congestion

Tell your doctor if you develop:

  • White patches in your mouth or throat
  • Nervousness or tremors
  • Vision problems
  • Persistent sore throat
  • Difficulty sleeping

Get medical help immediately if you experience chest pain, seizures, dizziness, fainting, or an irregular heartbeat.

Warnings & Precautions

Do not use Symbicort if you are allergic to budesonide or formoterol. Notify your doctor of any allergies, health conditions, or if you are pregnant or breastfeeding.

Symbicort is not a rescue inhaler and should not be used for an asthma attack.

Do not suddenly stop taking Symbicort without speaking to your doctor first. The dose should be tapered off to prevent withdrawal.

Bone Mineral Density

Long-term use of corticosteroids can decrease bone density and increase your risk of developing osteoporosis. Certain risk factors such as prolonged immobility, post-menopausal status, and poor nutrition can increase your risk. Discuss with your doctor if you’ve been diagnosed with or have a family history of osteoporosis. Closer monitoring is recommended, and medications may need to be started to prevent or treat osteoporosis.

Children

Symbicort is not approved for children younger than 6 years old. Growth should be monitored regularly in pediatric patients because Symbicort can slow growth. To reduce variability, a reliable growth scale such as a stadiometer should be used. Symbicort dose should be titrated to the lowest dose tolerated while still managing symptoms to prevent growth delay.

Diabetes and Hyperglycemia

Corticosteroids are known to raise blood sugar levels. If you are diabetic or pre-diabetic, you may have to monitor your blood sugar more closely.

Eye problems

Using Symbicort can increase your risk of cataracts, glaucoma, or increased ocular pressure. If you’re at risk for any of these conditions, baseline and routine monitoring is recommended. Immediately report any vision changes to your doctor.

Avoid contact with eyes. When priming the inhaler, ensure the mouthpiece is facing away from you. When administering a dose, ensure your lips are firmly wrapped around the mouthpiece before administering the medication. If the medication comes in contact with eyes, promptly rinse eyes with water and notify your doctor if persistent redness or irritation occurs.

Heart problems

Notify your doctor if you have heart failure, hypertension, or an irregular heart rhythm such as atrial fibrillation or bradycardia. Symbicort can cause a change in your heart rhythm called QT-prolongation which can be serious. Notify your doctor if you also take a diuretic or a water pill as low levels of potassium or magnesium can significantly increase your risk of QT-prolongation.

Infection

Using Symbicort can make you more susceptible to developing an infection. Notify your doctor if you are also taking an immunosuppressant, as this can further increase your risk of infection. Avoid contact with others who have communicable diseases such as influenza, chickenpox, or measles. Other infections such as pneumonia can be more likely to occur. If you develop a fever or notice worsening shortness of breath or a cough, notify your doctor immediately.

A fungal infection called thrush is particularly common and can manifest as white patches on the tongue or throat. Thrush can be avoided by rinsing the mouth with water after using Symbicort. Do not swallow the water after rinsing. Notify your doctor if you suspect you have thrush.

Liver problems

Liver dysfunction can cause medications like Symbicort to build up in your system. Notify your doctor if you have any liver problems such as hepatitis or cirrhosis. Monitor for yellowing of the skin or the whites of the eyes, as well as itching, abdominal pain, or dark urine, all of which indicate liver dysfunction.

Pregnancy & Breastfeeding

Do not take Symbicort if you are breastfeeding, pregnant, or plan to become pregnant. Symbicort is classified by the FDA as a pregnancy category C. This means that some adverse fetal effects were noted in animal testing and that no adequate human studies exist. Risk vs. benefit must be closely evaluated with your doctor.

One of the medications in Symbicort, budesonide, is known to pass into breast milk. It is unclear if budesonide is harmful to babies, or if the other medication in Symbicort, formoterol, passes into breast milk. Discuss with your doctor before breastfeeding.

Overdose

If immediate help is required, call 911. If overdose is suspected, call poison control at 800-222-1222. Symptoms of overdose include nervousness, tremors, chest pain, rapid heartbeat, or seizures.

Drug Interactions

It’s important to note that this is not a complete list of drug interactions. Notify your doctor of all medications you’re taking, including vitamins and over-the-counter supplements.

Strong cytochrome P450 3A4 inhibitors

These drugs may increase the corticosteroid effects of Symbicort. E.g. Ritonavir, Atazanavir

Beta-blockers

Beta-blockers may produce bronchospasm by interfering with the beta-agonist effect of Symbicort. E.g. Metoprolol, carvedilol

Monoamine oxidase inhibitors (MAOI) and tricyclic antidepressants

These may increase the effects of formoterol by causing vasodilation. E.g. Phenelzine, Amytriptyline

Diuretics

Non-potassium-sparing diuretics in particular can worsen hypokalemia and increase the risk of harmful EKG changes. E.g. Furosemide

Alternative Medications

Notify your doctor of all medications and inhalers you are prescribed. Do not take another LABA in addition to Symbicort.

Combination Inhalers

These are inhalers that are a combination of a corticosteroid and bronchodilator, similar to Symbicort. While they are used for the treatment of asthma and COPD, they do contain different drugs so depending on the individual, one inhaler may work better than another. Do not take 2 combination inhalers at the same time, as this can potentially be harmful. Examples include:

  • Advair Diskus (fluticasone and salmeterol)
  • Breo (fluticasone and vilanterol)
  • Dulera (mometasone and formoterol)1

Inhaled Corticosteroids

This class of drugs decreases airway inflammation

  • Flovent (fluticasone)
  • Pulmicort (budesonide)
  • Asmanex Twisthaler (mometasone)

Long-Acting Beta Agonists (LABA)

This class of drugs relaxes the airway muscles, allowing air to pass more easily

  • Serevent (salmeterol)
  • Theophylline (Theo-24)
    • Theophylline is an oral pill, not an inhaler

Leukotriene-inhibitors

This class of drugs works specifically to decrease swelling in your lungs caused by irritants or allergies.

  • Singulair (montelukast)
  • Zafirlukast (accolate)
  • Zileuton (zyflo)

Frequently Asked Questions

You should prime your inhaler if using it for the first time, if you dropped it, or if you haven’t used it for more than 7 days.

  1. Shake the inhaler for 5 seconds
  2. Remove the mouthpiece cover
  3. With the inhaler facing away from you, press down on the top to release a test spray
  4. Shake again for 5 seconds
  5. Release a second test spray
  6. Replace the mouthpiece cover
  1. Shake the inhaler for 5 seconds and remove the mouthpiece cover
  2. Fully exhale and place your lips around the mouthpiece
  3. While breathing in through your mouth, press down on the top to release a puff while you continue to breathe in
  4. Hold your breath for 10 seconds or as long as you comfortably can
  5. Shake again for 5 seconds
  6. Repeat steps 2-4
  7. Replace the mouthpiece cover
  8. Gargle and rinse your mouth with water. Do not swallow the water.

You should clean your inhaler at least once a week. Using a dry cloth, gently clean the inside and outside of the mouthpiece. Never disassemble your inhaler or place it in water.

Your inhaler should last 1 month if using the standard dose of 2 inhalations, twice a day

On the top of the inhaler is a counter which will show you how many doses remain. Once the counter shows “0” it’s important to discard the inhaler – even if it appears to still be operating, it may not be delivering the correct dose.

If the missed dose is a little late, administer the dose and then continue with your regular schedule. If it’s close to the next dose, skip the missed dose and administer the next dose at the regular time. Do not administer 2 doses at once to make up for a missed dose.

For COPD, symptom improvement can occur within 5 minutes of administration. For asthma, symptom improvement can occur within 15 minutes of administration. However, it’s important to note that it can also take up to 2 weeks of use before you notice any improvement.

You should wait 1 minute in between each inhalation of Symbicort.

If you’re having an asthma attack, use your rescue inhaler or seek medical attention. Symbicort is NOT a rescue inhaler.

You should take Symbicort the morning and night, 12 hours apart.

Rinsing your mouth after using Symbicort gets rid of any remaining medication in your mouth, which can lead to a fungal infection called thrush.

You should not take Symbicort if you are immunosuppressed, have an active infection, liver problems, diabetes, an irregular heart rhythm, osteoporosis, or a seizure disorder.

Symbicort should be discarded 3 months after being removed from the foil wrapper.

Yes, some patients use multiple inhalers. However, it’s important to notify your doctor of all other medications and inhalers you are prescribed because some inhalers can interact with Symbicort. Do not take another LABA or long-acting bronchodilator in addition to Symbicort.

No, Symbicort should be taken only as prescribed and never more than 4 inhalations a day, 2 in the morning and 2 at night.