What is Symbicort Turbohaler?
Symbicort Turbohaler is an inhaler used to help people with asthma and chronic obstructive pulmonary disease (COPD) breathe easier. It contains two active ingredients: budesonide and formoterol.
Budesonide is a corticosteroid that reduces lung inflammation, helping prevent breathing problems. Formoterol is a long-acting beta2-agonist that relaxes the muscles around the airways, keeping them open to make breathing easier and prevent symptoms like wheezing and chest tightness.
However, Symbicort Turbohaler is not meant for sudden breathing problems and should not replace a rescue inhaler.
Dosage Information and Usage
Dosage Form and Strengths of Symbicort Turbohaler
- Symbicort Turbohaler is available in two strengths:
- 80 mcg budesonide / 4.5 mcg formoterol
- 160 mcg budesonide / 4.5 mcg formoterol
- Each inhaler contains 60 or 120 doses.
Usage
For asthma, it is prescribed for patients aged 6 and older who need more than a regular asthma-control medication. It’s taken twice daily to control and prevent asthma symptoms, but it is not meant for sudden breathing problems. In some cases, the SYmbicort Turbohaler may be used as a controller and reliever inhaler (known as SMART, or Single Maintenance and Reliever Therapy) for patients aged 12 and older.
For COPD, Symbicort Turbohaler 160/4.5 is used for long-term maintenance to improve breathing and reduce flare-ups.
Steps on How to Use Symbicort Turbohaler
- Prepare the Inhaler:
- Remove Symbicort from the protective foil pouch.
- Write the date you opened the pouch on the box.
- Note: Unlike metered-dose inhalers, the Symbicort Turbohaler does not require shaking or priming before use. Simply twist the base to load the dose.
- Inhale the Medication:
- Breathe out fully to empty your lungs.
- Place the mouthpiece in your mouth and close your lips around it, keeping the inhaler upright.
- Breathe in deeply and slowly through your mouth while pressing down firmly on the top of the inhaler to release a puff of medicine.
- Continue to breathe in and then hold your breath for about 10 seconds, or as long as comfortable.
- Remove the inhaler from your mouth and breathe out gently.
- Repeat for the Second Dose:
- If you need a second inhalation, twist the base again to load another dose and repeat the inhalation steps.
- After Use:
- Replace the mouthpiece cover after using the inhaler.
- Rinse your mouth with water and spit it out to help reduce the risk of oral infections.
- Monitor Doses:
- The counter on top of the inhaler shows the number of puffs left. When the counter approaches 20, it indicates it’s time to get a refill. Discard the inhaler when the counter reads zero or 3 months after opening the pouch, whichever comes first.
- Cleaning:
- Clean the white mouthpiece with a dry cloth at least once a week.
- Do not put any part of the inhaler in water.
Side Effects of Symbicort Turbohaler
Common Side Effects
- Throat irritation
- Upper respiratory tract infection
- Sinusitis (inflammation of the sinuses)
- Back pain
- Stomach discomfort
- Thrush in the mouth and throat (rinse mouth after use to prevent)
- Headache
- Throat pain
- Flu
- Nasal congestion
- Vomiting (in people with asthma)
- Bronchitis (in people with COPD)
Serious but Rare Side Effects
- Chest pain
- Fast and irregular heartbeat
- Tremor
- Increased blood pressure
- Nervousness
- Fungal infection in the mouth or throat (thrush)
- Pneumonia and other lung infections
- Immune system effects leading to more infections
- Adrenal insufficiency (not enough steroid hormones)
- Increased wheezing after use
- Serious allergic reactions (rash, hives, swelling, breathing problems)
- Lower bone mineral density (osteoporosis)
- Slowed growth in children
- Eye problems (glaucoma and cataracts)
- Swelling of blood vessels (pins and needles, numbness, rash, flu-like symptoms)
- Decrease in blood potassium levels (hypokalemia)
- Increase in blood sugar levels (hyperglycemia)
Warnings and Precautions
- Serious Asthma-Related Occurrences: Using LABA (Long-Acting Beta2-Agonists) alone without ICS (Inhaled Corticosteroids) for asthma raises the risk of asthma-related death, hospitalization, and intubation. LABA relaxes the airways to make breathing easier, while ICS reduces airway inflammation and helps prevent asthma symptoms. When LABA is combined with ICS, there is no significant increase in these risks compared to using ICS alone.
- Excessive Use of Symbicort and Use with Other LABAs: Symbicort should not be used more frequently or at higher doses than prescribed. Using Symbicort with other medications containing LABA, like salmeterol or formoterol, can lead to serious cardiovascular effects and fatalities.
- Local Effects: Some patients using Symbicort might get mouth and throat infections caused by Candida albicans, a fungus that naturally lives on the body. Too much candida can lead to infections. If this happens, antifungal treatment should be used while continuing Symbicort. Rinsing the mouth with water after each use can help prevent these infections.
- Pneumonia and Lower Respiratory Tract Infections: Physicians should monitor patients with COPD for signs of pneumonia and other lower respiratory tract infections during treatment with Symbicort. Clinical studies have shown a higher incidence of these infections in COPD patients using Symbicort compared to placebo.
- Immunosuppression: Patients using Symbicort who are on immunosuppressive therapy are more susceptible to infections. Conditions like chickenpox and measles can have severe or fatal outcomes in such individuals. Patients should avoid exposure to these infections and seek immediate medical attention if exposed. Specific immunoglobulin therapies may be necessary in certain cases.
- Transitioning Patients From Systemic Corticosteroid Therapy: Patients transitioning from systemic corticosteroids to Symbicort require careful monitoring. Sudden withdrawal of systemic corticosteroids can lead to adrenal insufficiency, particularly during stress conditions like trauma or illness.
- Hypercorticism and Adrenal Suppression: Long-term use of Symbicort can lead to systemic effects related to corticosteroid absorption. Patients should be monitored for symptoms of hypercorticism and adrenal suppression, especially when using higher-than-recommended doses over prolonged periods. Dose reduction should be gradual to minimize these risks.
- Drug Interactions With Strong CYP3A4 Inhibitors: Be cautious when using Symbicort with strong CYP3A4 inhibitors like ketoconazole or ritonavir. These interactions can increase the levels of budesonide in your system, potentially causing side effects.
- Paradoxical Bronchospasm and Upper Airway Symptoms: In rare cases, Symbicort can cause paradoxical bronchospasm, which happens when the muscles around the airways suddenly tighten after using an inhaler. If this happens, stop using Symbicort right away and consider other treatments.
- Immediate Hypersensitivity Reactions: Some patients may experience immediate hypersensitivity reactions after using Symbicort, such as urticaria, angioedema, rash, or bronchospasm. These reactions require immediate medical attention and discontinuation of Symbicort.
- Cardiovascular and Central Nervous System Effects: Symbicort contains beta-adrenergic agonists that may cause side effects like fast heart rate, irregular heartbeats, nervousness, headaches, tremors, and high blood pressure. Patients with heart conditions should use Symbicort carefully and report any significant symptoms to their healthcare providers.
- Reduction in Bone Mineral Density: Long-term use of Symbicort may decrease bone mineral density, particularly in patients with multiple risk factors for osteoporosis. Regular monitoring and consideration of osteoporosis treatment are recommended, especially in high-risk patients.
- Glaucoma and Cataracts: Long-term use of inhaled corticosteroids like budesonide in Symbicort may increase the risk of developing glaucoma and cataracts. Patients with a history of increased intraocular pressure or glaucoma should undergo regular eye examinations during Symbicort treatment.
- Eosinophilic Conditions and Churg-Strauss Syndrome: In rare instances, patients using inhaled corticosteroids like budesonide might develop systemic eosinophilic conditions, similar to Churg-Strauss syndrome. This syndrome causes blood vessel inflammation.
- Coexisting Conditions: Symbicort should be used carefully in patients with seizure disorders, overactive thyroid, or those highly sensitive to certain medications. Monitor patients with diabetes or ketoacidosis closely.
- Hypokalemia and Hyperglycemia: The beta-adrenergic agonists in Symbicort can cause temporary low potassium and high blood sugar in some patients. It’s recommended to monitor potassium and blood sugar levels during treatment.
Overdosage
Overdosing on Symbicort, with budesonide and formoterol, is uncommon but can intensify effects common to beta2-agonists and corticosteroids. While immediate toxicity from budesonide overdose is unlikely, prolonged excessive use may result in systemic corticosteroid effects.
An overdose of Formoterol could lead to seizures, heart problems like angina or irregular heartbeats, and metabolic issues. If you overdose, discontinue Symbicort right away and address the symptoms promptly.
Cardioselective beta-blockers such as atenolol, betaxolol, bisoprolol, esmolol, acebutolol, metoprolol, and nebivolol can be cautiously used to handle heart-related symptoms.
These medications selectively block beta-1 receptors in the heart, helping to control heart-related symptoms from formoterol overdose, but should be used carefully to avoid worsening bronchospasm. Cardiac monitoring is recommended due to the risk of serious cardiovascular effects.
Drug Interactions With Other Medications
- Inhibitors of Cytochrome P4503A4: Drugs like ketoconazole that inhibit CYP3A4 can raise budesonide levels in the body. CYP3A4, a key enzyme in the liver and intestines, helps break down and process drugs and toxins, making them easier to eliminate. Inhibiting this enzyme may increase budesonide exposure and the risk of corticosteroid side effects.
- Monoamine Oxidase Inhibitors and Tricyclic Antidepressants: Patients using monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants (TCAs) should be cautious with Symbicort. MAOIs lower blood pressure when lying down and cause a greater drop when standing up. TCAs also increase the drop in blood pressure when standing. These medications can amplify formoterol’s effects on the cardiovascular system, potentially raising heart rate or blood pressure.
- Beta-Adrenergic Receptor Blocking Agents: Beta-blockers can reduce the effectiveness of formoterol for asthma treatment by blocking its effects on the lungs. They might also cause severe bronchospasm in asthma patients. Cardioselective beta-blockers might be an option in some cases, but they should be used with caution.
- Diuretics: Non-potassium-sparing diuretics (like loop or thiazide diuretics) can lead to electrolyte imbalances, like low potassium levels. When used with beta-agonists such as formoterol in Symbicort, the risk of ECG changes may increase. It’s important to be cautious when using these medications together.
Questions for Your Doctor
Important Information or Questions to Ask Your Healthcare Provider Before Taking Symbicort
- Do I have any heart problems that could be affected by Symbicort?
- How will Symbicort interact with my high blood pressure?
- Could Symbicort affect my seizures?
- Should I be concerned about my thyroid condition while taking Symbicort?
- How might Symbicort impact my diabetes management?
- What should I know about using Symbicort with my liver issues?
- How does Symbicort affect osteoporosis, if at all?
- Will Symbicort interact with my immune system disorder?
- Could Symbicort worsen my eye conditions like glaucoma or cataracts?
- Am I allergic to any medications that are similar to Symbicort?
- Should I be worried about infections while using Symbicort?
- What precautions should I take if I’ve been exposed to chicken pox or measles?
- Is it safe for me to use Symbicort if I am pregnant or planning to become pregnant?
- Can I continue breastfeeding while using Symbicort? What are the risks?
- Should I adjust my current medications, including prescriptions, over-the-counter drugs, vitamins, or herbal supplements, while taking Symbicort?
- Are there specific medications, such as antifungal or anti-HIV drugs, that I should avoid while using Symbicort due to potential interactions?
Frequently Asked Questions
Disclaimer
Pharma Giant provides medical information to help you better understand medications and medical conditions.This content is for informational use only and does not replace advice from a licensed medical practitioner. Consult your doctor or pharmacist before starting or changing any medication. All our partners follow strict safety standards set by their country’s health authorities to make sure you receive safe and high-quality medications.
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