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Budesonide and Formoterol

Symbicort Inhaler

Symbicort Inhaler is an FDA-approved medication for asthma and COPD, combining Budesonide and Formoterol. The combination eases breathing by reducing airway inflammation and relaxing muscles. It is available in two strengths: 80 mcg/4.5 mcg and 160 mcg/4.5 mcg. The typically recommended dose is two puffs twice daily or as guided by a healthcare provider. It is suitable for adults and adolescents (6 years and older). Those with heart, blood pressure, liver, or kidney issues need caution while using it. Common side effects include throat irritation, headache, and mouth fungal infections. You should rinse your mouth with water after each inhalation to prevent these infections. Missed doses should be taken promptly, but overdoses need medical attention. Store it at room temperature, avoiding moisture and heat. Always follow your healthcare provider’s advice closely for optimal use.

Product Overview

Symbicort Inhaler is an FDA-approved medication used for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Its active ingredients include Budesonide, an inhaled corticosteroid, and Formoterol, a long-acting beta-agonist bronchodilator. This combination works by reducing inflammation in the airways and relaxing the muscles around the airways, making it easier to breathe.

Symbicort Inhaler has two strengths: 80 mcg Budesonide/4.5 mcg Formoterol and 160 mcg Budesonide/4.5 mcg Formoterol per inhalation. It is typically administered as two puffs twice daily, although a healthcare professional should determine the dosage. It is suitable for adults and adolescents aged 6 years and older with asthma or COPD.

However, it may not be suitable for everyone, particularly those with certain medical conditions like heart disease, high blood pressure, liver disease, or kidney impairment. Common Symbicort side effects may include throat irritation, coughing, headache, and fungal infections in the mouth. You should rinse your mouth with water after each use to minimize the risk of such diseases. Seek medical advice if symptoms worsen or if new symptoms develop. 

If a dose of Symbicort is missed, it should be taken immediately unless it’s almost time for the next dose. Doubling up on doses should be avoided. In the case of an overdose, seek medical help. It should be stored at room temperature, away from moisture and heat. You should follow your healthcare provider’s advice regarding the proper use of Symbicort Inhaler and the potential risks associated with it.

Uses of Symbicort Inhaler

It is used for the treatment of:

  • Asthma symptoms in adults and children aged 6 years and older.
  • Symptoms of chronic obstructive pulmonary disease (COPD), such as emphysema and chronic bronchitis.

[Important Warning: Symbicort Inhaler is not appropriate for treating sudden asthma attacks or bronchospasms. You should consult your doctor for personalized advice and proper usage.]

How to Use Symbicort Inhaler?

Dosage

Strengths and Forms

Symbicort is available as a metered-dose inhaler in two strengths:

  1. Symbicort Inhaler 80 /4.5 mcg (80 mcg of Budesonide and 4.5 mcg of Formoterol)
  2. Symbicort Inhaler 160 /4.5 mcg (160 mcg of Budesonide and 4.5 mcg of Formoterol)

Recommended Dosage for Symbicort Inhaler

For Adults and Adolescents (12 Years and Older) with Asthma:

  • The initial Symbicort dosing is 2 inhalations 80/4.5 or 160/4.5 twice daily.
  • The maximum recommended dosage is 2 inhalations of Symbicort 160/4.5 twice daily.
  • Adjustments may be needed based on individual responses.

For Pediatric Patients (6 to Less Than 12 Years) with Asthma:

  • The typically recommended Symbicort dosing is 2 inhalations of 80/4.5 twice daily.

For Chronic Obstructive Pulmonary Disease (COPD):

  • The typically recommended dosage is 2 inhalations of Symbicort 160/4.5 twice daily.

[Note: Remember these recommendations for Symbicort dosing may vary from person to person. Discuss it with your healthcare professional, and they’ll decide your dosage accordingly.]

How to Take It?

Here is a step-by-step guide to using Symbicort Inhaler properly:

  1. Prepare the inhaler by removing the cap from the mouthpiece and shaking it well for 5 seconds.
  2. Breathe out gently to empty your lungs before using the inhaler.
  3. Hold the inhaler upright with the mouthpiece facing you, ensuring your thumb is at the base, and your index and middle fingers are on top of the canister.
  4. Seal your lips tightly around the mouthpiece to prevent air leaks.
  5. Press down firmly on the canister while breathing in deeply and slowly through your mouth.
  6. After inhaling, remove the inhaler from your mouth and hold your breath for about 10 seconds.
  7. Exhale slowly and gently away from the inhaler.
  8. Rinse your mouth with water to prevent mouth irritation or thrush.
  9. Replace the cap on the mouthpiece to keep it clean until your next dose.
  10. After each use, wipe the mouthpiece with a dry tissue or cloth to maintain cleanliness.

[Note: Your healthcare professional will determine the correct Symbicort dosing for you based on your condition, following guidelines and studies on the drug. Your doctor may adjust it as needed over time.]

How Does Symbicort Inhaler Work?

The Symbicort Inhaler operates through the collaboration of its two key components. Budesonide, a corticosteroid, alleviates airway inflammation, thwarting swelling and constriction to manage and prevent symptoms of asthma and COPD. Simultaneously, Formoterol, a long-acting bronchodilator, relaxes airway muscles, promoting dilation and enhancing airflow. This dual action helps individuals breathe more easily, offering comprehensive relief from respiratory conditions by addressing inflammation and facilitating improved lung function.

Important Safety Information

Side Effects

Common side effects of Symbicort Inhaler may include:

  • Headache
  • Throat irritation
  • Cough or voice changes
  • Thrush (oral yeast infection)
  • Nausea
  • Vomiting
  • Stomach upset
  • Diarrhea
  • Tremor (shakiness)
  • Nervousness or agitation

Mild side effects of Symbicort Inhaler may include:

  • Dry mouth
  • Dizziness
  • Nasal congestion
  • Muscle cramps
  • Sleep disturbances (difficulty falling asleep or staying asleep)
  • Increased heart rate (tachycardia)
  • Palpitations (feeling of a rapid or irregular heartbeat)
  • Muscle weakness
  • Increased sweating

Serious side effects of Symbicort Inhaler may include:

  • Allergic reactions (rash, itching, swelling of the face, tongue, or throat, severe dizziness, trouble breathing)
  • Worsening breathing problems (paradoxical bronchospasm)
  • Cardiovascular effects (increased blood pressure, chest pain, irregular heartbeat)
  • Osteoporosis (weakening of bones)
  • Glaucoma or cataracts (if the medicine gets into the eyes)
  • Adrenal insufficiency (fatigue, weakness, loss of appetite, weight loss)
  • Hypokalemia (low potassium levels in the blood)
  • Immune system suppression
  • Sudden worsening of asthma or COPD symptoms

[Note: Remember, this list may not cover all possible side effects of Symbicort Inhaler. Always consult with your healthcare giver for medical advice about Symbicort side effects.]

Warnings

Asthma-Related Death Risk: Long-acting beta2-adrenergic agonists (LABAs) like Formoterol in Symbicort Inhaler increase the risk of asthma-related death. Concurrent use with inhaled corticosteroids may not fully mitigate this risk. Symbicort inhalers should only be used when other asthma control medications are inadequate or if disease severity warrants both an inhaled corticosteroid and LABA.

Excessive Use and Concurrent LABAs: Overuse of Symbicort Inhaler or combining it with other LABAs can lead to adverse effects, including cardiovascular events and fatalities. Avoid using Symbicort Inhaler more frequently or at higher doses than recommended.

Deterioration and Acute Episodes: Symbicort inhalers should not be initiated during rapidly deteriorating asthma episodes. Increasing use of short-acting beta2-agonists may indicate worsening asthma and requires reevaluation. Symbicort inhalers are not for acute symptom relief; short-acting bronchodilators are used for acute symptoms.

Local Effects: Symbicort inhalers may cause localized infections in the mouth and pharynx. You should rinse your mouth after inhalation to minimize this risk.

Lower Respiratory Tract Infections: Your healthcare professional should monitor you for pneumonia and other lower respiratory tract infections, especially in the case of COPD. Although lung infections occurred more frequently with Symbicort Inhaler in clinical studies, pneumonia incidence did not significantly increase.

Immunosuppression: If you are on immunosuppressive drugs, you are more susceptible to infections. Caution should be exercised to avoid exposure to chickenpox and measles. Consider prophylactic measures if exposed.

Transferring from Systemic Corticosteroids: Carefully transition patients from systemic corticosteroids to Symbicort Inhaler to avoid adrenal insufficiency. Patients requiring systemic corticosteroids during stress or severe asthma attacks should resume oral corticosteroids immediately.

Hypercorticism and Adrenal Suppression: Prolonged use of Symbicort Inhaler at higher than recommended doses may lead to systemic corticosteroid effects, including hypercorticism and adrenal suppression. Monitor patients for signs and symptoms of adrenal insufficiency.

Drug Interactions: Caution is advised when using Symbicort Inhaler with potent CYP3A4 inhibitors, as it may increase systemic exposure to Budesonide.

Paradoxical Bronchospasm and Hypersensitivity Reactions: Symbicort inhalers may cause paradoxical bronchospasm and immediate hypersensitivity reactions. Discontinue use if these occur and initiate alternative therapy.

Cardiovascular and Central Nervous System (CNS) Effects: Beta-adrenergic stimulation may lead to cardiovascular and CNS effects. Use Symbicort Inhaler cautiously in patients with cardiovascular disorders.

Reduction in Bone Mineral Density: Long-term use of Symbicort Inhaler may decrease bone mineral density. Consider monitoring BMD in patients with risk factors for reduced bone mass.

Effect on Growth of Children: Pediatric patients may experience reduced growth velocity with long-term Symbicort Inhaler use. Monitor growth regularly and titrate to the lowest effective dose.

Glaucoma and Cataracts: Long-term use of inhaled corticosteroids like Budesonide may increase the risk of glaucoma and cataracts. Monitor patients with a history of increased intraocular pressure or glaucoma.

Eosinophilic Conditions and Churg-Strauss Syndrome: Rare cases of systemic eosinophilic conditions, including Churg-Strauss syndrome, have been reported with inhaled corticosteroids. Monitor patients for signs of vasculitis.

Hypokalemia and Hyperglycemia: Symbicort inhalers may cause hyperglycemia or hypokalemia in some patients. Monitor blood glucose and serum potassium levels periodically.

Precautions

  • Do not use Symbicort Inhaler if you are allergic to any of its ingredients.
  • Inform your doctor about any medical conditions you have before using Symbicort Inhaler.
  • Use Symbicort Inhaler regularly as prescribed by your doctor, even if you have no symptoms.
  • Do not use Symbicort Inhaler to treat sudden asthma attacks. Use a rescue inhaler for immediate relief.
  • Avoid getting Symbicort Inhaler in your eyes. Rinse thoroughly with water if it happens.
  • Do not exceed the prescribed dosage of Symbicort Inhaler.
  • Consult your doctor before using Symbicort Inhaler if you are pregnant or breastfeeding.
  • Inform your doctor about all your medications and medical conditions before using Symbicort Inhaler.
  • Keep Symbicort inhalers away from extreme heat or cold and out of reach of children.
  • If you experience worsening asthma symptoms or difficulty breathing after using Symbicort Inhaler, seek medical help immediately.

Symbicort Inhaler Contraindications

  • Hypersensitivity to any of the ingredients in Symbicort Inhaler.
  • Primary treatment of status asthmaticus or acute episodes of asthma or COPD requiring intensive measures.

Missed Dose

If you forget to take a dose of Symbicort Inhaler, simply skip the missed dose and continue with your usual Symbicort dosing schedule. Do not double up on doses to make up for the missed one. It’s essential to stay within four inhalations per day.

[Note: If you have missed a dose of Symbicort Inhaler and are still determining when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

Symptoms of an overdose of Symbicort Inhaler can include:

  • Headache
  • Heart palpitations (irregular heartbeat)
  • Chest pain
  • Excessively high or low blood pressure
  • Seizures
  • Nausea
  • Lightheadedness
  • Muscle cramps
  • Nervousness
  • Insomnia (trouble sleeping)

[Note: If you consumed more than the recommended Symbicort dosing, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Storage

  • Keep your Symbicort Inhaler at room temperature away from moisture, heat, and direct sunlight. 
  • Store it in a dry place and avoid exposing it to extreme temperatures. 
  • Keep the inhaler tightly closed when not in use. 
  • Keep your Symbicort Inhaler out of the reach of children and pets. 
  • Check the expiration date on the inhaler and discard it if it has expired.

[Note: Discuss with your healthcare professional about the proper disposal of any unused Symbicort Inhaler and any questions you may have regarding its storage.]

Symbicort Inhaler Interactions

  • Potent CYP3A4 inhibitors (ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin)
  • Diuretics
  • Xanthine derivatives
  • Androgenic drugs
  • Steroids
  • Monoamine oxidase inhibitors (MAOIs)

[Note: This isn’t a complete list, and there could be other drugs that interact with Symbicort Inhaler. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Symbicort Inhaler Alternatives

  • Advair Diskus (fluticasone/salmeterol)
  • Breo Ellipta (fluticasone/vilanterol)
  • Dulera (mometasone/formoterol)
  • Breztri (fluticasone/umeclidinium/vilanterol)
  • Trelegy (fluticasone/umeclidinium/vilanterol)

[Note: Your doctor will choose the best alternative of Symbicort Inhaler for you. Only use these alternative medications after consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How long does it take for Symbicort to work?

Symbicort typically starts showing its effects within 15 minutes of use. However, the maximum benefit may take 2 weeks or longer. Consistent usage is essential for optimal asthma or COPD control. Always follow your doctor’s instructions for the best results.

Can children use Symbicort Inhaler?

Yes, children can use Symbicort Inhaler, specifically those aged 6 years and older, for the management of asthma. However, it’s essential to follow the prescribed dosage and consult a healthcare provider for personalized guidance. Safety and efficacy in younger children may vary, so professional advice is crucial.

Can I drink alcohol while using Symbicort Inhaler?

There aren’t any known interactions between Symbicort Inhaler and alcohol. However, it’s essential to be aware that drinking alcohol can increase your risk of side effects from Symbicort. For instance, Symbicort may cause headaches, nausea, or vomiting, and alcohol can also cause these side effects. So, if you consume alcohol while using Symbicort, you may be at a higher risk of experiencing side effects.

Can I use Symbicort Inhaler for an acute asthma attack?

No, Symbicort Inhaler is not suitable for treating an acute asthma or bronchospasm attack. It is a maintenance medication used to control and prevent symptoms in adults and children with asthma or chronic obstructive pulmonary disease (COPD). For acute attacks, use a fast-acting inhaler like albuterol instead.

Can I use Symbicort Inhaler in pregnancy?

Symbicort Inhaler is generally considered safe to use during pregnancy. There is no increased risk of adverse pregnancy outcomes or congenital disabilities. Uncontrolled asthma or COPD poses a higher risk than potential Symbicort risks. Always consult your healthcare provider for personalized advice.

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