Symbicort (Budesonide/Formoterol) Inhalation Aerosol

What is Symbicort?

Symbicort is a combination drug used for the management of asthma and chronic obstructive pulmonary disease (COPD) symptoms. The two active ingredients of Symbicort are budesonide and formoterol. This combination helps relax the airways and makes breathing easier.

Budesonide can be nebulized and is also available in the form of pills. Other forms of this steroid drug are in rectal preparations and nasal sprays. Budesonide helps lessen inflammation in the airways due to asthma.

Formoterol is a bronchodilator, which helps prevent bronchial spasms by relaxing the muscles in the lungs. This bronchodilator is available as an inhalation solution, metered dose inhaler, and dry powder inhaler. 

The approved uses of Symbicort are as follows:

• COPD - Long-term use of Symbicort 160/4.5 mcg is taken to help improve the symptoms of COPD. It is particularly used to improve breathing and help reduce emphysema and chronic bronchitis flare-ups. 

• Asthma - Symbicort is approved for use in patients who are 6 years old and above, especially when asthma is poorly controlled on other types of asthma medications. Once asthma is well-controlled, doctors may tell their patients to stop using this medication.

Note: Symbicort should not be used as a substitute rescue inhaler for sudden symptoms of asthma or COPD.

Side Effects

The most common side effects of Symbicort are: 

• Headache
• Cold symptoms (runny or stuffy nose, sneezing, sore throat, and sinus pain)
• Symptoms of flu (fever, body aches, and chills)
• Throat irritation after inhalation
• Vomiting
• Abdominal discomfort
• Back pain

Budesonide can affect children's growth. Consult your healthcare provider if your child is using this medication and not growing at a normal rate.

Seek emergency medical attention if you have the following signs of an allergic reaction:

• Difficulty breathing
• Hives
• Swelling of the face, tongue, lips, or throat

If you have the following symptoms, call your doctor right away:

• Difficulty breathing or worsening breathing
• Other breathing problems, such as choking and wheezing after taking Symbicort 
• Trouble swallowing
• White patches in the throat or mouth
• Vision problems (eye pain or swelling, tunnel vision, blurred vision, or halos around lights)
• Signs of infection (high fever, body aches, chills, nausea and vomiting, and weakness)
• Symptoms of pneumonia (high fever, shortness of breath, stabbing chest pain, coughing up yellowish green mucus)
• Symptoms of high blood sugar (dry mouth, headache, fruity odor on one's breath, headache, increased thirst, increased urination, and an increased appetite)
• Symptoms of low potassium levels (irregular heartbeats, constipation, leg cramps, chest flutters, muscle weakness, numbness or tingling sensations, increased thirst, and increased urination)
• Swelling of the blood vessels (flu-like symptoms, sinus pain, stuffy nose, numbness or tingling sensations in the arms or legs, or skin rash)

Precautions

If you have any allergies or health conditions, make sure to inform your doctor about them. This medication should not be used if you have an allergy to:

• Budesonide (Pulmicort, Entocort, Uceris, or Rhinocort)
• Formoterol (Dulera, Foradil, or Perforomist)

Before taking Symbicort, you also need to inform your healthcare provider if you have had any illness or infection within the past few weeks. Budesonide is a steroid medication, which can weaken the body's immune system, making people who use it become more susceptible to developing an infection or experience a worsening infection they may have or an infection they recently had. 

To ensure that Symbicort is safe for you to use, inform your doctor if you have or have had a history of any of the following conditions:

• Hypertension (high blood pressure)
• Cardiovascular or heart disease
• Diabetes
• Epilepsy or other seizure disorders
• Thyroid problems and disease
• Tuberculosis
• Eye problems (cataracts, glaucoma, or herpes simplex keratitis)
• Bacterial, viral, parasitic, or fungal infection
• An electrolyte imbalance (e.g., low potassium levels)
• Osteoporosis
• Liver disease

Symbicort should not be given to children who are below 6 years old.

Bone Health

There has been a link between reduced bone density and the long-term use of inhaled corticosteroids. The use of these medications causes osteoporosis and make the bones to become brittle.

The risk of bone thinning also increases if a person has any of the following risk factors:

• Brittle bones or thinning bones
• Regular alcohol consumption
• Smoking
• Poor nutrition
• Has a family history of osteoporosis

You should discuss with your doctor on how your condition will affect the dosage and effectiveness of the medications you're taking.

Diabetes

Changes in blood sugar may occur due to the combination of the two active ingredients present in Symbicort.

Eye Problems

The risk of developing glaucoma and cataract increases when budesonide is used. 

Heart Disease

Symbicort can cause serious cardiovascular side effects, such as hypertension (high blood pressure), heart rhythm changes, and increased heart rate. 

Pneumonia

In one study, the risk of developing pneumonia increased, particularly in people who have COPD and using budesonide as treatment. 

Infections

By using this medicine, thrush infections may occur, talk to your doctor on how the risk of such infections can be reduced.

Liver Function

This medicine may build up in the body due to liver disease or when the liver function is impaired.

Pregnancy and Breastfeeding

It is still unknown whether this medication will harm an unborn child. Inform your doctor if you are pregnant or planning to become pregnant.

The active ingredients of Symbicort, budesonide and formoterol, can pass into breast milk and may harm a baby when breastfeeding. Do not breastfeed your baby while on this medication. 

How to Use Symbicort

Follow the directions given by your doctor or pharmacist or read the information printed in the leaflet. If you are not sure how to use this medication, then contact your pharmacist or doctor.

1. Asthma

To help manage your asthma symptoms, your doctor will give you an action plan. 

a. Symbicort 100/6 and 200/6

The dose is 1-2 inhalations two times a day. These medications are often used to relieve the symptoms of asthma. When used as a preventer and reliever, do not use it for more than 12 inhalations per day or 6 inhalations on a single occasion. 

Contact your healthcare provider if the symptoms are not relieved for more than three days of using the medication.

b. Symbicort Turbuhaler 400/12

This strength is only recommended to patients who are 18 years old and above. It is not used as a reliever. When used as a preventer, the usual dose is two inhalations twice a day. The dosage may be reduced when the symptoms of asthma have become well-controlled. 

2. COPD

Symbicort turbuhaler 200/6 has a usual dose of 1-2 inhalations two times a day. However, your doctor may also increase the dose to four inhalations twice a day. If the symptoms become well-controlled, you may only need to take this medicine once a day.

In one study, patients with persistent asthma were treated with high doses of Symbicort and safety was assessed. Results showed that in such patients, a high dose of the medication was safe and effective.

The best way to manage the symptoms will be shared by your doctor so that the frequency of flare-ups can also be reduced. Additional medications may also be prescribed if you experience breathlessness or sudden attacks. 

Patients who are unable to control the symptoms of their asthma through inhaled steroids may find Symbicort as a useful medication. Make sure to discuss the possible risks and benefits of using this combination treatment with your doctor. Inform your doctor right away if you have worsening symptoms while using this medication. 

References

Kelly, H William., et. al. Effect of long-term corticosteroid use on bone mineral density in children: a prospective longitudinal assessment in the childhood Asthma Management Program (CAMP) study. Pediatrics vol. 122,1 (2008): e53-61.

Wang JJ., et. al. Use of inhaled and oral corticosteroids and the long-term risk of cataract. Ophthalmology. (2009) Apr;116(4):652-7. doi: 10.1016/j.ophtha.2008.12.001. 

Hollis, S. et. al. Risk of pneumonia with budesonide-containing treatments in COPD: an individual patient-level pooled analysis of interventional studies. International journal of chronic obstructive pulmonary disease vol. 12 1071-1084. 5 Apr. 2017. doi:10.2147/COPD.S128358.

Jenkins, C., et. al. Efficacy and safety of high-dose budesonide/formoterol (Symbicort) compared with budesonide administered either concomitantly with formoterol or alone in patients with persistent symptomatic asthma. Respirology. 2006 May;11(3):276-86. doi: 10.1111/j.1440-1843.2006.00856.x.