Formoterol / Budesonide

Symbicort Turbuhaler

Symbicort Turbuhaler is an FDA-approved inhalation medication combining budesonide, an inhaled corticosteroid, and formoterol, a long-acting beta2-agonist. It is used for managing asthma in adults and children aged 6 and older and as a routine treatment for chronic obstructive pulmonary disease (COPD). Symbicort helps reduce inflammation and open airways, improving breathing. It is not intended for sudden breathing problems and should be used consistently as prescribed. Common side effects include headache, oral thrush, and nasal congestion. Patients should follow their doctor’s instructions, consider potential interactions with other medications, and ensure proper use to minimize side effects.

Product Overview

Symbicort Turbuhaler is a combination inhalation medication containing budesonide and formoterol. Budesonide is an ICS (inhaled corticosteroid) that helps reduce inflammation in the airways, while formoterol is a long-acting beta2-agonist (LABA) that helps relax and open the airways, making breathing easier. Symbicort is approved for treating asthma in adults and children aged 6 years and older and is also prescribed for managing chronic obstructive pulmonary disease (COPD) on a routine basis.

Symbicort comes as a metered-dose inhaler, delivering medication in a fine spray form directly into the lungs. It is available in strengths of 80 mcg/4.5 mcg and 160 mcg/4.5 mcg per puff, with inhalers providing either 60 or 120 puffs. The typical dosage for adults and older children is two puffs twice daily, while younger children are usually prescribed the lower strength. Symbicort should not be used as a rescue inhaler for sudden breathing problems. Common side effects include headache, oral thrush, nasal congestion, nausea, and upper respiratory infections. 

Serious side effects may include increased risk of infections, paradoxical bronchospasm, decreased growth in children, and changes in blood pressure or heart rhythms. Patients should inform their doctors of their complete medical history, including any infections, heart conditions, osteoporosis, thyroid problems, or diabetes, to ensure safe use. Potential drug interactions, particularly with CYP3A4 inhibitors, certain antidepressants, and beta-blockers, should also be considered. Proper usage and adherence to prescribed dosages are crucial for the effective management of asthma and COPD with Symbicort.

Uses of Symbicort Turbuhaler

Symbicort is an inhalation medication approved for the following uses:

• Treating Asthma adults and children aged 6 years and older.
• It is also prescribed as a routine treatment for managing chronic obstructive pulmonary disease (COPD)

[Important Warnings: Symbicort isn’t approved to help ease sudden breathing problems. It’s not a rescue inhaler.]

How to Use a Symbicort Turbuhaler?

Dosage

• Symbicort is a metered-dose inhaler designed to deliver the medication in a fine spray form that you inhale directly into the lungs. Each puff from the inhaler dispenses a premeasured amount of drugs, ensuring consistent dosing. Available Strengths of Symbicort:
  • 80 mcg of budesonide / 4.5 mcg of formoterol per puff
  • 160 mcg of budesonide / 4.5 mcg of formoterol per puff
• Inhaler Options: Each Symbicort inhaler is available with either:
  • 60 puffs per inhaler
  • 120 puffs per inhaler

Recommended Dosage for Different Patients

Adult Dosage for Asthma

• Typical Dosage: Adults with asthma are generally prescribed two inhalations (puffs) of Symbicort twice a day.
• Strength: The specific strength (either 80 mcg of budesonide/4.5 mcg of formoterol or 160 mcg of budesonide/4.5 mcg of formoterol per puff) will depend on the severity of your asthma symptoms, as determined by your doctor.

Pediatric Dosage for Asthma

• Children Ages 6 to 11 Years: The typical dosage for young children with asthma is two puffs of the 80-mcg/4.5-mcg strength of Symbicort, administered twice daily.
• Children Ages 12 Years and Older: Older children and teenagers are generally prescribed two puffs of Symbicort twice a day. The strength recommended will be based on their asthma symptoms, similar to adult dosing.

Dosage for Chronic Obstructive Pulmonary Disorder (COPD)

• Typical Dosage: For individuals with COPD, the recommended dosage is two puffs of the 160-mcg/4.5-mcg strength of Symbicort, taken twice daily.

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

• The dosage of Symbicort prescribed by your doctor will vary based on several important factors:
  • Type and Severity of Condition
  • Age
  • Other Medical Conditions
• Your doctor will aim to prescribe the lowest dosage that effectively manages your condition to minimize potential side effects.
• While the exact dosage will be determined by your healthcare provider, the information below outlines typical dosages used for treating asthma and COPD. 
• Remember, you should always follow the specific dosage instructions provided by your doctor, as they are tailored to meet your individual needs.
• Always take Symbicort exactly as your healthcare provider has directed. Typically, the dosage is two puffs taken twice a day, approximately 12 hours apart.
• Maintaining a regular schedule for your doses is crucial for effective management of your condition. Missing doses can lead to less effective control of symptoms.
• To prevent oral thrush, a yeast infection in the mouth, it’s important to rinse your mouth with water and spit it out after each use of your inhaler. Make sure to do this after your morning and evening doses.
• If Symbicort is prescribed for your child, ensure they use the inhaler correctly. Supervise their technique to help control their symptoms more effectively.
• Setting reminders on your phone or using a medication timer can help you always remember to take your medication on time.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Symbicort Turbuhaler Work?

Asthma and COPD are long-term conditions that affect your airways. Symbicort helps by reducing inflammation and irritation in your airways while also relaxing and opening them up. This combination makes breathing easier and helps to reduce the symptoms of asthma or COPD.

Important Safety Information

Side Effects

Common side effects of Symbicort may include:

• Headache
• Oral thrush (a yeast infection in your mouth)
• Nasal congestion
• Nausea or vomiting
• Upper respiratory tract infection, such as the common cold, flu, bronchitis, or sinusitis
• Stomach discomfort
• Back pain
• Pain when speaking and trouble speaking

Serious side effects of Symbicort may include:

• Increased risk of infection, such as chickenpox or measles
• Paradoxical bronchospasm signs may include:
  • Trouble breathing
  • Tightness in chest
  • Cough
  • Wheezing
• Decreased growth in children signs may include:
  • Slower than expected growth in children
• Increased level of a hormone called cortisol, signs may include:
  • Salt cravings
  • Low blood pressure when standing
  • Weight loss
  • Extreme tiredness
  • Weakness
• Hyperglycemia (high blood sugar) signs may include:
  • Increased urination
  • Dizziness
  • Trouble concentrating
  • Increased thirst
• Eosinophilia (high level of specific white blood cells) signs may include:
  • Peripheral neuropathy (pain, numbness, or weakness that often affects your hands or feet)
  • Rash
  • Trouble breathing
• Decrease in bone density signs may include:
  • Bone breaks (if bone density changes are severe)
• Hypokalemia (low level of potassium) signs may include:
  • Changes in heart rhythm
  • Fainting
  • Muscle cramps
  • Dizziness
• Central nervous system problems signs may include:
  • Headache
  • Seizures
  • Tremor
  • Dizziness
• Allergic reactions
• Pneumonia (a type of lung infection) signs may include:
  • Fever
  • Trouble breathing
  • Low energy
  • Cough
  • Extreme tiredness
• Cataracts & Glaucoma (types of eye problems)

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

Warnings

This medication has several precautions. Before using Symbicort, discuss your medical history with your doctor. Symbicort might not be suitable for you if you have certain health conditions or other factors that could affect your health. These include:

• Heart or Central Nervous System Conditions: If you have certain central nervous system (spinal cord and brain) or heart conditions, taking Symbicort may increase your risk of side effects. These conditions include abnormal heart rhythms, high or low blood pressure, seizures, and other convulsive disorders. Before taking Symbicort, talk with your doctor if you have any of these conditions. They can help you choose the best treatment options for you, ensuring your safety and effectiveness of the treatment.
• Acute Severe Asthma: If you or someone has status asthmaticus (a type of acute severe asthma), Symbicort may not be the most appropriate medication for you. It is crucial to consult your doctor to explore other treatment options that may be more suitable for managing your condition effectively. Your doctor can help determine the best course of action for your specific health needs.
• Allergic Reaction: If you have ever had an allergic reaction to Symbicort or any of its ingredients, you should not use this medication. It is essential to inform your doctor about your allergy history so they can suggest alternative treatment options that are safe for you. Discussing this with your doctor will help ensure you receive the most appropriate and effective treatment.
• Use of Oral Corticosteroids: If you are currently taking an oral corticosteroid (in pill or tablet form) and are prescribed Symbicort, you will need to gradually reduce your use of the corticosteroid. Stopping or reducing the use of an oral corticosteroid too quickly can cause side effects, such as the adrenal glands not producing enough hormones, flare-ups of arthritis or eczema, and withdrawal symptoms like joint or muscle pain and depression. Inform your doctor if you are taking a corticosteroid or have recently stopped using one before starting Symbicort. This step is crucial to ensure a safe transition and to minimize potential side effects.
• Infections or a Weakened Immune System: Using this inhaler may increase your risk of developing new infections or worsening existing ones. You should not use Symbicort if you have a fungal, bacterial, viral infection, tuberculosis (TB), or eye herpes. Your doctor can recommend alternative medications for you. If you do not have an infection and your doctor prescribes Symbicort, make sure your vaccinations, including those for chickenpox and measles, are up to date. These infections can be very severe or even fatal for people with weakened immune systems or those taking corticosteroids. Symbicort contains budesonide, which is a corticosteroid. It is important to inform your doctor about any current or past infections to ensure your safety while using this medication.
• Using Long-Acting Beta2-Agonist: This medication has two medications: formoterol & budesonide. Budesonide is an ICS (inhaled corticosteroid), and formoterol is a long-acting beta2-agonist (LABA). Using a LABA without an ICS may increase the risk of asthma-related severe events, such as hospitalization, intubation (inserting a breathing tube), or death. However, this risk is not increased when a LABA is taken with an ICS. Do not use an LABA without an ICS unless directed by your doctor.
• Osteoporosis: If you have a condition such as osteoporosis or osteopenia, which results in low bone density, inform your doctor before taking Symbicort. Symbicort contains budesonide, a corticosteroid, which can decrease bone density with long-term use. Your doctor may monitor you more closely, especially if you have other risk factors for reduced bone density, such as having gone through menopause, being an older adult, using certain medications, or using tobacco. Your doctor may also consider prescribing a different drug to treat your condition.
• Cataracts & Glaucoma: Eye problems such as glaucoma and cataracts have been reported in people taking inhaled corticosteroids like budesonide, an active ingredient in Symbicort. Before taking Symbicort, it is crucial to inform your doctor if you have a history of glaucoma or cataracts. Your doctor will likely monitor you more closely during your treatment to ensure your eye condition does not worsen. Regular check-ups will help manage and prevent potential eye issues associated with the medication.
• Ketoacidosis or Diabetes: If you have ketoacidosis or diabetes, taking Symbicort may worsen your condition. Ketoacidosis is a serious complication of diabetes that occurs when the body breaks down fat too quickly. If you’ve had ketoacidosis in the past or currently have diabetes, it is important to talk with your doctor before taking Symbicort. The medication may increase your blood sugar levels, and you may need to be monitored more closely to manage your condition effectively.
• Thyrotoxicosis: If you have thyrotoxicosis (an excess of thyroid hormone in your body), you may be more likely to experience side effects from taking Symbicort. This is because thyrotoxicosis can cause symptoms similar to those of the medication’s side effects. Talk with your doctor before taking Symbicort if you have thyroid problems. They may choose a different medication for you or treat your thyroid condition first to ensure your safety.

Precautions

• Pregnancy: The safety of using Symbicort during pregnancy is not well established. This medication contains 2 active ingredients: formoterol & budesonide. There are no human studies on the effects of formoterol during pregnancy. Studies on inhaled budesonide alone suggest that it does not increase the risk of birth defects. If you are pregnant or planning to become pregnant, consult your doctor. They can help you determine the best treatment options for managing asthma or COPD during pregnancy.
• Birth Control: It’s not known if Symbicort is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, discuss your birth control needs with your doctor while using Symbicort. They can provide guidance on the best options to ensure safety and effectiveness.
• Breastfeeding: The safety of using Symbicort while breastfeeding is not well established. Budesonide is known to pass into breast milk, but there is no human data on whether formoterol does as well. If you are breastfeeding, inform your doctor before taking Symbicort. They will help you determine the best way to feed your child and recommend appropriate treatment options for managing asthma or COPD.
• Alcohol: Symbicort is not known to interact with alcohol. However, consuming alcohol while using Symbicort may increase your risk of side effects, particularly if you have conditions such as high blood pressure or heart problems. If you drink alcohol, consult your doctor before taking Symbicort. They can advise you on how much alcohol is safe to consume during your treatment.

Contraindications

• Symbicort should not be used by people who have had an allergic reaction to it in the past. 
• It is also not suitable for treating severe asthma or COPD attacks that need immediate medical attention. In such urgent cases, other treatments are recommended as the standard care.

Missed Dose

• If you miss a dose of Symbicort, do not take an extra dose to make up for the missed one. Instead, continue with your next dose at its regularly scheduled time. Timing your doses:
  • It’s essential to aim for approximately 12 hours between doses to maintain optimal effectiveness and control of your symptoms.
• Tips to Remember Your Doses:
  • Set a Reminder: Utilizing the alarm or reminder function on your phone can help you take your medication on time.
  • Use a Medication Timer: Consider a medication timer or app that alerts you when it’s time for your next dose. This can be especially helpful if you have a busy schedule or tend to forget your medication.
• Following these guidelines will help ensure that you receive consistent treatment and manage your condition effectively.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

Using more than the recommended dosage of Symbicort can lead to serious side effects. Symbicort contains two active ingredients: budesonide and formoterol. An overdose of budesonide is not as severe or life-threatening as an overdose of formoterol. Taking too much budesonide over a long time can lead to overdose symptoms, while an overdose of formoterol can cause symptoms almost immediately. Symptoms of an overdose can include:

• Muscle cramps
• Nausea
• Chest pain
• Dizziness
• Anxiety (nervousness)
• Hyperglycemia (high blood sugar)
• Palpitations (feeling of skipped or extra heartbeats)
• Headache
• Hypokalemia (low level of potassium)
• Racing heart
• Shaking hands (tremor)
• Changes in blood pressure
• Seizures
• Trouble sleeping

If you think you’ve taken too much of this drug, call your doctor. You can also contact the American Association of Poison Control Centers or use their online tool. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

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

Storage

• Avoid storing it in places where it could be exposed to heat or open flame. 
• Store Symbicort in a dry area at room temperature (68°F to 77°F / 20°C to 25°C) with the mouthpiece down. 
• Do not expose the medication to temperatures greater than 120°F (49°C), as the canister may burst.
• The FDA website provides valuable tips on medication disposal. You may ask your pharmacist as well for information on disposal.
• If you no longer need Symbicort and have leftover medication, dispose of it safely to prevent accidental use by others, including children and pets, and to protect the environment. 
• Do not puncture or burn your Symbicort inhaler. 
• Contact your local trash or recycling center for proper disposal guidelines, as rules can vary by state.

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

Symbicort Turbuhaler Interactions

Symbicort Turbuhaler can interact with various medications, leading to different outcomes. Some interactions may hinder the effectiveness of Symbicort or the other involved drug, potentially reducing the therapeutic benefits. Other interactions might increase the likelihood or severity of side effects. This can occur when Symbicort is used with medications that have similar side effects or when one medication affects the metabolism of the other.

It’s crucial to inform your healthcare provider about all medications, supplements, and over-the-counter drugs you are currently taking. This information will help your doctor to manage potential interactions effectively and ensure your treatment remains safe and effective.

Medications That Can Interact with Symbicort

Symbicort may interact with a variety of medications. While this list isn’t exhaustive, it highlights some common medications that could potentially interact with Symbicort:

Interactions with Certain Antidepressants: When using Symbicort, it’s essential to be cautious if you’re also taking certain antidepressants. Some antidepressants can interact with Symbicort, potentially increasing the risk of heart-related side effects. Types of Antidepressants That May Interact with Symbicort:

1. Nefazodone: This antidepressant could enhance cardiovascular side effects when taken with Symbicort.
2. Monoamine Oxidase Inhibitors (MAOIs): These include medications such as:
   • Selegiline (Emsam)
   • Phenelzine (Nardil) MAOIs can increase the risk of heart-related side effects when used concurrently with Symbicort.
3. Tricyclic Antidepressants: Examples include:
   • Amitriptyline
   • Desipramine (Norpramin)
   • Nortriptyline (Pamelor): Similar to MAOIs, tricyclic antidepressants may increase the risk of cardiovascular side effects when taken with Symbicort.

Your doctor can assess the risks and may suggest an alternative antidepressant that does not have the same interaction risks, ensuring both your respiratory and mental health conditions are effectively managed without undue side effects.

Interactions with Strong CYP3A4 Inhibitors: Symbicort contains budesonide, one of its active ingredients, which is metabolized in the body by an enzyme called CYP3A4. Drugs that inhibit this enzyme, known as CYP3A4 inhibitors, can affect how budesonide is broken down in your body. Impact of CYP3A4 Inhibitors on Symbicort:

• Increased Budesonide Levels: Taking CYP3A4 inhibitors with Symbicort may slow the breakdown of budesonide, leading to increased levels in the body. This can heighten the risk of experiencing side effects associated with budesonide.
• Potential for Side Effects: Higher levels of budesonide might lead to enhanced systemic effects, which could manifest as side effects.

Examples of CYP3A4 Inhibitor Medications:

• HIV Protease Inhibitors: such as ritonavir (Norvir), atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), and saquinavir (Invirase).
• Antibiotics: including clarithromycin and telithromycin.
• Antifungals: such as itraconazole (Sporanox) and ketoconazole.

Before starting Symbicort, it is crucial to inform your doctor if you are taking any of the above medications. Your doctor may need to adjust your treatment plan or choose a different medication to manage your condition safely. This is to ensure that your therapy is effective and minimizes the risk of adverse effects.

Interactions with Certain Diuretics: When using Symbicort, particularly if you are also taking diuretics, you need to be aware of how these medications can interact and affect your body, especially concerning potassium levels and heart rhythm. Effects of Combining Symbicort with Diuretics:

1. Lower Potassium Levels: Symbicort can reduce potassium levels in your blood, which is crucial for normal muscle and heart function. Low potassium levels can lead to issues such as irregular heart rhythms and muscle cramps.
2. Heart Rhythm Changes: Both Symbicort and diuretics can alter heart rhythms. Symptoms may include dizziness, fainting, a racing heart, or palpitations (sensations of skipped or extra heartbeats).
3. Increased Severity of Side Effects: Using Symbicort with diuretics may intensify these side effects. While potassium levels typically normalize on their own after stopping Symbicort, the presence of diuretics can complicate this recovery, potentially leading to persistent low potassium levels.

Examples of Common Diuretics:

• Hydrochlorothiazide (Microzide)
• Furosemide (Lasix)
• Bumetanide (Bumex)

Interactions with Beta-Blockers: Combining Symbicort with beta-blockers can lead to potential issues in managing respiratory conditions such as asthma or COPD. Possible Effects of Beta-Blockers on Symbicort:

1. Reduced Effectiveness: Beta-blockers may diminish the effectiveness of Symbicort in relieving respiratory symptoms. This occurs because beta-blockers can counteract some of the bronchodilatory effects of Symbicort, which are essential for easing airflow in the lungs.
2. Increased Risk of Bronchospasms: Beta-blockers can potentially cause bronchospasms, a condition characterized by the tightening of the airways. This effect can make breathing difficult, especially for individuals with respiratory disorders.

Examples of Common Beta-Blockers:

• Atenolol (Tenormin)
• Metoprolol (Toprol)
• Bisoprolol (Zebeta)
• Labetalol (Trandate)

If you are prescribed a beta-blocker for a heart condition or hypertension, it’s crucial to inform your healthcare provider if you are also using Symbicort for asthma or COPD. Your doctor may need to adjust your treatment plan to avoid interactions. This might involve choosing a different type of respiratory medication that does not interact with beta-blockers, ensuring both your respiratory and cardiovascular conditions are managed safely and effectively.

Symbicort and Herbs and Supplements

While there are no specific herbs or supplements known to directly interact with Symbicort, it is still important to exercise caution. The absence of reported interactions doesn’t guarantee safety, as limited research might exist on the combined effects of Symbicort with various supplements and herbal products.

Symbicort and Foods

Certain foods can affect how medications work in your body, and for Symbicort, grapefruit is a particular concern. It is advisable to avoid grapefruit and grapefruit juice while taking Symbicort. Discuss any dietary concerns with your healthcare provider to ensure that your food choices do not negatively impact your medication regimen.

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

Symbicort Turbuhaler Alternatives

• Serevent (salmeterol)
• Stiolto Respimat (olodaterol/tiotropium)
• Bevespi Aerosphere (formoterol/glycopyrrolate)
• Advair Diskus (salmeterol/Fluticasone)
• Anoro Ellipta (Vilanterol/Umeclidinium)
• Atrovent HFA (ipratropium)
• Dulera (formoterol/mometasone)
• Breo Ellipta (Vilanterol/Fluticasone)
• Lonhala Magnair (glycopyrrolate)
• Tudorza Pressair (aclidinium)
• Seebri Neohaler (glycopyrrolate)
• Daliresp (roflumilast)
• Spiriva (tiotropium)
• Incruse Ellipta (Umeclidinium)
• Perforomist (formoterol)
• Theochron (Theophylline)
• Foradil (formoterol)
• Serevent (salmeterol)
• Arcapta (indacaterol)
• Striverdi (olodaterol)
• Asmanex Twisthaler (mometasone)
• Flovent HFA (Fluticasone)
• Alvesco (ciclesonide)
• Singulair (montelukast)
• Pulmicort Flexhaler (budesonide)
• Qvar RediHaler (beclomethasone)
• Theo-24 (Theophylline)
• Accolate (zafirlukast)
• Zyflo (zileuton)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

Is Symbicort a corticosteroid?

Budesonide is an ICS (inhaled corticosteroid) that helps reduce inflammation (irritation) in the airways, making it easier to breathe. Inhaling the medication ensures that most of it reaches your airways. However, corticosteroids can weaken your immune system’s ability to fight infections. If you’re exposed to certain diseases, you may have a greater risk of those infections becoming serious. It is important to take precautions and inform your doctor if you have concerns about infections while using Symbicort.

Can you drink coffee after taking Symbicort?

Both caffeine and formoterol (one of the active ingredients in Symbicort) can increase blood pressure and heart rate. Combining them may enhance these effects. It is important to talk to your doctor before consuming coffee after taking Symbicort, especially if you have a history of high blood pressure or heart disease. Your doctor may provide personalized advice based on your specific health conditions.

Is Symbicort Turbuhaler a rescue inhaler?

No, you should not use Symbicort as a rescue inhaler. It is not meant to help with breathing problems that occur suddenly. Instead, you take this medication consistently to help control your symptoms over time. Your doctor will prescribe a different medication for you that’s considered a rescue inhaler, which you will use when needed for flare-ups of asthma or COPD. Do not take extra doses of Symbicort. If you feel like your asthma or COPD is not well controlled, inform your doctor. They can review and adjust your treatment plan as needed to ensure effective management of your condition.

How many days does it take for Symbicort to work?

If you use Symbicort for asthma, you may notice an improvement in your symptoms within 15 minutes of inhalation. However, full improvement in your symptoms may take 2 weeks or longer after you have started treatment. Results can vary between patients, so following your doctor’s instructions and being patient as your body adjusts to the medication is essential.

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