What It Is:
Symbicort is an inhaled asthma medication that contains two different asthma medications mixed together that are sometimes used separately:- Pulmicort (budesonide), an inhaled steroid
- Foradil (formoterol), a long-acting beta agonist (LABA)
Symbicort is used on an ongoing basis to control asthma symptoms. It is one of the preventive — or controller — types of asthma medicines. Symbicort can be used both in adults and in children age 12 years and older. It is most commonly used in people who have not been able to achieve adequate asthma control with an inhaled steroid.
How It Works:
Symbicort controls asthma in two different ways:- Foradil, a bronchodilator, reduces airway constriction, which is the tightening of the muscles around the walls of your airways.
- Pulmicort, which is a corticosteroid, reduces airway inflammation, swelling and irritation.
Together, the two medicines combine to relax and widen the airways, thus increasing the airflow through your lungs and lessening or preventing asthma symptoms, such as wheezing, coughing, shortness of breath and chest tightness.
Forms and Doses:
Symbicort is contained in what is known as a metered dose inhaler. This means that each time you dispense it by pressing on the canister, it releases the same measured amount of medicine. Symbicort is available in two different strengths:- 80/4.5
- 160/4.5
The first number is measured in micrograms and refers to the amount of Pulmicort per puff. The second number is also in micrograms and refers to the amount of Foradil per puff. Most people take 2 puffs of Symbicort in the morning and 2 more before bedtime. Which dose level your doctor prescribes will depend on the severity of your asthma and the dose of inhaled steroid you were taking before switching to Symbicort.
Risks and Side Effects:
Symbicort currently has what is known as a "black box warning" from the FDA. This was issued in relation to the formoterol that is in Symbicort. This warning was issued because a few studies showed that another LABA, called "salmeterol," had a slightly increased risk of breathing problems and death in people with asthma, especially African-Americans.The studies, however, originally looked only at people taking salmeterol by itself. When they took a closer look, they found that there was no increased risk when LABAs were taken with an inhaled steroid, such as Pulmicort. In addition, a recent study that looked at Symbicort specifically shows that Symbicort has a similar positive safety profile to its inhaled steroid, Pulmicort.
Like most asthma medicines, Symbicort is usually well-tolerated. Some of the more common side effects, however, include:
- nose and throat irritation
- headache
- upper respiratory tract infection
- sore throat
- sinusitis
- stomach discomfort
If any of these side effects persist or become bothersome, be sure to talk with your doctor.
What You Need to Know:
The kinds of reactions that the black box warning talk about are rare, especially in combination medicines, such as Symbicort. If your doctor has prescribed Symbicort because an inhaled steroid alone wasn't controlling your asthma, do not let your fears stop you from taking the medicine. Just be aware of the risk and be sure to contact your doctor right away with any concerns or changes in your breathing.Symbicort can interact with other medicines, such as the types used to treat depression. So be sure your doctor knows everything you are taking, even if it is over the counter or a herbal product. It's important to follow the package instructions on how to use Symbicort. You can also find the instruction here on the web (PDF). Keep track of when you are running low by keeping a dose log and allow time to refill your prescription, so that you don't miss any doses.
If you are switching to Symbicort from an oral corticosteroid, such as Prednisone, follow your doctor’s instructions to avoid health risks when you stop using oral corticosteroids.
Symbicort is a preventive asthma medicine, not a quick-relief medication, so it should not be used to relieve asthma attacks or other acute asthma symptoms. Nor should it be used to treat exercise-induced asthma.
When to Call Your Doctor
Call your doctor right away if any of the following things occur:
- Your breathing problems get worse while you are taking Symbicort.
- You need to start using your rescue inhaler more often than usual.
- Your rescue inhaler stops relieving your asthma symptoms.
- You need to use four or more puffs of your rescue inhaler for two or more days in a row.
- You use one whole canister of your rescue inhaler medicine in less than eight weeks time.
- Your peak flow meter results worsen.
- Your asthma symptoms do not improve after you've been using Symbicort regularly for one to two weeks.
Also, some people may experience increased blood pressure, heart rate or a change in heart rhythm. Tell your doctor if you have a heart condition or high blood pressure before starting on Symbicort.
If you'd like to learn more about Symbicort, including how it may interact with other medications you are taking, check out the Drugs A to Z pages.
Sources:
AstraZeneca. "Symbicort Prescribing Information." 28 Aug 2008
"Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma." NHLBI Guidelines for the Diagnosis and Treatment of Asthma. 28 Aug 2007. National Heart Lung and Blood Institute. 18 Dec. 2007 <http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf>
Aaronson DW. The "Black Box" Warning and Allergy Drugs. J Allergy Clin Immunol. 2006;117:40-4.
Nelson HS, Weiss ST, Bleeker ER, et al. The Salmeterol Multicenter Asthma Research Trial. Chest. 2006;129:15-26.
Nelson HS. Long-Acting Beta-Agonists in Adult Asthma: Evidence that these Drugs are Safe. Primary Respiratory Care Journal. 2006;15:271-77
