Symbicort (Budesonide/Formoterol) Inhalation: Uses, Side Effects, Dosage

What Is Symbicort?

Symbicort is an inhaled treatment that contains two different medicines: budesonide and formoterol. It is used to treat asthma in people aged 6 and older and chronic obstructive pulmonary disease (COPD).

Budesonide is a corticosteroid that fights off inflammation, which can be caused by lung conditions like asthma and COPD. Many types of steroids exist. Corticosteroids are an important part of human biology that affect the body's immune response.

Formoterol is called a long-acting beta-agonist (LABA). This medicine targets the airways in your lungs and causes them to relax and open up, making it easier to breathe.

Symbicort is a prescription drug, which means you need an order for it from your healthcare provider. You'll pick it up from your pharmacy rather than purchasing it over-the-counter (OTC) from a drugstore or grocery store.

Drug Facts

Generic Name:&nbsp;Budesonide and formoterol

Brand Name(s):&nbsp;Symbicort

Drug Availability: Prescription

Administration Route:&nbsp;Inhalation

Therapeutic Classification:&nbsp;Anti-asthma, anti-inflammatory/bronchodilator combination

Available Generically:&nbsp;Yes

Controlled Substance:&nbsp;N/A

Active Ingredient:&nbsp;Budesonide and formoterol fumarate dihydrate

Dosage Form(s): Aerosol liquid (for inhalation by mouth)

What Is Symbicort Used For?

The Food and Drug Administration (FDA) approved Symbicort to treat asthma in people at least 6 years old, and COPD, including both chronic bronchitis and emphysema.

How to Take Symbicort

Symbicort comes as a type of inhaler called an MDI or metered-dose inhaler. This is one of the most common types of inhalers. It uses a chemical called a propellant to move the medicine from a canister into your lungs as you inhale.

Getting the full dose of medicine into your lungs is dependent on your inhaler technique, especially with MDIs.

First off, you'll need to prime your inhaler if:

It's your first time using the inhaler
It's been seven days or more since you last used your inhaler
If you've accidentally dropped the inhaler

The following steps will ensure you get the full dose:

If you need to prime your inhaler, shake it for at least five seconds. Then, remove the mouthpiece and press the canister down twice to release two test sprays into the air, away from your face. Only perform this step if the inhaler needs to be primed. You do not need to prime the inhaler before each use.
When you're ready for a dose, exhale as fully as you can.
Wrap your lips around the mouthpiece, and press down on the canister while inhaling as deeply as possible. Then you can remove the inhaler from your mouth but hold that deep breath and count to 10 slowly before breathing normally again.
Wait at least one minute before your second inhalation, then repeat steps two and three.
After you're done taking Symbicort, rinse your mouth out or brush your teeth. Any medicine left behind in your mouth after inhaling can cause a bad taste, a hoarse voice, or potentially a fungal infection in your mouth.

Storage

Store your Symbicort inhaler at room temperature (68 to 77 degrees Fahrenheit) in a dry place. This usually means humid areas like the kitchen or bathroom are not the best options as they can expose the inhaler to steam. Likewise, avoid hot areas like a car trunk, glove box, or anywhere in direct sunlight.

The inhaler has a dose counter that will tell you how many inhalations are left before it's time for a refill. The canister may not feel totally empty at that time, and the inhaler may still spray medicine. It's best to go ahead and get your refill, as you are not guaranteed to get the full amount of medicine once the dose counter runs out.

The medicines you inhale when you take Symbicort, budesonide and formoterol, are designed to target the airways in the lungs and improve symptoms caused by asthma and COPD. For this reason, there are no common off-label uses for Symbicort.

It is worth noting that LABAs are not used to treat acute asthma attacks. They work over a longer period to prevent attacks and will not help the symptoms of an asthma attack that has already started.

How Long Does Symbicort Take to Work?

You can expect to see some improvement in your asthma and COPD symptoms within about 15 and five minutes, respectively, after taking Symbicort. It might take a couple of weeks to feel the full effects. Call your healthcare provider if you don't notice any improvement after a week or if your symptoms get worse.

What Are the Side Effects of Symbicort?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The following are some of the more common side effects of Symbicort. Notify your healthcare provider if you notice these side effects and think they are severe or do not go away:

Hoarse voice or scratchy throat
Headache
Oral candidiasis (a fungal infection in the mouth)
Nasopharyngitis, or symptoms that feel like a common cold such as a stuffy or runny nose or congestion

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.

Serious side effects can include pneumonia or lower respiratory tract infections in people with COPD. Symbicort may also cause hypokalemia, or a low potassium level, leading to irregular heart rate or rhythm.

Other serious side effects are associated with the long-term use of corticosteroids (such as budesonide) found in Symbicort.

Long-Term Side Effects

The following are some side effects associated with using any type of corticosteroid over a long period of time. This includes the budesonide found in Symbicort.

However, since it is an inhaled medication, less budesonide will enter your blood circulation (and therefore other bodily organs). Instead, more of it will remain in the lungs compared with other medications ingested by mouth or injected into the veins.

Some long-term side effects associated with Symbicort include:

Immunosuppression: Using Symbicort more often than prescribed may suppress your immune system due to high amounts of corticosteroids (e.g., budesonide). This could make it easier for you to get sick and harder to heal from cuts or wounds.
HPA axis suppression: Corticosteroids are an important part of human biology. Sometimes when we start taking corticosteroid medicines from outside sources (like Symbicort), our bodies can have trouble knowing whether they are still supposed to make the corticosteroids or if they don't need to anymore. This is sometimes also called HPA axis suppression. Symptoms include weakness and fatigue, tiredness during the day, headache, and nausea. If these effects occur with Symbicort, let your healthcare provider know so that a plan can be made to adjust your dose and get your HPA axis back in line.
Decrease in bone density: Bone density is a measure of the strength of your bones. Lower density is associated with more fragile bones and a greater risk of fractures with falls. Small decreases in bone density have been seen with the long-term use of Symbicort. Let your healthcare provider know if you have a family history of osteoporosis or other factors you know to affect bone health.

Effect on children's growth: Long-term use of inhaled steroids like Symbicort may cause a decrease in how quickly children grow.&nbsp;
Glaucoma and cataracts: Long-term use of Symbicort has been associated with higher intraocular pressure (the pressure inside the eye). Let your healthcare provider know about any changes in vision or if you have a history of glaucoma or cataracts.

Report Side Effects

Symbicort may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Symbicort Should I Take?

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For inhalation dosage form (aerosol):
- For preventing an asthma attack:
  - Adults and children 12 years of age and older—2 inhalations in the morning and another 2 inhalations in the evening. Each inhalation contains 80 or 160 micrograms (mcg) of budesonide and 4.5 mcg of formoterol.
  - Children 6 to 11 years of age—2 inhalations in the morning and another 2 inhalations in the evening. Each inhalation contains 80 mcg of budesonide and 4.5 mcg of formoterol.
  - Children younger than 6 years of age—Use and dose must be determined by your child's doctor.
- For treatment and prevention of worsening attacks of COPD:
  - Adults—2 inhalations in the morning and another 2 inhalations in the evening. Each inhalation contains 160 micrograms (mcg) of budesonide and 4.5 mcg of formoterol.
  - Children—Not used for COPD in this age group.

Modifications

In some cases, your healthcare provider may adjust your dose or treatment with Symbicort.

Use in Children

While Symbicort is approved to treat children 6 years and older, long-term use of corticosteroids like budesonide may slow their growth. If your child is taking Symbicort, the healthcare provider may need to monitor their growth. They may prescribe the lowest dose possible, to be safe.

Use in Older Adults

Not enough adults aged 65 years and older were included in initial clinical studies of Symbicort, so it is unknown if they will respond differently to the medication. Since older individuals are more likely to have impaired wound healing or altered mental status, the benefits of using corticosteroids should outweigh the risks of potential side effects.

Pregnancy or Breastfeeding

There have not been any adequate studies of formoterol use in pregnant people. However, studies involving budesonide use in pregnancy have not shown an increased risk of abnormalities or toxicity to the developing fetus.

As for nursing, one study showed that the dose of budesonide in the breast milk consumed by the infant is about 0.3% to 1% of the dose inhaled by the user from a dry powder inhaler. The dose from an MDI would be expected to be similar. Talk to your healthcare provider if you are breastfeeding or planning to breastfeed.

Missed Dose

If you forget a dose of Symbicort, you can take it as soon as you remember. If you are closer to your next dose than the dose you missed, go ahead and skip the missed dose and wait for your next scheduled one.

Overdose: What Happens If I Take Too Much Symbicort?

If you only take Symbicort as directed, you shouldn't be too concerned about using too much or overdosing. If you accidentally double up doses, continue your schedule as usual. Since Symbicort consists of two different medicines, the effects of taking too much of either of these can be considered separately.

Taking too much budesonide would be unlikely to have immediate effects. If you take too much over a long time, your chances of experiencing long-term side effects of corticosteroids would most likely be increased.

Taking too much formoterol would be more likely to cause acute or exaggerated symptoms, such as:

Irregular heart rate or heart rhythm
High or low blood pressure
Muscle cramps
Dizziness
Seizures

These effects were rare, even in studies where twice the dose was administered.

What Happens If I Overdose on Symbicort?

If you think you or someone else may have overdosed on Symbicort, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Symbicort, call 911 immediately.

Precautions

It is very important that your doctor check the progress of you or your child at regular visits&nbsp;to make sure that this medicine is working properly and to check for any unwanted effects. You may need to have your eyes checked at regular visits. Be sure to keep all appointments.

Although this medicine decreases the number of asthma episodes, it may increase the chances of a severe asthma attack when they do occur. Be sure to read about these risks in the patient information leaflet and talk to your doctor about any questions or concerns that you have.

This should not be the first and only medicine you use for asthma or COPD. It will not stop an asthma attack that has already started. Your doctor may prescribe another medicine for you to use in case of an acute asthma attack or an acute COPD flare-up. If the other medicine does not work as well, tell your doctor right away.

Take all of your COPD medicines as your doctor ordered. If you use any type of corticosteroid medicine to control your breathing, keep using it as ordered by your doctor. Do not change your doses or stop using your medicines without first asking your doctor.

You or your child should not use this medicine if your asthma attack has already started or if you already have a severe asthma attack. Your doctor may prescribe another medicine (eg, a short-acting inhaler) for you to use in case of an acute asthma attack. Call your doctor immediately for instructions.

Do not use any other asthma medicine or medicine for breathing problems without talking to your doctor. This medicine should not be used with salmeterol (Serevent®), formoterol (Perforomist™), or arformoterol (Brovana®) inhalers.

Talk to your doctor or get medical care right away if:

Your or your child's symptoms do not improve after using this medicine for 1 week or if they become worse.
Your short-acting inhaler does not seem to be working as well as usual and you need to use it more often (eg, you use 1 whole canister of your short-acting inhaler in 8 weeks time, or you need to use 4 or more inhalations of your short-acting inhaler for 2 or more days in a row).
You or your child have a significant decrease in your peak flow when measured as directed by your doctor.

Do not change your dose or stop using your medicine without first asking your doctor.

You may get infections more easily while using this medicine. Tell your doctor right away if you or your child have been exposed to someone with chickenpox or measles.

This medicine may cause fungus infection of the mouth or throat (thrush). Tell your doctor right away if you or your child have white patches in the mouth or throat, or pain when eating or swallowing.

Patients with COPD may be more likely to have pneumonia when taking this medicine. Check with your doctor if you start having increased sputum (spit) production, change in sputum color, fever, chills, increased cough, or an increase in breathing problems.

Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor if you or your child have more than one of these symptoms while you are using this medicine: darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.

This medicine may cause paradoxical bronchospasm, which may be life-threatening. Check with your doctor right away if you or your child are having a cough, difficulty with breathing, or wheezing.

If you or your child develop a skin rash, hives, or any allergic reaction to this medicine, check with your doctor right away.

This medicine may decrease bone mineral density when used for a long time. A low bone mineral density can cause weak bones or osteoporosis. If you have any questions about this, ask your doctor.

This medicine may cause children to grow more slowly than usual. Talk to your child's doctor if you have any concerns.

This medicine may affect blood sugar and potassium levels. If you notice a change in the results of your blood or urine sugar or potassium tests or if you have any questions, check with your doctor.

Your doctor may want you to carry a medical identification (ID) card stating that you or your child are using this medicine and that you may need additional medicine during times of emergency, a severe asthma attack or other illness, or unusual stress.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Symbicort?

Before starting Symbicort, tell your healthcare provider if any of the following applies to you:

You take oral steroids regularly.
You have any condition associated with high or low cortisol levels or adrenal insufficiencies, such as Addison's disease or Cushing's disease.
You have poor nutrition, chronic use of drugs that can reduce bone mass or a family history of osteoporosis.

Your healthcare provider will determine whether it is safe for you to take Symbicort and if any dosage adjustments or extra monitoring are needed.

What Other Medications Interact With Symbicort?

Drug interactions can occur with Symbicort.

Watch for the following medications:

Beta-blockers, such as metoprolol (e.g., Lopressor, Toprol-XL), atenolol (e.g., Tenormin), or esmolol (e.g., Brevibloc)
CYP3A4 inhibitors, such as ritonavir (e.g., Norvir), atazanavir (e.g., Reyataz), clarithromycin (e.g., Biaxin XL), among others
Diuretics (water pills), such as bumetanide (e.g., Bumex) and furosemide (e.g., Lasix)
Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (e.g., Marplan) and selegiline (e.g., Emsam)
Tricyclic antidepressants, such as amitriptyline and nortriptyline (e.g., Pamelor)

Beta-blockers

These are medicines often used for heart failure or high blood pressure. Since beta-blockers have the opposite effect as beta-agonists, they can block the effect of formoterol. Beta-blockers are not the best choice for people with asthma or COPD.

CYP3A4 Inhibitors

These drugs can interrupt how your body processes Symbicort and may make it stay in your system a little longer.

Diuretics

These are medicines that also commonly treat high blood pressure or heart failure. They have the potential to cause hypokalemia (low potassium level), which Symbicort may also do. Used together, the risk of hypokalemia is increased slightly.

MAOIs and Tricyclic Antidepressants

Use extreme caution with these medications if you are also taking Symbicort. MAOIs and tricyclic antidepressants may increase the effects of formoterol on the vascular system.

Always tell your healthcare provider about all medications, prescription or OTC, and supplements you take.

What Medications Are Similar?

Other inhalers that contain both an inhaled corticosteroid and an LABA include:

Advair (fluticasone and salmeterol): The corticosteroid in Advair is fluticasone and the LABA is salmeterol. Advair is available as an MDI like Symbicort and a dry powder inhaler.
AirDuo (fluticasone and salmeterol): AirDuo contains the same medicines as Advair but provides a lower dose of salmeterol.
Dulera (mometasone and formoterol): Like Symbicort, the LABA in Dulera is formoterol, but the corticosteroid is mometasone. Dulera is also available as an MDI.
Breo Ellipta (fluticasone and vilanterol): Breo Ellipta is the newest on this list and is a dry powder inhaler. The corticosteroid in this inhaler is fluticasone and the LABA is vilanterol.

This list is a list of drugs also prescribed for asthma or COPD. It is NOT a list of drugs recommended to take with Symbicort. In fact, you should not take these drugs together. Ask your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

Symbicort is a long-term inhaler used to reduce asthma attacks in people 6 years and older and to control COPD symptoms, such as chronic bronchitis and emphysema.
Symbicort contains two different medicines: budesonide and formoterol. Budesonide is a corticosteroid that fights inflammation in the lungs. Formoterol is a LABA (long-acting beta-agonist) that opens up the airways in the lungs, making breathing easier.
Once you start taking Symbicort, don't stop taking it before talking to your healthcare provider. They may want you to taper (gradually lower your dose) the medication, so that your body has time to increase its natural production of corticosteroids.

How Can I Stay Healthy While Taking Symbicort?

Dealing with lung conditions like asthma and COPD can be downright debilitating. If you or your child has asthma or COPD, it's understandable to feel frustrated, sad, or angry about not being able to do things you would typically do or watch your child miss out on certain activities.

In addition to taking your medications as prescribed, there are many ways you can improve your quality of life with these conditions, such as:

Identifying and avoiding asthma triggers, such as mold, dust, smoke, or pollen
Stopping smoking
Making time to incorporate stress-reducing activities and hobbies
Engaging in exercises less likely to set off symptoms, like swimming, walking, or leisurely biking
Eating a healthy diet

You can also check out support groups, online or in-person, that may help you cope with your diagnosis. It can be helpful to meet other people who are dealing with similar challenges.

Understanding your or your child's medications, how they work, and how best to take them will provide the best chance of improving overall symptoms. Remember that your healthcare team is there to help you with any questions or concerns.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

Symbicort (Budesonide/Formoterol) Inhalation: Uses, Side Effects, Dosage - Verywell Health

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