Budesonide and Formoterol

Known by the brand name Symbicort, budesonide and formoterol are combined to help improve lung function and control asthma symptoms in patients who did not respond well to other treatments.

Overview

Budesonide and formoterol are combined to create an inhaled corticosteroid that helps relax the lungs and relieve the symptoms of asthma. This medication is commonly known as Symbicort. It relaxes the muscles in the lungs to help prevent shortness of breath and wheezing. If you have not experienced relief from other asthma medications, this particular medication may be an option.

Symbicort is only available with a prescription from your doctor and is usually an alternative treatment to other more common types of asthma medications. This drug is also helpful with the treatment of chronic obstructive pulmonary disorder or COPD. It is available for use by both adults and children six years of age and older. Symbicort is only meant for use in patients who have severe asthma or COPD and is not well controlled through other forms of treatment.

Symbicort is not meant to be used as an emergency treatment if an asthma attack is already underway, but rather a daily preventative measure. This drug may increase the risk of death associated with asthma and should be used with caution under the supervision of your healthcare provider. If you have any pre-existing conditions or organ failure, you should discuss the benefits and risks of using this treatment with your doctor. You may not be a good candidate for this method of treatment if your pre-existing condition puts you at a high risk of side effects or organ failure.

It is important to closely monitor your mineral and bone density when using Symbicort. This medication may also impact your vision, so it is advised that you have regular vision screenings to help detect any changes in your vision. You should also rinse your mouth out after using this medication to help prevent thrush, which is a fungal infection. If, for some reason, you have a change in your lifestyle, increased stress, illness, or surgery, you may need to have your dose adjusted to compensate for these factors. If you decide to quit taking Symbicort, you should consult with your doctor about the proper method to taper off. It is not advised that patients quit taking this medication suddenly because they could suffer withdrawals.

Use caution when storing your Symbicort. Do not puncture the canister or store it where it will be exposed to heat or direct sunlight. Dispose of the unused portion if three months have passed since you punctured the foil seal on your canister. If you miss your dose of Symbicort, you should take it as soon as you remember. If it is time for your next dose, you should take the current dose only and resume your normal schedule. Do not double your dose if you miss one.

If you use steroids for an extended period of time, you may develop problems such as a marked increase in body fat, acne, impotence, loss of interest in sex, menstrual problems, thinning skin, and bruising easily. Once your asthma seems easily controlled, you may consider beginning the process of eliminating it from your daily routine. If you are pregnant or nursing you should refrain from using this medication because it is known to be harmful to developing and breastfeeding babies. Using Symbicort also increases your risk of infection. If you think you are at high risk for an infection, you should tell your doctor immediately.

Condition treated

  • Asthma
    COPD

Type of medication

  • Long-acting beta agonist

Side effects

This medication poses the risk of a variety of side effects which range from common to rare. Some side effects can create life-threatening situations such as an allergic reaction. An allergic reaction can cause difficulty breathing, hives, and swelling of the lips, face, throat, and tongue. If you experience any of these symptoms, or you experience severe side effects, you should tell your doctor right away and seek emergency medical treatment if necessary. Contact your healthcare provider immediately if you experience any of the following:

  • Trouble breathing, choking or wheezing after using this product. This can be a sign of an allergic reaction or intolerance to this medication and can potentially pose a risk to your life if not addressed.
  • You asthma symptoms get worse. In some instances, a patient who is not tolerating this medication well will notice their symptoms become more pronounced.
  • Tunnel vision, swelling, and pain in the eyes, lights with halos, or blurred vision. This can signal an allergic reaction.
  • Infection which presents symptoms such as tiredness, nausea, vomiting, fever, chills, and body aches.
  • Pneumonia symptoms such as yellow or green mucus accompanying a cough. Some individuals report wheezing or a stabbing pain in their chests.
  • Blood vessels inflammation and swelling which can present symptoms such as stuffy nose, flu-like symptoms, tingling and numbness in the arms or legs, and even sinus pain.
  • Low potassium which can cause leg discomfort, extreme thirst, increased urination, confusion, muscle weakness, unusual heart beat.
  • High blood sugar that can cause weight loss, dry skin, blurry vision, fruity breath odor, hunger, increased thirst, increased urination, drowsiness, and dry mouth.

Common side effects:

Aches and pains in the body

There may not be a specific place that you feel aches and pains, but rather, it could be all over your body or covering a large area. This may be a sign that you are not tolerating this course of treatment well and may need either a dose adjustment or a completely different treatment.

Chills

Many patients who are taking Symbicort report that they have experienced chills when taking it during the initial adjustment period which is the first few weeks. If this persists past the adjustment period or becomes worse you may need to change your treatment or seek medical assistance.

A sore throat, cough, fever, or sneezing

You may experience any, or all of these symptoms when taking Symbicort. Monitor your side effects closely for signs of an allergic reaction or an intolerance to this medication. If the symptoms persist you may want to inquire about treatment alternatives or a change in your treatment plan.

Breathing difficulty

This serious side effect can signal a serious life-threatening medical event. In some cases, it may be directly related to the condition this medication is treating, but it can also be a serious side effect or an allergic reaction to the medication called anaphylaxis and requires emergency treatment.

Ear congestion

You may, in some instances, experience temporary ear congestion when using this medication.

Fever

If you develop a fever when taking this medication, you may need to change treatments due to an adverse reaction.

Headache

You may develop a mild headache when taking this medication.

Change or loss of voice

Report any loss of voice or significant change to your health care provider. You may need to change your dosage.

Muscle pain

You may experience muscle pain or cramping when taking a corticosteroid.

Pain around the cheekbones or eyes

If you develop sensitivity or pain in your facial area, you should discuss a change in your treatment.

Runny or stuffy nose

You may develop a stuffy or a runny nose when you take Symbicort.

Chest tightness

Chest tightness may be a side effect of this medication, or it could be the sign of a life-threatening condition.

Weakness or tiredness that is unusual

You may feel weak or tired when taking Symbicort. If this side effect is excessive you should tell your doctor.

Less common side effects:

Stomach or abdominal pain

Report any pain in your stomach or abdomen.

Pain in the bladder

This is a potentially serious side effect.

Urine that is bloody or cloudy

Your urine may be cloudy when taking Symbicort. Report any blood in your urine immediately.

Congestion

Some people experience congestion associated with taking this drug.

A cough with mucus

A cough with mucus could signal a chest infection.

Diarrhea

If you experience frequent diarrhea, you may need to seek an alternative treatment.

Painful or burning urination

Report any painful or burning urination. It may be the sign of an infection.

Dry throat

If you experience a persistent dry throat, you may need a dose adjustment.

Irregular, fast, or pounding heartbeat

This medication is known to increase or cause irregular heart rate in some users.

Feeling ill or unwell

People who do not tolerate this medication well report feeling ill or unwell.

Hoarseness

Some people who take corticosteroids report hoarseness.

Joint pain

Joint pain is possible when taking this course of treatment. You may be able to obtain a prescription to help alleviate this side effect.

Appetite loss

Some may notice a decrease in appetite associated with taking this drug.

Pain in the lower back or sides

Some individuals have reported pain in their back or sides during the initial adjustment period.

Nausea

Some individuals have reported a feeling of nausea when taking Symbicort, especially during the adjustment phase.

Loudy breathing

Loud or labored breathing should be brought to the attention of your healthcare provider.

Shaking extremities

Monitor any shaking of your extremities closely.

Shivers

If you develop shivers, you may need a dose adjustment or a change in your treatment plan.

Sore tongue or mouth

You may not tolerate this medication well if you develop a sore tongue or mouth.

Sweating

Some individuals have reported unusual sweating with Symbicort.

Tender or swollen glands

This medication may cause swelling or tender lymph glands.

Trembling feet and hands

Monitor any trembling of the hands and feet, especially if accompanying any other side effects.

Insomnia

You may find that you have trouble sleeping when taking this medication. There may be medications you can take to help relieve this side effect.

Problems swallowing

If you develop trouble swallowing you may be having an allergic reaction to this medication.

Vocal change

Some people have reported changes in their voice when using Symbicort.

Vomiting

If you experience vomiting, you should consider other treatment options.

White patches on tongue or in the mouth

This may be a sign of thrush or other unusual side effect cause from Symbicort.

Rare side effects:

Blurry vision

If you experience blurry vision it may be a sign of a more serious condition caused by the use of corticosteroids.

Confusion

If you experience confusion when taking this medication, you may not be tolerating it well, or you may be having an adverse reaction.

Urine output decrease

Monitor your urine output if it seems to have decreased with the use of this medication. Keep your health care provider informed about any change in your condition.

Lightheadedness or dizziness when getting up from a seated or lying position

This medication is known to cause changes in blood pressure, which may cause you to experience lightheadedness or dizziness when standing suddenly. If this side effect persists you should ask about your treatment options.

Dry mouth

If you begin to experience dry mouth when using Symbicort, there are products available over the counter to help alleviate this uncommon side effect.

Pupil enlargement

Corticosteroids can cause dilation of pupils in some individuals.

Fainting

If you experience fainting when taking this medication, you should seek emergency medical assistance.

Dry, flushed skin

You may notice flushing of the skin that may be a result of increased heartbeat and blood pressure.

Fruity breath odor

You may notice a fruit-like odor on the breath when taking this medication.

Increased appetite

You may notice an increase in your appetite when taking this medication. Increased body fat may also accompany this side effect.

Light sensitivity

Some patients have reported having an increased ocular sensitivity to light when taking Symbicort.

Sweating which may include clammy skin or fever

Sweating accompanied with or without fever and clammy skin may be the sign of an intolerance to this medication, or could be a sign of a more serious medical condition.

Thirsty

You may experience unusual thirst when taking Symbicort.

Weight loss

Weight loss can be a potential side effect in some individuals. If you begin to experience this side effect for more than a few weeks, you may need a dose adjustment or possibly inquire about another course of treatment.

Sore or stiff neck

If you begin to experience a sore or stiff neck you should inquire about seeking another form of treatment or possibly have your dose adjusted to help relieve this rare side effect.

Irregular pulse or heartbeat

Corticosteroids such as Symbicort have been known to create irregularities in the heartbeat. If this condition persists or becomes severe, you should seek medical attention.

Headache

Some individuals in rare instances will experience occasional headaches when using this medication. Monitor this side effect and tell your health care provider if this condition persists or worsens while taking this treatment. You may be able to take additional medications to help relieve this rare side effects.

Chest pain

Chest pain can be a sign of serious underlying issues. Although this medication can cause chest pain, other possibilities should not be ruled out. If you have chest pain you should seek medical attention.

Seizure

This medication is known to increase the risk of seizures, especially in patients who already suffer from seizures. Discuss your medical history thoroughly with your healthcare provider before beginning treatment with this medication.

Pounding in the ears

This medication is known to increase the incidence of heart palpitations and increase blood pressure, which could cause pounding in the ears.

Tingling in the lips, hands, or feet

If you experience tingling in the feet, hands, or lips you should consult your healthcare provider. Although uncommon, this can be a sign of an allergic reaction or another serious medical event.

Cramps

This medication has been known, in some rare instances, to cause muscle cramping in individuals who are taking Symbicort. Monitor your situation and discuss the possibility of altering your dose or changing medications to reduce this side effect.

Hive-like swelling of the tongue, throat, legs, hands, feet, face, eyelids, lips, or sex organs

This is rare, but a serious side effect that can signal a life-threatening condition which is a result of an intolerance to this medication or an allergic reaction. Seek help immediately if you experience any of these side effects.

Increased urine output

Although this is a rare occurrence, there is still the potential for this medication to increase urine output. Monitor your side effects and keep your doctor or health care provider informed.

Dosage

Symbicort is an inhaled corticosteroid that is intended to be used twice daily, approximately 12 hours apart. Once inhaled, the person using this medication should rinse out their mouth to avoid the potential of developing thrush in their mouth. Before using this medication from the canister for the first time, you should aim the opening away from the face and spray twice to prime the device before using it. If you have not used the canister for over 7 days, you should prime the device again to ensure that it is working properly and that you are getting the correct dose.

This medication is not recommended for use more than twice daily because it increases the likelihood of developing a serious adverse reaction in higher doses. Your dose may rely on your age, as well as the severity of your asthma. Most individuals will notice a marked improvement in their asthma symptoms 15 minutes after using Symbicort. This medication, is not, however, intended for use as a rescue inhaler. If you begin to experience a sudden onset of asthma symptoms and require immediate treatment, you should use your rescue inhaler containing a short-acting beta2 agonist.

The dosage instructions are the same for individuals who are using this treatment to relieve the symptoms of COPD. If shortness of breath occurs, you should use a rescue inhaler for immediate relief of your symptoms.

Interactions

Currently, there are a total of 1096 known drug interactions which are associated with Symbicort. Of these 1096 interactions, there are 68 major drug interactions, 991 moderate drug interactions, and 37 minor drug interactions. The most common drugs that interact with Symbicort include albuterol, amlodipine, aspirin, prednisone, ProAir HFA, furosemide, trazodone, lisinopril, and metformin.

Lifestyle/Food interactions:

Grapefruit juice

Grapefruit juice is considered a moderate interaction risk. It is advised that individuals who are taking Symbicort avoid ingesting grapefruit juice. When ingested, grapefruit juice can increase plasma concentrations which alters the effectiveness of this medication. The effects of the medication are therefore doubled when taken with generous amounts of grapefruit juice. This also includes fresh grapefruits.

Hypertension (high blood pressure)

This medication poses a risk of increasing the heart rate and blood pressure. It may also result in tachycardia, ECG changes, and palpitations. Individuals who have hyperthyroidism, coronary insufficiency, cardiac arrhythmias, and other underlying cardiac disorders should be treated under close supervision.

Disease interactions:

Cardiovascular

Patients who have cardiovascular conditions are at risk of a moderate interaction with Symbicort. Anyone who has a cardiovascular condition should only use this medication under the close supervision of their doctor or healthcare provider.

Diabetes

This medication may increase the blood's glucose levels which, are usually mild, but in higher than average doses, can pose a significant health risk to patients with diabetes. It is thought that high doses of albuterol can exacerbate diabetes mellitus and ketoacidosis.

Hypokalemia

This medication may pose the risk of decrease potassium concentrations. For some individuals, hypokalemia may occur and have adverse cardiovascular effects.

Seizures

This medication poses a moderate interaction risk and has the potential to cause CNS stimulation and should be used with caution. Another route can be chosen to minimize the risks to patients who have seizures.

Hepatic impairment

Corticosteroids are passed through the liver and may accumulate in patients who have hepatic impairments, which can cause them to pose a toxicity risk. Patients with hepatic disorders should be closely monitored when taking this medication.

Infections

This medication poses a moderate risk to individuals who have or may develop an infection. The symptoms of the medication may be masked and pose a significant health risk. It is also known to promote secondary infections. Patients who have untreated respiratory infections or any fungal, bacterial, or viral infections should consult their doctor and tell them before beginning this treatment to prevent the potential of a life-threatening situation.

Ocular Herpes Simplex

Individuals who have ocular herpes simplex are at a greater risk for corneal perforations and should be monitored closely during the treatment.

Ocular toxicities

If you use corticosteroids for an extended period of time you are at risk for developing posterior subcapsular cataracts and can also develop an increased interocular pressure which can trigger glaucoma or can damage the optic nerve. Although these instances are rare, use of this medication should be monitored closely for ocular toxicities and abnormalities. Using the lowest effective dose to help prevent adverse effects.

Osteoporosis

Using corticosteroids for an extended period of time lowers bone and mineral density. These instances occur primarily in individuals who are taking more than 800 mcg daily for over the course of 1 year.

Warnings

If you take a corticosteroid such as Symbicort it is important to know that it increases the chance of asthma-related death. Ask your doctor about this possibility before beginning this treatment. Corticosteroids are also known to increase the risk of asthma-related hospital stay in children and teens. This medication is not intended to be used as a rescue inhaler, but rather a long-term preventative treatment to help control your asthma or COPD symptoms.

This medication is not intended for use in patients under the age of 6 years. Do not take more of this medication than prescribed because it could increase the risk of side effects. Do not stop taking this medication suddenly because it can cause withdrawal symptoms. When you use this medication you should rinse your mouth to help prevent the development of thrush on the tongue and in the mouth. Do not drink grapefruit juice when taking this medication because it could increase the levels absorbed in your stomach and pose a toxicity risk.

Storage

When storing Symbicort, you should keep the canister away from heat or flame. It is also advised to keep the canister out of the direct sunlight. Keep your medication stored at room temperature and avoid puncturing the container. Once you remove the foil seal from the canister, you should use the medication within three months. If you have a canister of Symbicort that has been opened for longer than three months it should be disposed of in a proper manner.

Summary

Budesonide and formoterol are used to treat breathing issues presented by asthma and chronic obstructive pulmonary disorder or COPD. It is known by the brand name Symbicort and is effective in treating severe asthma that is not well controlled by other medications. This drug is a corticosteroid and is used to help patients control their asthma and is not intended for long-term use. There are a variety of side effects which are possible as a result of taking this medication.

It is important to speak with your doctor about any issues you may have such as organ failure or renal impairment, as this may make this medication a poor fit for your treatment needs. This medication has been known to increase some pre-existing conditions and disease. Discuss your medical history thoroughly with your doctor before beginning treatment with Symbicort. Tell your doctor about any medications and supplements both herbal and vitamins that you take. Do not stop taking this medication suddenly because it can have very unpleasant side effects. If you begin to experience severe side effects or withdrawals from this medication, you should notify your doctor immediately and seek emergency medical attention if necessary.

This medication is not intended for use in an emergency situation. It is a preventative medication intended to reduce the severity of symptoms related to severe asthma or COPD. Using a corticosteroid for an extended period of time can have a negative effect on your health. It can cause a variety of issues from weight gain to low bone and mineral density. It is important that you keep your scheduled appointments and carefully monitor your overall health while being treated with this medication. If you have a change in your health, stress level, or are expecting to have a medical procedure, you should tell your doctor because your dose may need to be adjusted to compensate for the additional factor.

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Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017
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