Did you know that asthma and chronic obstructive pulmonary disease (COPD) are among the top 20 causes of global disability, with each affecting more than 200 million people, globally?[1]

By causing swelling in the airways, these diseases make it hard to breathe, which can significantly decrease the affected patients’ quality of life.

Although there is currently no cure for asthma and COPD, a variety of medications are available that can reduce the impact of these diseases on a patient’s life by helping to control the symptoms and slowing down their progression.

Asthma and COPD medications can be divided into two types:

  1. Quick-relief medicines (fast-acting bronchodilators) to help treat breathlessness and other symptoms, by relaxing the airways, in case of a flare-up.
  2. Long-term bronchodilators that help to manage their symptoms and prevent flare-ups, in the long-run.

Symbicort belongs to the second group of asthma and COPD treatment medicines.

What is Symbicort?

Symbicort is the brand name for a combination medicine that is used to help manage asthma and chronic obstructive pulmonary disease for patients who do not find relief from an inhaled corticosteroid (ICS) or whose disease is so severe that they require both an ICS and LABA (long-acting beta2-adrenergic agonist).

Containing Budesonide (ICS) and Formoterol (LABA), the medicine helps to prevent the airflow obstruction, in the long-run, by reducing inflammation in the lungs and relaxing the smooth muscles around the airways. The medicine may also help patients to prevent flare-ups, which means a decreased need to use rescue medications.

Limitation of Use

Symbicort is not a rescue inhaler and hence, cannot be used to get relief from acute bronchospasm.

Available Dosage Forms and Strengths

Symbicort is available in the form of a metered-dose oral inhaler in 80/4.5 and 160/4.5 strengths, with 80 or 160 mcg budesonide and 4.5 mcg formoterol.

Each dosage strength is available in two varieties; 60 and 120 actuations per canister.

Storage and Handling

A Symbicort inhaler should be stored at controlled room temperature between 68 to 77 degrees Fahrenheit (20-25 degrees centigrade), with the mouthpiece down. Protect from heat and open flame and do not expose to temperatures above 120 degrees Fahrenheit as it can cause the canister to burst.

Never perform the float test (dip the inhaler in water) to determine the remaining amount of drug in the canister.

Recommended Dosage of Symbicort

While it might vary across patients, the most commonly prescribed dosages for Symbicort are as follows:

For Pediatric Asthma Patients

Two inhalations of 80/4.5 strength Symbicort, twice daily, is generally prescribed for asthma patients that are 6 to less than 12 years old.

Symbicort is not used for treating asthma in children less than 6 years of age.

For Adolescent and Adult Asthma Patients – Aged 12 or Older

The starting dosage of Symbicort may vary according to the severity of the diseases, control over symptoms, and the risk of flare-ups with the currently used inhaled corticosteroids. However, the maximum dosage shouldn’t exceed two inhalations of 160/4.5 strength Symbicort, twice daily.

Typically, the treatment of asthma with Symbicort starts with two inhalations of 80/4.5 strength, twice daily, and is only replaced with a higher strength if the patient doesn’t respond to it or it doesn’t provide adequate control on the disease.

Doctors usually wait and monitor the effects of the medicine for 1 to 2 weeks before prescribing a higher dosage.

For Patients of Chronic Obstructive Pulmonary Disease

Two inhalations of 160/4.5 strength Symbicort taken twice daily is the recommended dose for patients suffering from COPD.

Important: When treating respiratory diseases with Symbicort, it is highly important that you strictly follow the recommended dosage. Do not take more than the prescribed dosage or skip a dose.

How to Use Symbicort Inhaler

Prime the Symbicort inhaler when using it for the first time. For that, shake the inhaler well for about 5 seconds and then spray it once away from your mouth. Repeat the process one more time. Your Symbicort inhaler is now primed and ready to be used.

Important: The Symbicort inhaler will need to be primed again if you drop it or are using it after more than 7 days.

When taking the dose, shake the inhaler for 5 to 10 seconds before every use. Breathe out and then put the mouthpiece of the inhaler in your mouth, closing your lips around it. Make sure your tongue or teeth aren’t blocking the mouthpiece and it is pointed towards the back of your throat.

Push the actuator while breathing in through your mouth, slowly and deeply. Hold your breath for 5 to 10 seconds and then breathe out while releasing the actuator.

Take the inhaler out of your mouth, wait for 30 seconds, shake the inhaler again for 5 seconds, and then repeat the procedure for the second puff.

It is recommended to rinse your mouth thoroughly with water after taking Symbicort as it helps to decrease the risk of getting a mouth infection that comes with using oral inhalers. Make sure you don’t swallow the water and spit it out completely.

How to Clean Symbicort Inhaler

It is recommended to clean your Symbicort inhaler once a week, so the residues of the drugs do not build up and block the spray. Here’s how to do that:

Remove the cap and clean the circular opening (from where the medicine comes out of the canister) with a dry cotton swab followed by cleaning with a damp tissue.

Do it after taking your evening dose, so there is enough time for the spray to dry. Only put the cover back when it has completely dried.

How Long Does Symbicort Take To Provide Relief?

Patients can start experiencing an improvement in their condition as quickly as within 15 minutes after administering Symbicort. However, it takes around 2 weeks (or longer, at times) before the patients experience significant symptom relief.

What to Tell Your Doctor before You Start Taking Symbicort

Symbicort can interact with certain drugs, so it is critical to tell your doctor about all the prescription, over-the-counter, and herbal medicines and dietary supplements you are taking. In particular, make sure to tell your doctor if you are taking any of the following:

  • Diuretics
  • Beta-blockers, including eye drops
  • Tricyclic antidepressants and monoamine oxidase inhibitors (these medicines shouldn’t be taken with or within 2 weeks of discontinuing Symbicort.
  • Strong cytochrome P450 3A4 inhibitors, such as ritonavir, clarithromycin, nelfinavir, telithromycin, nelfinavir, itraconazole, saquinavir, indinavir, and atazanavir
  • Bepridil
  • Amisulpride
  • Cisapride
  • Dronedarone
  • Desmopressin
  • Mesoridazine
  • Piperaquine
  • Pimozide
  • Sparfloxacin
  • Saquinavir
  • Thioridazine
  • Terfenadine
  • Ziprasidone

In addition to these medications, it is also important to tell your doctor if you are:

  • Pregnant or planning to get pregnant – it is not known if the two active drugs present in Symbicort can cause any harm to the fetus.
  • Nursing mother – It is important to determine the safety of Symbicort for the child as Budesonide, one of the medicine’s active ingredients, is known to pass into breast milk.
  • Allergic to any medicine
  • Suffering from any other health condition(s), particularly:
  • High blood pressure
  • Heart issues
  • Seizure disorders, such as epilepsy
  • Diabetes
  • Thyroid problems
  • Liver disease
  • Issues of immune system
  • Osteoporosis
  • Eye issues
  • Tuberculosis
  • Electrolyte imbalance

Possible Side Effects of Symbicort

As with any other medicine, it is possible for patients taking Symbicort to experience some negative effects, which is why it is highly important to be aware of the possible side effects that the drug can cause. So make sure to tell your healthcare practitioner if you experience any of them.

Here are the most common side effects of Symbicort:

  • Headache
  • Irritation and pain in throat
  • Nasal congestion
  • Flu
  • Infection of the upper respiratory tract
  • Sinusitis
  • Back pain
  • Stomach discomfort
  • Vomiting
  • Thrush in the mouth or throat (rinsing your mouth thoroughly with water after every dose can help prevent it)

Serious Side Effects of Symbicort

Some patients may experience serious negative effects from Symbicort. Some of the serious effects the medicine could cause include:

  • High blood pressure
  • Increased heart rate
  • Changes in the heart rhythm
  • Pneumonia
  • Infections of the lower respiratory tract – symptoms include increased breathing issues, chills, increased cough, change in the color of mucus, and/or increased mucus production.
  • Worsened breathing issues or increased wheezing immediately after taking Symbicort
  • Increased vulnerability to infections due to immunosuppression
  • A decrease in the blood sugar and/or potassium levels
  • Serious allergic reactions, such as swelling of the tongue, mouth, and face, hives, and rash
  • Decreased done mineral density
  • Eye problems, such as cataracts and glaucoma
  • Slowed growth in children
  • Swelling of the blood vessels – symptoms include numbness or a pricking sensation in the arms or legs, swelling of the sinuses, and flu-like symptoms
  • Metabolic effects
  • Reduced efficiency of your rescue inhaler in relieving the symptoms of asthma and COPD
  • The need to use the rescue inhaler more often
  • Adrenal insufficiency (in patients who switch to inhaled corticosteroid from oral corticosteroid)

Immediately seek medical help if you experience any serious reactions after taking Symbicort.

Precautions While Taking Symbicort

Do not use any other medicine that contains a long-acting beta agonist (LABA), for any reason, while you are on Symbicort.

Also, avoid meeting people who are sick or suffering from infections, chicken pox and measles in particular. Tell your doctor right away if you meet someone suffering from these.

Prescription Assistance for Symbicort

A 30-days supply of Symbicort costs more than $300, which a lot of people cannot afford to pay. To help all such patients, AstraZeneca, the manufacturer of the drug, offers a couple of prescription assistance options:

  • People who have a private insurance, but it doesn’t cover the full cost of their prescription medicines, and the uninsured patients can get Symbicort free of cost, for up to one year, with the Symbicort Savings Offer. Click here to find out the eligibility criteria and to apply for this prescription assistance.
  • Under the AZ&Me Prescription Savings Program, the patients who are uninsured or have Medicare Part D, but still can’t afford Symbicort, can get the medicine for free for up to a year, with the option to re-enroll at the end of the year. Visit the AZ&Me website or call 1-800-292-6363 to learn more about the requirements and application procedure.

A number of prescription assistance programs are offered by both state and private authorities all over the country to bring prescription drugs within everyone’s reach. Therefore, if you cannot afford a medicine, talk to your doctor or pharmacy to find out the right assistance program for you.

[1] https://www.who.int/respiratory/en/