Symbicort (budesonide / formoterol) is a combination inhaler containing a steroid (budesonide) and a long-acting beta-agonist (formoterol). Both medications work together to treat asthma and chronic obstructive pulmonary disease (COPD). The typical dose for Symbicort (budesonide / formoterol) is 2 inhalations by mouth twice a day, about 12 hours apart. Common side effects include symptoms of common cold, such as stuffy nose and cough. It's available in two different strengths, both with generic versions.
Symbicort (budesonide / formoterol) is a combination of two medications.
Budesonide is a corticosteroid that works in your lungs to lower swelling and inflammation, making it easier for you to breathe.
Formoterol is a long-acting beta-agonist (LABA) that relaxes the muscles around the airways to the lungs. This opens up the lungs and makes breathing easier.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Body aches or pain
chills
difficulty with breathing
ear congestion
headache
loss of voice
muscle aches
pain or tenderness around the eyes and cheekbones
stuffy or runny nose
tightness of the chest
unusual tiredness or weakness
Less common
Bladder pain
bloody or cloudy urine
congestion
cough producing mucus
difficult, burning, or painful urination
dryness of the throat
fast, irregular, pounding, or racing heartbeat or pulse
frequent urge to urinate
general feeling of discomfort or illness
hoarseness
joint pain
loss of appetite
lower back or side pain
noisy breathing
shakiness in the legs, arms, hands, or feet
shivering
sore mouth or tongue
stomach pain
sweating
tender, swollen glands in the neck
trembling or shaking of the hands or feet
trouble with sleeping
trouble with swallowing
voice changes
vomiting
white patches in the mouth or on the tongue
Rare
Blurred vision
confusion
decreased urine
dizziness or lightheadedness when getting up suddenly from a lying or sitting position
enlarged pupils
fainting
flushed, dry skin
fruit-like breath odor
increased hunger
increased sensitivity of the eyes to light
increased sweating, possibly with fever or cold, clammy skin
increased thirst
increased urination
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
muscle cramps
nervousness
numbness or tingling in the hands, feet, or lips
pounding in the ears
seizures
severe chest pain
severe headache
slow, fast, pounding, or irregular heartbeat or pulse
stiff or sore neck
unexplained weight loss
Incidence not known
Blindness
decreased vision
puffiness or swelling of the eyelids or around the eyes, face, lips or tongue
tearing
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Arm, back, or jaw pain
chest pain or discomfort
darkening of the skin
drowsiness
mental depression
rapid, deep breathing
restlessness
skin rash
stomach cramps
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Stomach discomfort
Less common
Belching
difficulty with moving
indigestion
muscle spasms or stiffness
pain in the arms or legs
stomach upset
swollen joints
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Long-term treatment for both COPD and asthma
Might feel relief in as soon as 15 minutes for asthma
Safe for children 6 years and older for asthma
Combines two medications into one inhaler for convenience
Won't work well for asthma attacks or COPD flare ups
Can cause thrush in mouth or throat as a side effect
Taken 2 times a day
Possible bone loss if used long term
Before using Symbicort (budesonide / formoterol), write down the expiration date (3 months after you open the canister) on the inhaler. Expired medication might not work well for your symptoms. If your inhaler has expired, discard it and obtain a new one from your provider.
Symbicort (budesonide / formoterol) is available in two different strengths. Make sure you're using the correct dose directed by your provider. Don't use Symbicort (budesonide / formoterol) more often or at a higher dose than prescribed since it can cause serious side effects.
Try to avoid areas that will make your asthma symptoms worse. Always take your rescue inhaler with you when you go outside.
Use Symbicort (budesonide / formoterol) every day to control your asthma and COPD symptoms. This isn't an as-needed medication.
Symbicort (budesonide / formoterol) isn't used to treat symptoms of an asthma attack or a COPD flare up. If you experience wheezing, cough, shortness of breath, chest pain or tightness, let your provider know right away. Make sure you've a rescue inhaler, such as albuterol (Ventolin) in case of an asthma or COPD flare-up.
If you were taking oral steroids on a regular basis in the past, make sure to carry a warning card if you're switching from oral steroids to Symbicort (budesonide / formoterol). The warning card should state that you might need oral steroids during an asthma attack or a COPD flare up.
Make sure you get your routine tests done on time while you're taking Symbicort (budesonide / formoterol). This helps your provider make sure this medication is working for you and not causing side effects. Typically the provider will check your blood works, breathing, and eye exams.
Before starting any new medications, speak with your provider first. Some medications, such as beta blockers or diuretics ("water pills"), can interact with Symbicort (budesonide / formoterol) and lead to more side effects.
Before you use each new Symbicort (budesonide / formoterol), shake the inhaler well, and spray 2 puffs into the air to "prime" the medication. If you haven't used it for more than a week or if you dropped it, repeat these steps again. This is to make sure you get the full dose of medication when you inhale it through your mouth.
Take the mouthpiece cover off of the inhaler, and shake the inhaler well. When you're ready, exhale fully. Then, put the mouthpiece into your mouth. Next, inhale deeply as you spray 1 puff into your mouth. Then, move the inhaler away from your mouth, and hold your breath for as long as you can, up to 10 seconds. Repeat the steps for the second puff.
Wipe the mouthpiece with a dry cloth once a week so the medication doesn't build up and block the spray through the mouthpiece.
Clean the mouthpiece with a dry cloth every 7 days. Don't rinse the inhaler with water.
After using Symbicort (budesonide / formoterol), rinse your mouth with water and spit it out right away. This can help lower the chances of developing a fungal infection in your mouth and throat (thrush). If you develop white patches or a cotton-like feeling in the mouth, let your provider know. You might need to take antifungal medication(s) for this side effect.
Symbicort (budesonide / formoterol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Using Symbicort (budesonide / formoterol) during asthma attacks or severe episodes of asthma | Using more doses of Symbicort (budesonide / formoterol) than prescribed
Although rare, Symbicort (budesonide / formoterol) can worsen symptoms of asthma or COPD by tightening the airways. This medical condition is called paradoxical bronchospasm and can be life-threatening if not treated quickly. If you feel more wheezing, shortness of breath, or coughing after using Symbicort (budesonide / formoterol), stop this medication right away and speak to your provider.
In addition, Symbicort (budesonide / formoterol) shouldn't be used to treat asthma attacks or any severe episodes of asthma or COPD. You should only use a rescue inhaler, such as albuterol (ProAir), to treat asthma attacks or COPD flare ups. If your rescue inhaler isn't working well to control your symptoms, let your provider know because you might need additional medications, such as steroid pills.
Risk factors: Using too much Symbicort (budesonide / formoterol) | Using together with other LABAs
Using Symbicort (budesonide / formoterol) more often, at a higher dose than prescribed, or together with another LABA (e.g., Striverdi Respimat (olodaterol)) can raise the risk of overdose. Get medical attention right away if you think you've taken too much of this medication or have symptoms of overdose, including chest pain, fast heartbeat, dizziness, headache, dry mouth, muscle cramps, nausea, or trouble sleeping.
Risk factor: Not rinsing mouth after using Symbicort (budesonide / formoterol)
There's a chance of fungal infections, such as thrush in the mouth and throat, while using Symbicort (budesonide / formoterol). The risk is higher if you don't rinse your mouth right after using this medication. Symptoms of oral thrush include white patches on the inside of the mouth, mouth redness or soreness, and pain while eating or swallowing. If you develop thrush in your mouth, let your provider know right away. You will need to take an antifungal medication to treat the infection.
Risk factors: Active, chronic (long-term), or recurrent infection | Medical conditions that weaken the immune system | Taking other medications that can weaken the immune system
Symbicort (budesonide / formoterol) can lower your ability to fight infections. Infections, such as tuberculosis (TB), chickenpox, and measles, can be more serious in people who use Symbicort (budesonide / formoterol). If you have any of the risk factors listed above, discuss with your provider about how you can safely use this medication. Don't use Symbicort (budesonide / formoterol) if you have an active infection or an infection that keeps coming back without speaking with your provider first. Symbicort (budesonide / formoterol) can make these infections worse. Let your provider know right away if you have signs or symptoms of an infection, such as fever, cough, white patches in your mouth, or sore throat.
Additionally, Symbicort (budesonide / formoterol) can also raise the risk of certain lung infections, including pneumonia. Keep in mind that symptoms of pneumonia are similar to COPD flare ups, so let your provider know if you experience cough, chest pain, shortness of breath. Your provider can help decide what is the right treatment for you.
Risk factors: Long-term use of oral steroids | Suddenly stopping prednisone 20 mg or equivalent dose of steroid | History of asthma or COPD
When switching from an oral to an inhaled steroid, your provider might closely observe you for withdrawal symptoms, such as nausea, tiredness, weakness, or muscle and joint pain. This is because switching between different forms of steroids can affect the cortisol levels in your body. Cortisol is a steroid hormone that controls blood sugar, blood pressure, and other important functions in your body. It also helps the body respond to stressful situations, such as trauma, surgery, and infection. Don't switch between steroids without proper guidance from your provider. Let your provider know if you develop any symptoms, such as tiredness, weakness, loss of energy, nausea, vomiting, or low blood pressure.
If you have used oral steroids for long periods of time and have asthma or COPD, it's important to carry a warning card with you that states that you might need steroid pills during an asthma attack or a COPD flare up. In these cases, a rescue inhaler alone might not be enough to treat your emergency. Your provider might also perform tests to monitor your lung function and breathing more closely.
Risk factors: Using high potency steroids | Using steroids for a long period of time | Using oral steroids | Stressful events (e.g., surgery)
Rarely, using inhaled steroids, such as Symbicort (budesonide / formoterol), for a long time can cause a medical condition called adrenal suppression. This happens when your adrenal gland doesn't make enough of steroid hormones for your body, which creates a dependence on steroid medication. If you suddenly stop the medication, it can be dangerous to your body. In adults, symptoms of withdrawal include fever, joint or muscle pain, and low energy. In children, symptoms often include stunted growth, weight gain, and headaches. To prevent adrenal suppression from happening, your provider will prescribe the lowest possible dose of Symbicort (budesonide / formoterol) that works well for you for the shortest amount of time. If you need to use Symbicort (budesonide / formoterol) for a long period of time, their provider might ask you to do some lab work to test how well your adrenal gland works. Let your provider know if you have symptoms of withdrawal. Don't suddenly stop using Symbicort (budesonide / formoterol) without talking to your provider first.
Risk factors: History of heart problems or nerve problems | Using too much Symbicort (budesonide / formoterol) | Using together with other LABAs
Rarely, using too much Symbicort (budesonide / formoterol) can cause serious problems, including seizures, heart problems, and changes in blood pressure. To lower your risk, don't use Symbicort (budesonide / formoterol) with other inhalers that have LABA (e.g., formoterol (Perforomist)) and don't use this medication more than directed. Talk to your provider right away if you experience chest pain, fast heart rate, headache, tremor, nausea, dizziness, and trouble sleeping.
Risk factors: Using Symbicort (budesonide / formoterol) long term | Unable to move for a long period of time | Family history of osteoporosis | Poor diet | Using medications that can cause bone loss
People taking Symbicort (budesonide / formoterol) for a long time might be at risk of bone loss or poor growth. If you've any of the risk factors listed above, you might be more likely to experience weakened bones or slowed growth after using Symbicort (budesonide / formoterol) long-term. Your provider might measure your bone density regularly to make sure your bones are healthy. If you've had bone fractures before or history of osteoporosis, talk to your provider about their risk before using this medication.
Risk factors: Long-term use of Symbicort (budesonide / formoterol) | History of eye problems like glaucoma or cataracts
Using Symbicort (budesonide / formoterol) for a long time can raise eye pressure, worsen glaucoma, and cause cataracts (cloudiness in the eyes). Talk to your provider right away if you experience blurry vision, eye discomfort, or other changes in your vision after using Symbicort (budesonide / formoterol). You might need an eye exam.
Risk factor: History of allergy to medications containing budesonide
In some rare cases, Symbicort (budesonide / formoterol) can cause allergic reactions, which can be life-threatening. Don't use this medication if you've a history of allergy to medications containing budesonide. Watch out for signs and symptoms of allergic reactions, such as wheezing, dizziness, fainting, rash, itching, trouble breathing, and swelling of the tongue or throat. Get medical attention right away if you've any of these reactions.
Symbicort (budesonide / formoterol) can cause low potassium levels in some people, which can affect your heart rhythm. The low levels of potassium are typically temporary and usually don't require any treatment. Let your provider know if you have muscle pain or weakness, muscle cramps, or abnormal heartbeat as these can be signs of low potassium.
Although rare, Symbicort (budesonide / formoterol) can also raise blood sugar levels in some people. Let your provider know if you're feeling more thirsty or hungry than usual, confused, or urinating more often. These can be signs of high blood sugar.
Symbicort (budesonide / formoterol) comes in two different strengths:
Each inhalation of Symbicort 80/4.5 contains 80 mcg of budesonide and 4.5 mcg of formoterol.
Each inhalation of Symbicort 160/4.5 contains 160 mcg of budesonide and 4.5 mcg of formoterol.
Asthma
Adults and children age 12 years and older: The typical dose is 2 inhalations of Symbicort 80/4.5 or Symbicort 160/4.5 twice daily.
Children ages 6-11 years old: The typical dose is 2 inhalations of Symbicort 80/4.5 by mouth twice a day.
COPD
Adults: The typical dose is 2 inhalations of Symbicort 160/4.5 by mouth twice a day.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Asthma attacks
Severe episodes of asthma or COPD
Maintenance treatment of asthma in people ages 5 years and older
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Centers for Disease Control and Prevention. (2022). About chickenpox.
Magee, J. S., et al. (2018). Paradoxical bronchoconstriction with short-acting beta agonist. American Journal of Case Reports.
MedlinePlus. (2023). Bone density.
MedlinePlus. (2019). Formoterol oral inhalation.
MedlinePlus. (2022). High blood sugar - self-care.
MedlinePlus. (2023). Low blood potassium.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Symptoms & causes of adrenal insufficiency & Addison's disease.
You and Your Hormones. (2019). Cortisol. Society for Endocrinology.
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