Medication 101: Symbicort

Symbicort was the second of three combination inhalers I have tried and although it worked well for me, I did experience some quite significant side effects that meant that I should change to a different combination inhaler.

Symbicort like Flutiform is a preventer inhaler used to reduce asthma symptoms and prevent attacks. Symbicort contains 2 different medications and is therefore a combination inhaler. Symbicort is made up of a steroid [budesonide] and a long acting bronchodilator [Formoterol], and is indicated for use in people with moderate to severe asthma which isn’t controlled by a low-medium dose steroid inhaler alone.

Dose:

Symbicort comes in 3 different doses, the 100/6 [containing 100mcg Budesonide and 6mcg Formoterol], the 200/6 and the 400/12.
[Note: these doses are for the Symbicort turbohaler available in the UK, doses for the aerosol versions of Symbicort may vary]

Symbicort tends to be taken as 1-2 inhalations twice daily [max 8 inhalations a day for 100/6 and 200/6 doses]. However, some patients [age 18 and over] may benefit from Symbicort SMART therapy where Symbicort is used as both a preventer and reliever inhaler with a maximum of 12 inhalations taken a day [DO NOT SELF PRESCRIBE THE SMART THERAPY, SPEAK TO YOUR DOCTOR] Please note that the SMART regime is only available in 100/6 and 200/6 doses.

I took Symbicort from January 2013 all the way through to March 2014, so for quite a long time. I took the 100/6 dose and started off with 2 inhalations twice a day, then had it increased to 3 inhalations twice a day which worked when I wasn’t flaring or didn’t have a cold, but when I was flaring/ill I increased it to 4 inhalation twice a day.

Precautions:

Tell your doctor before you take Symbicort if you have diabetes, a chest infection, high blood pressure, thyroid problems, adrenal problems, low levels of potassium in your blood or severe liver problems.

You should also let your doctor know of you are taking any of the following medications before you take Symbicort including beta-blockers, medication for a fast, uneven or irregular heartbeat, heart failure medications, diuretics, theophylline for asthma, anti-depressants, anti-psychotics, anti-virals used to treat HIV, antibiotics, Parkinson’s medications or thyroid medications.

Side effects:

[I have marked the side effects I have experiences with an asterisk]

Common side effects occurring in less than 1 in 10 people include:
•Heart palpitations *
•Thrush
•Mild sore throat
•Headache

Uncommon side effects occurring in less than 1 in 100 people include:
•Feeling restless *
•Feeling nervous or agitated
•Disturbed sleep
•Feeling dizzy
•Nausea
•Fast heart beat *
•Muscle cramps * [these would wake me up in the middle of the night and were really painful, but I could usually sort them out quickly]
•Bruising of skin

Rare side effects occurring in less than 1 in 1000 people include:
•Bronchospasm * [I would end up having to take my reliever inhaler after taking Symbicort because of the bronchospasms, and this was the reason I switched to Flutiform]
•Rash, itching
•Low levels of potassium in blood
•Uneven heartbeat

Very rare side effects occurring in less than 1 in 10,000 people include:
•Depression
•Behavioural changes (especially in children)
•Angina
•Increase in blood glucose levels
•Changes in taste
•Blood pressure changes

Almost all of the side effects that I experienced [with the exception of bronchoconstriction] with Symbicort were a result of Formoterol, but I have also found that formoterol is the most effective long acting bronchodilator I have tried… But I have also found that the side effects didn’t effect me enough to warrant me changing to a different combination inhaler, until I started to experience bronchospasm, which my doctor and I have identified was a result of Symbicort being a dry powder inhaler.

Pros:
+ very flexible dose
+ easy to use
+ no need for a spacer as it is a dry powder inhaler
+ available as an aerosol in the US
+ Has a dose counter

Cons:
Only available as an aerosol in the US
it’s surprisingly loud and therefore hard to take discretely
Only contains 120 doses in the 100/6 and 200/6 doses which meant that I was going through and inhaler about every 15 days when I was taking 4 puffs twice a day which meant a lot of trips to the pharmacy… The 400/12 only has 60 doses.

Sources:
Patient information leaflet

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