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Inhaler: Common and serious Symbicort side effects
Drug Info

Symbicort side effects and how to avoid them

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By | Mar. 13, 2021 Medically reviewed by Gerardo Sison, Pharm.D.

Symbicort side effects | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Symbicort (active ingredients: budesonide/formoterol) is a brand-name prescription inhaled medication that treats asthma and controls the symptoms of chronic obstructive pulmonary disease (COPD), a medical condition encompassing both emphysema and chronic bronchitis. Symbicort combines two active ingredients: a steroid (budesonide) and a long-acting bronchodilator (formoterol fumarate). When inhaled, both ingredients work together to reduce inflammation and relax airway muscles. Side effects and drug interactions are possible, and Symbicort may not be appropriate for some people with pre-existing conditions. 

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Common side effects of Symbicort

The most common side effects of Symbicort are:

  • Sore throat
  • Throat irritation
  • Upper respiratory tract infection
  • Swollen sinuses (sinusitis)
  • Nasal congestion
  • Headache
  • Flu
  • Vomiting
  • Back pain
  • Stomach discomfort
  • A yeast infection (thrush) in the mouth and throat

There have been reports of Symbicort causing sleep disturbances. On the one hand, studies have shown that formoterol, one of the two active ingredients in Symbicort, may improve sleep. Inhaled budesonide might also improve sleep by reducing night-time asthma symptoms. Taking too much Symbicort, however, may cause insomnia or problems with sleep.

Serious side effects of Symbicort

Symbicort’s more serious side effects include:

  • Pneumonia and other lung infections
  • Weakened immune system and increased risk of infections
  • Breathing problems (paradoxical bronchospasm)
  • Severe allergic reactions including hives, swelling, and rash
  • Decrease in bone mineral density (osteoporosis)
  • Slowed growth in children
  • Glaucoma
  • Cataracts
  • Swollen blood vessels
  • Lower potassium levels (hypokalemia)
  • High blood sugar levels (hyperglycemia)

Some serious side effects are more likely if too much Symbicort is being taken. These include:

  • Adrenal gland problems: Hypercorticism can develop when the body is exposed to high levels of corticosteroids for prolonged periods of time. After taking high doses of corticosteroids for long periods of time, the adrenal glands also may start decreasing natural steroid production in the body (adrenal insufficiency). 
  • Heart and circulation problems: Formoterol in larger doses can cause high blood pressure, chest pain, fast heartbeat, and an irregular heartbeat. Fatalities have been reported in people taking excessive amounts of similar medications.

To avoid asthma-related death, the FDA and the manufacturer, AstraZeneca, recommend keeping Symbicort doses as low as possible once asthma is under control.

How long do Symbicort side effects last?

Symbicort side effects are usually temporary and can last a day or two after the last dose of Symbicort is taken. Some side effects, such as wheezing or bronchospasms, will require immediate intervention and may demand that Symbicort be stopped entirely. More serious side effects such as infections, heart problems, glaucoma, or decreases in bone density may require treatment and more time to resolve even after Symbicort has been stopped. 

Symbicort contraindications & warnings

Symbicort has a wide range of effects, so not everyone is an appropriate candidate for Symbicort. Fortunately, the drugs in Symbicort do not create dependency, but accidental overuse or overdose of the drug may cause serious or even life-threatening problems.

Allergies

Anyone with severe allergies to budesonide, formoterol, or any of the other ingredients in Symbicort should not take the medication.

Asthma attacks or COPD flare-ups

Symbicort is not to be used to treat sudden asthma attacks or COPD flare-ups. People using Symbicort should always keep a rescue inhaler on hand for sudden attacks.

Deteriorating asthma or COPD

Symbicort will not be started in people whose asthma or COPD is worsening. It is intended to be used for long-term asthma control or COPD maintenance in people whose conditions are stable.

Other medical conditions

Symbicort has a wide range of side effects that may worsen existing medical conditions. Patients with these medical conditions can take Symbicort, but only with caution and monitoring. Tell your doctor if you have a history of any of the following before using Symbicort:

  • Heart problems
  • Seizures
  • Liver impairment
  • Diabetes
  • Ketoacidosis
  • High blood pressure
  • Thyroid problems
  • Elevated pressure in the eye
  • Immune system problems
  • Active infections such as tuberculosis
  • Exposure to chickenpox or measles
  • Osteoporosis

Children

Symbicort is FDA approved for use in children 6 years of age and older to control symptoms of asthma. Symbicort has not been determined to be safe or effective in children younger than 6.

Seniors

In clinical trials, Symbicort has been shown to be both effective and safe in patients older than 65. The FDA does recommend, however, that any patient with heart problems be monitored while taking Symbicort.

Pregnancy

There is not enough research to determine if Symbicort is safe to take during pregnancy. In animal studies, inhaled Symbicort caused birth defects, but this has not yet been demonstrated in people. Formoterol may also potentially interfere with uterine muscle contractions during labor or delivery. At the same time, uncontrolled asthma may increase certain risks during pregnancy, such as preeclampsia and low birth weight.  Women who are pregnant or considering pregnancy will need to discuss the risks and benefits of taking Symbicort with the prescribing doctor or other healthcare provider.

Breastfeeding

There is not enough research to determine if Symbicort is safe to take while nursing. While budesonide does pass into breast milk, there is no data that has determined if formoterol, too, passes into breast milk. Nursing mothers should seek medical advice from a healthcare professional before taking Symbicort while breastfeeding.

Symbicort interactions

As a two-drug medication with a variety of side effects, Symbicort has a complex set of interactions with other drugs.

Symbicort and LABA bronchodilators

Formoterol, one of the active ingredients in Symbicort, belongs to a class of bronchodilators called long-acting beta2-adrenergic agonists, or LABA for short. Long-acting beta2 agonists work by relaxing the smooth muscles in the airways for several hours, providing more room for air to pass. Because of the risk of cardiovascular side effects, Symbicort is never to be used with other LABA bronchodilators for any reason. These drugs include:

  • Serevent (salmeterol)
  • Albuterol (salbutamol)
  • Brovana (arformoterol)

Symbicort and desmopressin

Desmopressin treats excessive urination, nighttime urination, and thirst. It is never to be combined with a corticosteroid such as budesonide, one of the active ingredients in Symbicort. Combining an inhaled corticosteroid like Symbicort with desmopressin increases the risk of water retention and low blood sodium.

Symbicort and beta-blockers

Beta-blockers are generally a problem for patients with asthma and COPD. These drugs, normally used to treat high blood pressure and heart problems, have the opposite effect of beta agonists like formoterol. If the two are combined, they essentially cancel each other out to some degree. Beta-blockers may also reduce the effects of formoterol and cause tightening of the airways in people with asthma. While some beta-blockers are safer than others for people with asthma or COPD, beta-blockers are generally avoided when taking Symbicort.

Symbicort, MAO inhibitors, and tricyclic antidepressants

Combining Symbicort with a tricyclic antidepressant (like amitriptyline) or MAO inhibitor (which includes some antidepressants, antibiotics, and epilepsy medications) may increase the risk of hypertension and other cardiovascular problems. These drugs aren’t to be avoided outright, but the FDA recommends that Symbicort be used cautiously with these medications. People taking these drugs may have to discontinue them for at least two weeks before taking Symbicort.

Symbicort and diuretics

Taken with non-potassium-sparing diuretics, such as thiazide and loop diuretics, Symbicort raises the risk of low potassium levels in the blood. Potassium-sparing diuretics may be prescribed instead.   

Drugs that increase the side effects of Symbicort

Some prescription drugs slow down the body’s breakdown of budesonide, increasing its concentration in the body as well as the risk of steroidal side effects, such as high blood pressure, increased risk of infection, and suppression of the adrenal glands. The FDA recommends that Symbicort be used cautiously with these drugs, including:

  • Certain types of macrolide antibiotics such as clarithromycin
  • Certain drugs that treat fungal infections (azole drugs) such as ketoconazole and itraconazole
  • Certain types of antiviral medications such as ritonavir and saquinavir

Taking Symbicort with other drugs that contain steroids, such as fluticasone, may also increase the risk of corticosteroid side effects.

How to avoid Symbicort side effects

All medicines may cause side effects, but medications like Symbicort involve weighing possible side effects against the benefits of taking the drug. Fortunately, there are ways to avoid or minimize side effects:

1.  Take Symbicort as directed

The benefits of taking Symbicort are maximized by taking the drug as prescribed: usually, two inhalations twice daily, once in the morning and once at night. Don’t miss a dose or take extra doses.  

2.  Don’t take too much Symbicort

Be careful not to overdo it. Taking too much Symbicort raises the risk of side effects from both medications—and those side effects can be serious. If you’re taking too much Symbicort, you may notice symptoms such as:

  • Chest pain
  • Elevated blood pressure
  • Fast or irregular heartbeat
  • Headache
  • Tremor
  • Nervousness

Seek medical advice if you notice side effects typical of overuse or overdose. A healthcare professional may help you develop a strategy to take the medicine correctly.

3.  Do not take a missed dose

Unlike many other medications, a missed dose of Symbicort should not be taken when remembered. Symbicort works in the body for around 12 hours at a time. If a dose is missed, then wait and take the next dose on schedule. Taking a Symbicort dose too soon may increase the risk of side effects.

4.  Use the actuation counter

The actuation counter on the Symbicort inhaler will help you keep track of all the doses you take. It primarily serves as a reminder for a new prescription. The inhaler contains enough doses for 30 days, that is, 120 puffs, and counts down to zero with each puff. Although the counter isn’t exact, keep track of its progress to see if you’re using too little or too much of the medicine. 

3.  Keep a medication diary or calendar

To avoid missing a dose or accidentally taking extra doses, a medication diary, wall calendar, or smartphone app can help accurately track daily doses. Schedule doses for major events in the day, such as right before breakfast or right after dinner. Or set an alarm on a clock, phone, tablet, or smartwatch to go off when a dose needs to be taken.

6.  Tell the doctor about all medical conditions

Unfortunately, Symbicort may not be the right medication for everyone. To avoid possible side effects, share with the prescribing doctor a complete history of medical conditions past and present, especially:

  • Heart problems
  • Liver problems
  • Thyroid problems
  • Immune system problems
  • High blood pressure
  • Diabetes
  • Osteoporosis
  • Seizures
  • Eye problems
  • Existing infections such as tuberculosis 
  • Exposure to chickenpox or measles

The doctor should also know about pregnancy or breastfeeding, including plans to become pregnant or nurse an infant. Neither may necessarily rule out Symbicort, but the doctor will review the risks with a patient before prescribing or continuing the medication.

7.  Tell the doctor about all medications being taken

It’s helpful to keep a list of all medications being taken by you or a person you’re caring for. This list should include any over-the-counter drugs, dietary supplements, and herbal remedies that are taken either regularly or occasionally. Keep this list handy and ready to share with any doctor, pharmacist, or healthcare provider. Make sure that the prescribing doctor is familiar with all the medications and supplements being taken before Symbicort is prescribed.

8.  Keep a rescue inhaler handy

Symbicort is not a rescue inhaler. Instead, Symbicort is a maintenance inhaler used for the long-term control of asthma and COPD symptoms. It can’t be used to treat a sudden bout of asthma symptoms or a COPD flare-up. Also, asthma symptoms such as wheezing can worsen right after taking Symbicort. Keep a rescue inhaler handy in case of unexpected wheezing right after inhaling Symbicort.

9.  Schedule regular eye exams

The use of Symbicort may increase the risk of glaucoma and cataracts. Even if your vision is great, schedule regular eye exams to catch problems with eye fluid pressure before they become too serious. Talk to a doctor, an optometrist, or an ophthalmologist about an appropriate eye exam schedule based on your risk of eye problems. Of course, any vision changes such as blurred vision should prompt an immediate visit to a healthcare professional.

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