Budesonide/formoterol | Side Effects, Dosage, Uses & More
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Generic Name:

budesonide-formoterol, Inhalation powder, pressurized

All Brands

  • Symbicort
SECTION 1 of 5

Highlights for budesonide-formoterol

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Budesonide/formoterol is a combination of two drugs in a single form used to treat asthma. It’s also used to treat chronic obstructive pulmonary disease (COPD).

2

It is available in this form: an inhalation aerosol, which is packaged in a metered dose inhaler (MDI).

3

Budesonide/formoterol is not available as a generic drug. It’s only available as the brand-name drug called Symbicort.

4

This drug doesn’t relieve sudden symptoms of your condition. Always have a rescue inhaler with you to treat sudden symptoms. If you don’t have a rescue inhaler, ask your doctor to prescribe one for you.

5

The more common side effects of this drug include throat irritation and pain, mouth, throat, and upper respiratory tract infections, and inflammation in the sinuses (sinusitis).

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.

Asthma-related death warning. People with asthma who take long-acting beta2-adrendergic agonist (LABA) medicines, such as formoterol, have an increased risk of death from asthma problems. It isn’t known whether budesonide, the other medicine in this combination drug, reduces the risk of death from asthma problems seen with formoterol.

This drug should be used only if your healthcare provider decides that your asthma isn’t well controlled with a long-term asthma medicine, such as a corticosteroid. When your asthma is better controlled, your doctor may have you stop taking this drug. They may prescribe a different drug instead.

Children and adolescents who take LABA medicines may have an increased risk of being hospitalized for asthma problems.

Sudden shortness of breath

This drug doesn’t relieve sudden symptoms of your condition. Always have a rescue inhaler with you to treat sudden symptoms. If you don’t have a rescue inhaler, ask your doctor to prescribe one to you.

When to seek emergency help

Seek emergency medical care if your breathing problems get worse quickly, or if you use your rescue inhaler but it doesn’t relieve your breathing problems.

Other long-acting beta2-agonists (LABAs)

While you’re using this drug, don’t use other medicines that contain a LABA. Ask your healthcare provider or pharmacist if any of the other drugs you’re taking are LABA drugs. Using too much of a LABA drug may cause symptoms such as chest pain, increased blood pressure, a fast and irregular heart rate, headache, tremor, and nervousness.

Drug features

This drug is a prescription drug. It is available as an inhalation aerosol, which is packaged in a metered dose inhaler (MDI).

This drug is not available as a generic drug. It’s only available as the brand-name drug called Symbicort.

This drug is a combination drug. It contains two drugs: budesonide and formoterol. It’s important to know about all the drugs in the combination because each drug may affect you in a different way.

This drug may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it's used

This drug is used to control and prevent symptoms of asthma, such as wheezing, in adults and children ages 12 years and older. This drug shouldn’t be used to treat asthma attacks. You should use a rescue inhaler to treat sudden symptoms of asthma.

More Details

How it works

This drug belongs to two classes of drugs. Budesonide belongs to a class of drugs called inhaled corticosteroids and formoterol belongs to a class of drugs called long acting beta2-adrenergic agonists (LABA). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

More Details

Why it's used

This drug is used to control and prevent symptoms of asthma, such as wheezing, in adults and children ages 12 years and older. This drug shouldn’t be used to treat asthma attacks. You should use a rescue inhaler to treat sudden symptoms of asthma.

This drug is also used to help improve lung function in adults with chronic obstructive pulmonary disease (COPD). Improving lung function helps you to breathe better.

How it works

This drug belongs to two classes of drugs. Budesonide belongs to a class of drugs called inhaled corticosteroids and formoterol belongs to a class of drugs called long acting beta2-adrenergic agonists (LABA). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Budesonide works by helping to reduce inflammation in your lungs. This can decrease your asthma symptoms.

Formoterol works by helping the muscles around the airways in your lungs stay relaxed. This prevents asthma symptoms, such as wheezing and shortness of breath. These symptoms can happen when the muscles around your airways tighten. This makes it hard to breathe. In severe cases, wheezing can stop your breathing and may be fatal (cause death) if it’s not treated right away.

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budesonide-formoterol Side Effects

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More Common Side Effects

The more common side effects of budesonide/formoterol include:

  • throat irritation or pain

  • infection in the mouth and throat (thrush)

  • upper respiratory tract infections

  • lower respiratory tract infections, such as bronchitis

  • inflammation of the sinuses (sinusitis)

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Pneumonia and other lower respiratory tract infections. Symptoms can include:

    • increase in mucus (sputum) production
    • change in mucus color
    • fever
    • chills
    • increased cough
    • increased breathing problems
  • Serious allergic reactions. Symptoms can include:

    • skin rash
    • hives
    • swelling of your face, mouth, and tongue
    • breathing problems
  • Infections. Symptoms can include:

    • fever
    • pain
    • body aches
    • chills
    • tiredness
    • nausea
    • vomiting
  • Adrenal insufficiency, a condition in which the adrenal glands don’t make enough steroid hormones. Symptoms can include:

    • tiredness and weakness
    • dizziness
    • dehydration
    • loss of appetite
    • side or stomach pain
    • nausea and vomiting
    • fever
    • low blood pressure
    • fast breathing and heart rate
    • unusual sweating on your face or palms
    • confusion
    • loss of consciousness or coma
  • Increased wheezing right after taking budesonide/formoterol. Always have a rescue inhaler with you to treat sudden wheezing.

  • Eye problems, including glaucoma and cataracts. Symptoms include:

    • blurred vision
    • double vision
    • not being able to see in dim light
    • seeing halos (circles) around lights
    • sensitivity to light
    • not being able to see
  • Lower bone mineral density (osteoporosis)

  • Slowed growth in children. Your child’s growth should be checked regularly while they’re taking this drug.

  • Swelling of your blood vessels. This can happen in people with asthma. Symptoms can include:

    • feeling of pins and needles or numbness of your arms or legs
    • flu-like symptoms, such as fever and chills, muscle aches and pains, and loss of energy
    • skin rash
    • pain and swelling of your sinuses
  • Decreases in blood potassium levels (hypokalemia). Symptoms can include:

    • tiredness
    • muscle cramps
    • weakness
    • abnormal heart rhythms (arrhythmias)
    • constipation
  • Increases in blood sugar levels (hyperglycemia). Symptoms can include:

    • blurry vision
    • needing to urinate frequently
    • increased hunger
    • increased thirst
    • tiredness
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug doesn’t cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

budesonide-formoterol May Interact with Other Medications

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Budesonide/formoterol can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Medications that might interact with this drug

Depression drugs

Certain drugs used to treat depression may increase the effect of formoterol, one of the drugs in this combination, on the heart. Talk to your doctor about whether these drugs are safe for you.

These drugs include:

  • monoamine oxidase inhibitors (MAOIs), such as:
    • isocarboxazid
    • phenelzine
    • selegiline
    • tranylcypromine
  • tricyclic antidepressants, such as:
    • amitriptyline
    • clomipramine
    • desipramine
    • doxepin
    • imipramine
    • nortriptyline
    • protriptyline
    • trimipramine

Using a certain antidepressant, nefazadone, with budesonide/formoterol can increase the levels of budesonide in your body. This can increase your risk of side effects from budesonide.

Glaucoma eye drops

Certain eye drops used for glaucoma may decrease how well formoterol, one of the drugs in this combination, works. This can cause severe airway narrowing (bronchospasm) in people with asthma.

These drugs include:

  • carteolol
  • levobunolol
  • timolol
  • metipranolol

Headache drugs

Certain drugs used to prevent or treat migraine headaches can decrease how well formoterol, one of the drugs in this combination, works. This can cause severe airway narrowing (bronchospasm) in people with asthma. In general, you shouldn’t take these drugs if you have asthma.

These drugs include:

  • nadolol
  • propranolol
  • timolol

Heart drugs

Certain heart drugs can decrease how well formoterol, one of the drugs in this combination, works and cause severe airway narrowing (bronchospasm) in people with asthma.

These drugs include:

  • acebutolol
  • atenolol
  • betaxolol
  • bisoprolol
  • carvedilol
  • labetalol
  • metoprolol
  • nadolol
  • nebivolol
  • penbutolol
  • pindolol
  • propranolol
  • timolol

Also, certain heart drugs called water pills (diuretics) can decrease your blood potassium levels and cause changes in your electrocardiogram (or ECG, a test that measures the electrical and muscular activity of the heart).

These drugs include:

  • thiazide diuretics, such as:
    • chlorothiazide
    • chlorthalidone
    • hydrochlorothiazide
    • indapamide
    • metolazone
  • loop diuretics, such as:
    • bumetanide
    • ethacrynate
    • furosemide
    • torsemide

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) drugs

Using certain drugs to treat HIV/AIDS with budesonide/formoterol can increase the levels of budesonide in your body. This can increase your risk of side effects.

Examples include:

  • atazanavir
  • indinavir
  • nelfinavir
  • ritonavir
  • saquinavir

Infection drugs

Using certain drugs used to treat infections with budesonide/formoterol can increase the levels of budesonide in your body. This can increase your risk of side effects.

These drugs include:

  • antibiotics, such as:
    • clarithromycin
    • telithromycin
  • antifungals, such as:
    • itraconazole
    • ketoconazole

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with heart problems, including high blood pressure

This drug may cause chest pain, high or low blood pressure, fast heart rate, and irregular heart rhythms. These effects may make your heart problem worse. Let your doctor know if you have heart disease.

People with seizures

This drug may increase your risk for seizures. Let your doctor know if you have a seizure disorder or epilepsy before starting this drug.

People with thyroid problems

This drug may increase thyroid activity. Talk to your doctor about whether this drug is safe for you if you have high thyroid levels.

People with diabetes

This drug may increase your blood sugar levels. Tell your doctor if you have diabetes before you take this drug.

People with an immune system problem

This drug weakens your immune system, which raises your chance for getting infections. Avoid contact with people who have contagious diseases, such as chicken pox or measles. Talk to your doctor about whether this drug is safe for you if you have tuberculosis, untreated infections, or herpes simplex in the eye.

People with weak bones or osteoporosis

This drug can cause decreases in bone strength. If you have weak bones or risk factors for osteoporosis, your doctor will monitor you closely to make sure this medication is safe for you to take.

People with eye problems

This drug can cause eye problems, such as increased pressure inside your eyes, glaucoma, and cataracts. Let your doctor know if you have a history of these eye problems. You should have your vision checked regularly.

People with liver problems

This drug is processed by your liver. If you have liver disease, more of this drug may stay in your body longer and increase your risk of side effects. Your doctor will monitor you closely.

Pregnant women

This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.

Women who are breast-feeding

This drug may pass into breast milk and may cause side effects in a child who is breast-fed.

Talk to your doctor if you breast-feed your baby. You may need to decide whether to stop breast-feeding or stop taking this medication.

For seniors

This drug should be used with caution in seniors who have heart problems because it may worsen this condition.

For children

For asthma: It isn’t known if this drug is safe and effective in children younger than 12 years.

Inhaled corticosteroids like budesonide (a component of this medication) can slow down a child’s growth. Your doctor should closely monitor your child’s growth while they’re using this drug.

For chronic obstructive pulmonary disease (COPD): This drug hasn’t been studied in children and shouldn’t be used in children younger than 18 years for this condition.

When to call the doctor

Call your healthcare provider or get medical care right away if:

  • Your breathing problems worsen with this drug.
  • You need to use your rescue inhaler more often than usual.
  • Your rescue inhaler doesn’t work as well to relieve your symptoms.
  • You need to use 4 or more inhalations of your rescue inhaler for 2 or more days in a row.
  • You use one whole canister of your rescue inhaler in 8 weeks.
  • Your peak flow meter results decrease. Your healthcare provider will tell you the numbers that are right for you.
  • Your symptoms don’t improve after using this drug regularly for 1 week.

Allergies

This drug can cause a severe allergic reaction. Symptoms can include:

  • skin rash
  • hives
  • swelling of your face, mouth, and tongue
  • breathing problems

Call 9-1-1 or go to the nearest emergency room if you develop these symptoms.

Don’t take this drug again if you’ve ever had an allergic reaction to it or its individual components before. Taking it again could be fatal (cause death).

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How to Take budesonide-formoterol (Dosage)

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All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Asthma

Brand: Symbicort

Form: inhalation aerosol, which is packaged in a metered dose inhaler (MDI)
Strengths: 
  • 80 mcg budesonide/4.5 mcg formoterol
  • 160 mcg budesonide/4.5 mcg formoterol
Adult dosage (ages 18 years and older)

The starting dose is 2 inhalations (puffs) taken by mouth twice daily, about 12 hours apart. Your doctor may change your dose based on how severe your asthma is. If you have any shortness of breath in between doses, use your rescue inhaler for relief.

Child dosage (ages 0–11 years)

It hasn’t been confirmed that budesonide/formoterol is safe and effective for use in children younger than 12 years.

Child dosage (ages 12–17 years)

The starting dose is 2 inhalations (puffs) taken by mouth twice daily, about 12 hours apart. Your doctor may change your dose based on how severe your asthma is. If you have any shortness of breath in between doses, use your rescue inhaler for relief.

Chronic obstructive pulmonary disease (COPD)

Brand: Symbicort

Form: inhalation aerosol, which is packaged in a metered dose inhaler (MDI)
Strengths: 
  • 80 mcg budesonide/4.5 mcg formoterol
  • 160 mcg budesonide/4.5 mcg formoterol
Adult dosage (ages 18 years and older)

The starting dose is 2 inhalations (puffs) of 160 mcg budesonide/4.5 mcg formoterol taken by mouth twice daily, about 12 hours apart. If you have any shortness of breath in between doses, use your rescue inhaler for relief.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in children younger than 18 years for this condition.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug comes with risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all

If you don’t take your medication at all, you may have more frequent and more severe asthma or chronic obstructive pulmonary disease (COPD) attacks. This can make your condition worse. Your lung function will decline and you’ll have more trouble breathing.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms may include:

  • chest pain
  • high or low blood pressure
  • fast and irregular heart rate
  • headache
  • tremor
  • nervousness
  • seizures
  • muscle cramps
  • nausea
  • dizziness
  • low potassium levels
  • high blood sugar levels
  • too much acid in your body (metabolic acidosis)
  • trouble sleeping
  • heart attack

If you think you’ve taken too much of the drug, act right away. Call your doctor or local poison control center, or go to the nearest emergency room. 

What to do if you miss a dose

Take your next dose at the same time you normally do. Don’t take this drug more often or use more puffs than you have been prescribed.

How to tell if the drug is working

Your asthma or COPD symptoms will be better controlled, and you’ll have fewer attacks or sudden symptoms of trouble breathing.

This drug is used for long-term treatment.

This drug should be taken in the morning and evening

The doses should be 12 hours apart.

Store this drug at room temperature

Keep it from 68°F to 77°F (20°C to 25°C). Keep it away from high temperatures.

Store this drug with the mouthpiece down. 

The contents of your this drug canister are under pressure. Don’t puncture or throw the canister into a fire or incinerator. Don’t use or store it near heat or an open flame. High temperatures may cause the canister to burst.

Throw away this drug when the counter reaches zero (“0”) or 3 months after you take it out of the foil pouch, whichever comes first.

Prescription is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you, such as in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

  • Your doctor, nurse, or pharmacist will talk to you about when to use a rescue inhaler, such as albuterol, versus a controller inhaler like this drug. They’ll also show you how to correctly use your inhalers.
  • You should use this drug as prescribed. It may take 1 week of regular use to tell if the medication is working for you.
  • Rinse your mouth water and spit the water out after using each dose (2 puffs). Don’t swallow the water. This prevents a fungal infection (thrush) in the mouth and throat.
  • The inhaler should be shaken well for 5 seconds before each use. If it hasn’t been used for more than 7 days, you should shake it and release a gentle spray before you use it to make sure it’s working right.

For asthma:

  • Your doctor may have you test your breathing with a home peak flow meter. A peak flow meter is a portable, hand-held device that measures your ability to push air out of your lungs. By checking your peak flow readings at home, you’ll be able to tell if it is within the correct range for you. Your doctor will give you an asthma action plan and tell you what to do when your peak flow readings fall within certain ranges. Based on your results, your doctor may adjust your medication.

Clinical monitoring

You’ll need to have your lung function monitored to make sure this medication is working.

This monitoring may be done using two tests:

  • Pulmonary function tests (PFTs). Your doctor will do PFTs to measure how well your lungs are working. During this test, you'll blow into a large tube connected to a machine called a spirometer. The spirometer measures how much air your lungs can hold and how fast you can blow the air out of your lungs.
  • Peak flow results. Your doctor may have you monitor your lung function at home. You may be asked to record your symptoms or to check how well your lungs are working with a peak flow meter.

You and your doctor should monitor certain health issues also. This can help make sure you stay safe while you take this drug. These issues include:

  • Bone strength. This drug may lower your bone strength.
  • Growth. This drug may lead to slowed or delayed growth problems in children.
  • Eyes. This drug may lead to serious eye problems, such as cataracts or glaucoma.
  • Blood. This medication can cause changes in some blood tests (sugar and potassium).

Hidden costs

You may need to purchase a peak flow meter.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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How Much Does budesonide-formoterol Cost?

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on October 5, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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