Budesonide-Formoterol, Inhalation Powder, Pressurized

Medically reviewed by University of Illinois-Chicago, Drug Information Group on January 24, 2018Written by University of Illinois-Chicago, Drug Information Group on December 6, 2017

Highlights for budesonide-formoterol

  1. Budesonide/formoterol inhalation powder is available as a brand-name drug. It’s not available as a generic drug. Brand name: Symbicort.
  2. Budesonide/formoterol comes only as an inhalation aerosol, which is packaged in a metered dose inhaler (MDI).
  3. 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).

Important warnings

  • Asthma warning: Adults with asthma who take drugs such as formoterol alone have an increased risk of death from asthma problems. Also, children and adolescents with asthma who take formoterol alone may have an increased risk of being hospitalized due to asthma. However, in clinical trials, people who took formoterol with drugs such as budesonide didn’t have these effects.
  • Usage warning: This drug doesn’t relieve sudden symptoms of your condition, such as shortness of breath. 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.
  • Emergency help warning: Seek emergency medical care if your breathing problems get worse quickly, or if your rescue inhaler doesn’t relieve your breathing problems.
  • LABA interaction warning: While you’re using this drug, don’t use other medications that contain a long-acting beta2-agonist (LABA). Ask your doctor 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.

What is budesonide-formoterol?

Budesonide/formoterol is a prescription drug. It comes only as an inhalation aerosol, which is packaged in a metered dose inhaler (MDI).

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

Budesonide/formoterol is a combination medication. 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.

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

Why it's used

Budesonide/formoterol is used to control and prevent symptoms of asthma, such as wheezing. 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 for maintenance treatment of chronic obstructive pulmonary disease (COPD). It’s also used to help reduce exacerbations of COPD.

How it works

Budesonide/formoterol belongs to two classes of drugs. Budesonide belongs to a class of drugs called inhaled corticosteroids. 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 or COPD symptoms.

Formoterol works by helping the muscles around the airways in your lungs stay relaxed. This prevents asthma or COPD 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.

When to call the doctor

  • While using this drug, call your doctor or get medical care right away if:
  • Your breathing problems get worse.
  • 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 four or more inhalations of your rescue inhaler in 24 hours for two 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).
  • You have asthma and your symptoms don’t improve after using this drug regularly for one week.

Budesonide-formoterol side effects

Budesonide/formoterol inhalation powder doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects of budesonide/formoterol include:

  • throat irritation or pain
  • thrush (infection in the mouth and throat)
  • upper respiratory tract infections
  • lower respiratory tract infections, such as bronchitis
  • sinusitis (inflammation of the sinuses)

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 911 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 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
  • Osteoporosis (decreased bone mineral density)
  • Slowed growth in children. Your doctor should check your child’s growth 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
  • Hypokalemia (low blood potassium levels). Symptoms can include:
    • tiredness
    • muscle cramps
    • weakness
    • abnormal heart rhythms (arrhythmias)
    • constipation
  • Hyperglycemia (increased in blood sugar levels). Symptoms can include:
    • blurry vision
    • needing to urinate frequently
    • increased hunger
    • increased thirst
    • tiredness

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.

Budesonide-Formoterol may interact with other medications

Budesonide/formoterol inhalation powder 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.

Examples of drugs that can cause interactions with budesonide/formoterol are listed below.

Depression drugs

Taking budesonide/formoterol with certain drugs used to treat depression may increase the effect of formoterol on the heart. Talk to your doctor about whether it’s safe for you to take these drugs with budesonide/formoterol.

Examples of these depression drugs include:

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

Using nefazodone, another antidepressant, 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

Taking budesonide/formoterol with certain eye drops used for glaucoma may decrease how well formoterol works. This can cause bronchospasm (severe airway narrowing) in people with asthma. Examples of these glaucoma drugs include:

  • carteolol
  • levobunolol
  • timolol
  • metipranolol

Heart drugs

Taking budesonide/formoterol with certain heart drugs can decrease how well formoterol works. This can cause bronchospasm (severe airway narrowing) in people with asthma. Examples of these drugs include:

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

Also, heart drugs called diuretics (water pills) 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).

Examples of diuretics include:

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

HIV drugs

Taking budesonide/formoterol with certain drugs used to treat HIV can increase the levels of budesonide in your body. This can increase your risk of side effects. Examples of these HIV drugs include:

  • atazanavir
  • indinavir
  • nelfinavir
  • ritonavir
  • saquinavir

Infection drugs

Taking budesonide/formoterol with certain drugs used to treat infections can increase the levels of budesonide in your body. This can increase your risk of side effects. Examples of these drugs include:

  • antibiotics, such as:
    • clarithromycin
  • 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.

Budesonide-formoterol warnings

This drug comes with several warnings.

Allergy warning

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

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

If you develop these symptoms, call 911 or go to the nearest emergency room.

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

Warnings for people with certain health conditions

For 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.

For 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.

For people with thyroid problems: This drug may increase thyroid activity. If you have high thyroid levels, talk to your doctor about whether this drug is safe for you.

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

For people with an immune system problem: This drug weakens your immune system, which raises your risk of 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.

For 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.

For 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 while you take this drug.

For 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 while you take this drug.

Warnings for other groups

For pregnant women: There are no studies of formoterol in pregnant women; however, studies of inhaled budesonide in pregnant women have not shown an increase in birth defects.

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.

If you become pregnant while taking this drug, call your doctor right away.

For women who are breastfeeding: This drug may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For children: For asthma: It isn’t known if this drug is safe and effective in children younger than 6 years for this condition.

Inhaled corticosteroids such as 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. It shouldn’t be used in children younger than 18 years for this condition.

How to take budesonide-formoterol

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

Drug form and strengths

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

Dosage for asthma

Adult dosage (ages 18 years and older)

  • Typical starting dosage: Two inhalations (puffs) of either strength formulation, depending on the severity of your condition, taken twice daily about 12 hours apart.
  • Dosage changes: Your doctor may change your dosage based on how severe your asthma is.
  • Note: If you have any shortness of breath in between doses, use your rescue inhaler for relief.

Child dosage (ages 12–17 years)

  • Typical starting dosage: Two inhalations (puffs) of either strength formulation, depending on the severity of your child’s condition, taken twice daily about 12 hours apart.
  • Dosage changes: Your doctor may change your child’s dosage based on how severe your child’s asthma is.
  • Note: If your child has any shortness of breath in between doses, they should use their rescue inhaler for relief.

Child dosage (ages 6–11 years)

  • Typical dosage: Two inhalations (puffs) of the 80-mcg budesonide/4.5-mcg formoterol formulation, taken twice daily about 12 hours apart.
  • Dosage changes: Your doctor may change your child’s dosage based on how severe your child’s asthma is.
  • Note: If your child has any shortness of breath in between doses, they should use their rescue inhaler for relief.

Child dosage (ages 0–5 years)

It hasn’t been confirmed that budesonide/formoterol is safe and effective for use in children younger than 6 years.

Dosage for chronic obstructive pulmonary disease (COPD)

Adult dosage (ages 18 years and older)

  • Typical starting dosage: Two inhalations (puffs) of 160 mcg budesonide/4.5 mcg formoterol taken by mouth twice daily, about 12 hours apart.
  • Note: 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 speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Budesonide/formoterol inhalation powder is used for long-term treatment. It 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 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
  • high blood sugar levels
  • trouble sleeping
  • heart attack

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

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 should be better controlled, and you should have fewer attacks or sudden symptoms of trouble breathing.

Important considerations for taking budesonide-formoterol

Keep these considerations in mind if your doctor prescribes budesonide/formoterol for you.

General

  • This drug can be taken with or without food.
  • This drug should be taken in the morning and evening. The doses should be 12 hours apart.

Storage

  • Store this medication at a temperature between 68°F and 77°F (20°C and 25°C). Keep it away from high temperatures.
  • Store this drug with the mouthpiece down.
  • The contents of 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.

Refills

A prescription for this medication 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. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container 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.
  • After each dose (2 puffs), rinse your mouth with water and spit the water out. Don’t swallow the water. This helps prevent thrush (a fungal infection in the mouth and throat).
  • Before each use, shake the inhaler well for 5 seconds. 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’s 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 dosage.

Clinical monitoring

You’ll need to have your lung function monitored to make sure this medication is working. This monitoring may be done using pulmonary function tests (PFTs). 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.

You and your doctor should also monitor other health issues. 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.

Prior authorization

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.

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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