Drug Symbicort for Asthma and COPD
The drug Symbicort has been fiercely advertised on television recently as one of the drug choices for people with asthma and chronic obstructive pulmonary disease (COPD). AstraZeneca markets Symbicort as the trade name; budesonide Budesonide and Formoterol Fumarate Dihydrate is the generic form of this drug. This drug is supplied as oral inhaler and can be classified therapeutically under antiasthmatics, bronchodilators; whereas pharmacologically it goes under the classification of adrenergics and corticosteroids. It is a respiratory agent. Symbicort is used mainly for two purposes – long term treatment to maintain remission and further decrease asthma symptoms, and management of airflow obstruction in patients with COPD including chronic bronchitis and emphysema. However, contrary to popular belief Symbicort shouldn’t be used for acute bronchospasm.
Since Symbicort is used for two related but different problems, the dosage varies. The dosage for asthma patients who are 12 years of age or older are 2 inhalation twice daily with 12 hours apart between doses. The dosage will usually depend on how much the patient is currently undergoing inhaled corticosteroid therapy or not. Those who does not receive corticosteroid therapy can be dosed 160/4.5 mcg or 80/4.5 mcg two inhalations twice daily, depending on the severity of the asthma. The maximum dosage remain at 160/4.5 mcg two puff twice daily or 640/18 mcg. Since the usual Symbicort dosages are long 12 hours apart, short-acting beta agonists are inhaled for immediate relief if symptoms arise in between. Now if the patient is using the Symbicort for maintenance treatment of COPD, dosage is much greater. The recommend dose is 160/18 mcg two inhalations and administered twice daily. However, as in the case of asthma if COPD patients suffer any symptoms such as shortness of breath between 12 hour dosing periods, they should inhale the short-acting beta agonist at that time. Regardless of the purpose for which the patient is using, Symbicorts are used the used way as an oral inhaler.
One of the reason patients has to be education by health professionals about drugs such as Symbicort is that it has wide range of harmful side effects. Therefore, Symbicort is not contraindicated for people whose asthma is well controlled by other medications. In other words, if the asthma is not severe enough to warrant long-acting beta agonists and is well maintained by other asthma controller medications shouldn’t use Symbicort. Otherwise, the patient would risks serious side effects of chest pain, tachycardia, arrhythmias, hypertension, seizure, nervousness, wheezing, throat problems (such as wheezing, choking and soreness), vision problems and confusion. All these side effects are common to adrenergics, also known as beta agonists; they make internal physiological system work fast in a “fight or flight” mode. Symbicort is also contraindicated in patients who are younger than 12 years of age; and precaution and considerations should be taken if the patient suffers from pulmonary and cardiac problems.
Symbicort is an expensive drug, the cost of which can range easily between $100 and $200 for an inhaler that has 60 puffs. Insurance usually cover this drug although they prefer generic drugs. But there are instances where the brand name drug has to be used due to its efficacy or doctor’s preferences. The pharmaceutical company of Symbicort, AstraZeneca, has started a Prescription Savings Program that helps individual who are making less than $30,000 a year or family of four making less than $60,000 annually and can’t afford this inhaler. According to Drugstore.com Symbicort comes in a two standard forms of 10.2 gm. The 80-4.5 mcg/act inhaler cost $176.28 whereas the 160-4.5 mcg/act cost $207.42. There is also a Symbicort 60 puffs 80-4.5 mcg/act inhaler that cost $122.79; for if the patient uses 2 puffs twice daily, he or she will have to buy two of these for a one month supply, which would cost about $250. The generics are available, but they are in different forms and wide range of prices. Budesonide is available as Budsonid and formoterol as Pulmicort; both of them are to be used with Nebulizer.
The Symbicort ad I have been seeing on is just about 1 minute long and it included a lot of information include the benefits and the side effects. However, the ad missed some important information that many patients would have like to know such as how many puffs in each dose, different sizes of inhaler and their cost, and that it is contraindicated in children who are younger than 12 years age. The ad also forgot to mention that the patient should use short-acting beta agonist to relief any symptoms in between two dosing periods and lot of serious side effects. Symbicort was first approved by FDA in July 2006. The last time I saw Symbicort ad was on CNN news; the intended audiences were people who are suffering from asthma and COPD specifically, and in general any public so they become aware that there are drug choices other than Advair for respiratory problems.
There have been various research and studies done about the Symbicort and most of them seem to agree that this drug is a good choice to treat asthma and COPD. In the article Poor Adherence With Inhaled Corticosteroids for Asthma: Can Using a Single Inhaler Containing Budesonide and Formoterol Help?, the authors compared using a Symbicort inhaler for asthma patients versus conventional best practice (CBP). They found that the Symbicort was not only as therapeutically effective as CBP using multiple inhalers to control asthma, but it used lower dose of corticosteroids and cost less. A lot of researchers seem to show interest in whether using Symbicort with corticosteroid to use as a single inhaler can work well and majority of them are in favor of this combination. Study by R. Louis and his recognized that asthma patients are not very compliant when using inhaled corticosteroid (ICS) regimen for numerous reasons (Sovani, M., Whale, C., Oborne, J., & Harrison, T.). In their research article A Comparison of Budesonide/ formoterol Maintenance and Reliever Therapy vs. Conventional Best Practice in Asthma Management, they studied to see if using the combination of ICS budesonide and formoterol will result in better adherence. Study proved patients prefer single inhaler and provide higher rate of adherences.
Other drugs that could be substituted for this drug include the generic Budesonide and Formoterol Fumarate Dihydrate, Avair HFA (Fluticasone Propionate and Salmeterol), Foradil Certihaler (Formoterol Fumarate Inhalation Powder), Ventolin (Albuterol), and Serevent Diskus (Salmeterol Xinafoate).
There are so many important things about the drugs. But patients should know at least three of the most critical information about Symbicort – how to administer the drug correctly, how it works and the side effects.
The website Drugs Information Online at www.drugs.com is great source for this learning how to use the Symbicort. This website uses the medical dictionary powered by Steadmans, which has been covering medical terms since 1911. Drugs.com is more importantly a drug information database that gathers drug detailed information from independent medical information suppliers of Wolters Kluwer Health, Physicians’ Desk Reference, Cerner Multum and Thomson Micromedex. And since they are just an information database and not affiliated with any pharmaceutical companies, they can be trusted. So according to drugs.com, Symbicort is to be used exactly as prescribed by the physician. It is important to know how to use this drug otherwise it will decompensate the purpose without proper use and handling. Symbicort has to be shaken well for 5 seconds, and when using it for the first time, it has to be primed by releasing two test sprays away from the face into the open air. Same is the case when it hasn’t been used for more than 7 days or been dropped down on the ground. When using it just for few days, patients can’t expect the symptoms to go right away. Since Symbicort is a long-acting drug and long term treatment, it can take few weeks for symptoms to alleviate. However, if patients suffer serious side effects they should stop and contact their doctor immediately. Symbicort is stored in room temperature, away from light and moisture.
Now we discuss how Symbicort works. The Internet Drug Index located at www.rxlist.com had good information about the pharmacology of this drug. Rxlist.com is a reliable source. It’s a part of WebMD network, which is used by lot of health professionals now a days. This website has been online since 1995 when it was invented by a pharmacist. It has knowledgeable staff writers with background in health and medical field, who continuously review and update drug information on this site using articles written by physicians and pharmacists. The rxlist.com explains the pharmacological mechanism of action of Symbicort really well. Understanding the pharmacology of the drug helps patient stay motivated and adheres to drug regimen for long period of time. Symbicort is a combination of anti-inflammatory corticosteroid budesonide and long acting adrenergic beta agonist formoterol. The anti-inflammatory action of budesonide inhibits inflammation caused by pathogenesis of COPD and asthma such as mast cells, eosinophils, neutrophils, macrophages, and lymphocytes, histamine, leukotrienes, and cytokines. The beta adrenergic works as a bronchodilator and helps COPD and asthma patients breathe better.
Third and most important thing to learn about any medication is their side effects because that way patient is able to weigh between the benefits and side effects of the drug. Also it is always a good idea to know in advance what to adverse reactions to expect. Lexi-PALS Drug Guide located at www.lexi.com just published an article about budesonide and formoterol, including the side effects. Lexi is a company that has been publishing drug information and clinical content for many years. They provide books and software for large institutions dealing with drug pharmacology. Some side effects, that weren’t discussed earlier, include weakness, dizziness, nausea, vomiting and hypoglycemia.
Citation for References:
Sovani, M., Whale, C., Oborne, J., & Harrison, T. (2008, January 1). Poor Adherence With Inhaled Corticosteroids for Asthma: Can Using a Single Inhaler Containing Budesonide and Formoterol Help? British Journal of General Practice, 58(546), 37-43.
Louis, R., Joos, G., Michlis, A., & Vandenhoven, G. (2009, October). A Comparison of
Budesonide/ formoterol Maintenance and Reliever Therapy vs. Conventional Best Practice in Asthma Management. Wiley-Blackwell Online Open, 1472-1241(2009.02185.x.), 1477-1488. Doi:10.1111/j
Symbicort. (2009, June 6). Rx List [The Internet Drug Index]. Retrieved from
Symbicort Information. (2009, October 14). Drugs Information online. Retrieved from
Budesonide and Formoterol. (n.d.). Retrieved August 3, 2009, from Consumer Health Complete
Symbicort – Drugstore.com. (n.d.). Symbicort – Drugstore.com [The Uncommon Drugstore].
Retrieved November 21, 2009, from http://www.drugstore.com/qxn00186037220_333181_sespider/symbicort/ symbicort.htm