Budesonide/FormoterolBudesonide/Formoterol Fumarate

About Budesonide/Formoterol

Budesonide calms airway inflammation and formoterol, a long-acting beta2-agonist, relaxes the airways. The Symbicort label covers asthma in patients 6 years and older who are not controlled on a long-term controller or whose disease warrants starting both medicines, and, at 160/4.5 only, maintenance treatment of airflow obstruction in COPD, including chronic bronchitis and emphysema, and reduction of COPD exacerbations. Children 6 to 11 take 2 puffs of 80/4.5 twice a day; from age 12 the dose is 2 puffs of 80/4.5 or 160/4.5 twice a day; adults with COPD take 2 puffs of 160/4.5 twice a day. If a working dose stops controlling asthma, the prescriber reevaluates treatment.

The current Symbicort label (July 2019) does not include as-needed or reliever use. It states that Symbicort is not indicated for the relief of acute bronchospasm and that a short-acting beta2-agonist should be taken for immediate relief of symptoms between doses; the generic and Symbicort Aerosphere labels say the same. Using it as a reliever is not an FDA-approved use, and the prescriber decides. There is no boxed warning; the one Symbicort carried was removed in December 2017. The label explains that a long-acting beta2-agonist used alone for asthma raises the risk of asthma-related death, while trials of the combination with an inhaled steroid showed no significant rise in serious asthma events. It is not used with another long-acting beta2-agonist or as the main treatment of status asthmaticus, and anyone allergic to its ingredients must not use it.

Other warnings cover thrush, pneumonia and other lower respiratory infections, more serious chickenpox or measles, adrenal insufficiency when switching from oral steroids, bone thinning, slower growth in children, glaucoma and cataracts, paradoxical bronchospasm, heart effects, low potassium and high blood sugar. Common side effects include colds, headache, sore throat, sinusitis, flu, back pain, stomach discomfort and thrush, and bronchitis in COPD. The inhaler is shaken for 5 seconds before each spray and primed with 2 test sprays before first use and after more than 7 days unused or a drop. Symbicort is listed with 60 or 120 puffs per canister; Breyna and the authorized generic list 120. Symbicort Aerosphere, approved in 2023 for COPD maintenance in adults and in April 2026 for asthma from age 12, delivers budesonide 80 or 160 mcg with formoterol 4.8 mcg per puff, is primed with 4 sprays and has no rated generic.

Taking Budesonide/Formoterol

How to take it

Usually 2 puffs twice a day, about 12 hours apart. Shake for 5 seconds before each spray, and prime with 2 test sprays into the air before first use and again after more than 7 days unused or if dropped (Symbicort Aerosphere: 4 sprays). Rinse your mouth with water and spit it out after each dose.

If you miss a dose

Inhale the missed dose as soon as you remember, unless it is almost time for the next one; then skip it. Do not inhale a double dose.

Storage

At room temperature, away from sunlight, excess heat and moisture (not in the bathroom), out of reach of children. Throw the inhaler away 3 months after taking it out of its foil overwrap or when the dose indicator reads 0, whichever comes first.

Interactions to know about

Strong CYP3A4 inhibitors such as ritonavir or ketoconazole can raise budesonide levels, so the label calls for caution. Beta-blockers can block formoterol’s effect; non-potassium-sparing diuretics can worsen low potassium; and monoamine oxidase inhibitors or tricyclic antidepressants call for caution.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Budesonide/Formoterol differs from pharmacy to pharmacy

Symbicort, its authorized generic, Breyna and the Teva generic are the same type of HFA inhaler in the same two strengths, and a rated generic can be dispensed for a Symbicort prescription where state law allows, unless the prescriber blocks substitution. Symbicort Aerosphere has different strengths and no equivalence rating, so it is not swapped with Symbicort or its generics. Quotes still differ by product and by each pharmacy’s fee and markup.

Canister size matters: at 2 puffs twice a day, a 120-puff canister holds about a month of doses and a 60-puff canister about two weeks, so compare quotes for the same canister size and number of inhalers.

Ways to pay less for Budesonide/Formoterol without insurance

• Check that the prescription allows a rated generic such as Breyna, unless the prescriber has a reason to require Symbicort.
• Make sure each quote is for the product, strength and canister size prescribed.
• Once your dose is stable, ask the prescriber whether a prescription covering more than one inhaler per fill suits you.
• If a quote is for the brand, ask the maker whether its savings or patient assistance program applies to someone paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Budesonide/Formoterol

1. 1.Is my inhaler a rated generic, and is it the strength on my prescription?
2. 2.How do I shake and prime my inhaler, and when do I prime it again?
3. 3.Which inhaler should I use for symptoms between doses?
4. 4.When should I throw my inhaler away?

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