Symbicort Online UK

Symbicort is a combination inhaler containing budesonide (an inhaled corticosteroid, ICS) and formoterol (a long-acting beta-2 agonist, LABA with rapid onset).

This dual mechanism targets airway inflammation and bronchoconstriction simultaneously.

A distinguishing feature of Symbicort over other ICS/LABA combinations is that formoterol has a rapid onset of action (within 1-3 minutes), making it suitable for both maintenance therapy and as-needed reliever use.

This approach, known as MART (Maintenance And Reliever Therapy), is recommended by NICE and BTS/SIGN guidelines at step 3 and above.

In the MART regimen, patients use Symbicort as both their regular preventer and their reliever, reducing the need for a separate short-acting beta-2 agonist (SABA).

Clinical trials (STAY, COMPASS, AHEAD) demonstrated that MART reduces exacerbation rates more effectively than fixed-dose ICS/LABA with a separate SABA reliever.

Symbicort is licensed for asthma and COPD. It is available via the Turbohaler dry powder device in multiple strengths.

Maintenance-only use: Inhale the prescribed number of doses twice daily (morning and evening, 12 hours apart) with a separate SABA reliever for acute symptoms.

MART regimen (Symbicort 200/6 only): One inhalation twice daily as maintenance, plus additional inhalations as needed for symptom relief, up to a total maximum of 8 inhalations per day.

To use the Turbohaler: twist the base to load a dose, breathe out away from the inhaler, inhale forcefully and deeply through the mouthpiece, hold breath for up to 10 seconds.

Rinse mouth with water after each maintenance dose to reduce oral candidiasis risk. Keep the Turbohaler dry and replace the cap after use.

The dose counter shows remaining doses; replace the device when the counter reaches 0.

Asthma maintenance therapy: Symbicort 100/6 or 200/6 — 1-2 inhalations twice daily. Symbicort 400/12 — 1 inhalation twice daily for severe asthma.

MART (Symbicort 200/6 only): 1 inhalation twice daily as maintenance, plus 1 additional inhalation as needed for symptoms.

Maximum total daily dose: 8 inhalations (1,600 mcg budesonide/48 mcg formoterol).

COPD: Symbicort 200/6 or 400/12 — 2 inhalations twice daily.

Use the lowest effective maintenance dose. Step-down should be considered after 3 months of sustained asthma control. No dose adjustment for mild-moderate renal or hepatic impairment.

Avoid potent CYP3A4 inhibitors with high-dose budesonide.

Side effects per SmPC frequency categories.

Common (≥1/100 to <1/10): Oropharyngeal candidiasis, headache, tremor, palpitations, mild throat irritation, cough after inhalation, hoarseness/dysphonia.

Uncommon (≥1/1,000 to <1/100): Tachycardia, muscle cramps, agitation, restlessness, nervousness, sleep disturbance, dizziness, nausea, bruising, rash.

Rare (≥1/10,000 to <1/1,000): Paradoxical bronchospasm, adrenal suppression, growth retardation in children, behavioural changes (anxiety, depression, aggression — particularly in children), hyperglycaemia, hypokalaemia, atrial fibrillation, angioedema, cataracts, glaucoma.

Oral candidiasis incidence is reduced by mouth rinsing. Tremor and palpitations from formoterol are typically mild and dose-related.

Systemic corticosteroid effects are possible at high doses with prolonged use.

Symbicort is not suitable as sole reliever therapy in the MART regimen — it provides both maintenance and reliever functions.

If symptoms require more than 6 additional MART inhalations in a single day, or consistently more than 4 additional inhalations per day, asthma control should be reassessed urgently.

Do not exceed 8 total inhalations per day with MART. Patients transitioning from oral corticosteroids require gradual tapering and monitoring for adrenal insufficiency.

The MHRA advises patients on high-dose ICS to carry a steroid emergency card.

Beta-blocker use (including ophthalmic beta-blockers) may reduce the bronchodilatory effect of formoterol and should be avoided in asthma. Monitor bone density in patients on prolonged high-dose ICS.

Formoterol may cause transient hypokalaemia; caution with concurrent hypokalaemia-inducing drugs (diuretics, theophylline).

Symbicort is contraindicated in patients with hypersensitivity to budesonide, formoterol, or lactose (the Turbohaler formulation contains lactose, which may contain trace milk proteins).

LABA monotherapy without ICS is contraindicated in asthma. Symbicort should not be used as first-line asthma therapy without prior trial of ICS monotherapy.