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Symbicort vs Advair HFA

Drug facts and comparison

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Medically reviewed by  Jamie Winn, PharmD

Symbicort

budesonide and formoterol fumarate dihydrate

Advair

fluticasone propionate and salmeterol

Uses

  • Treatment of asthma
  • Treatment of chronic obstructive pulmonary disease (COPD)
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  • Asthma in adults and children 12 years and older
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Summary

Brand name: Symbicort
Brand name: Advair
Manufacturer: Astra Zeneca
Manufacturer: GlaxoSmithKline
Active ingredient: budesonide and formoterol fumarate dihydrate
Active ingredient: fluticasone propionate and salmeterol
Indication: Treatment of asthma, treatment of chronic obstructive pulmonary disease (COPD)
Indication: Asthma in adults and children 12 years and older

Side Effects

Most common

  • Headaches
  • Sore throat
  • Coughing
  • Hoarse voice
  • Back pain
  • Fast heartbeat

More serious

  • Reduced immune system function
  • Increase in blood pressure
  • Swelling of your blood vessels
  • Increases in blood sugar levels (diabetes)
  • Decreases in blood potassium levels (hypokalemia)

Most common

  • Headaches
  • Dizziness
  • Nausea
  • Vomiting
  • Throat irritation
  • Hoarseness and changes to your voice
  • An increase in upper respiratory chest infections

More serious

  • A weakened immune system
  • Reduced adrenal gland function
  • Severe allergic reactions to the medication can cause swelling in your face, mouth, and throat, which can make it difficult to breathe
  • A sudden worsening of your asthma symptoms
  • Fungal infections

Drug Interactions

Severe interactions
  • Beta-blockers – labetalol, sotalol, timolol
  • Antibiotics – clarithromycin, telithromycin
  • TNF blockers – etanercept
  • Disease-modifying anti-rheumatic drugs – leflunomide, teriflunomide
Serious interactions
  • Treatments for an irregular heartbeat – amiodarone, dronedarone, disopyramide
  • Diuretics – bendroflumethiazide, furosemide
  • Antidepressants – citalopram, escitalopram, fluoxetine, sertraline
  • ACE inhibitors – captopril, enalapril, ramipril
  • NSAIDs – ibuprofen, meloxicam, naproxen
  • Antipsychotics – clozapine, haloperidol
Moderate interactions
  • Corticosteroids – beclomethasone, betamethasone, fludrocortisone, prednisolone
Severe interactions
  • Beta-blockers – sotalol, propranolol, timolol
  • Antifungals – itraconazole, ketoconazole

 

Serious interactions
  • Antipsychotics – clozapine, haloperidol
  • Antiarrhythmics – amiodarone, dronedarone
  • Diuretics – bendroflumethiazide bumetanide, furosemide
  • Antidepressants – citalopram, fluoxetine, sertraline, venlafaxine
  • Antibiotics – erythromycin, ofloxacin
  • Immunosuppressants – fingolimod, siponimod
Moderate interactions

Corticosteroids – dexamethasone, hydrocortisone, prednisolone

Warnings

You should not use Symbicort if you:

  • Are allergic to the active ingredients budesonide or formoterol fumarate dihydrate
  • Are allergic to any of the other ingredients found in Symbicort
  • Are under 12 years of age (for treating asthma)
  • Are under 18 years of age (for treating chronic obstructive pulmonary disease)

You should talk to your doctor before using Symbicort if you:

  • Are diabetic
  • Have a lung infection
  • Have severe liver problems
  • Have high blood pressure
  • Have or have had any heart problems, like narrowing of the arteries, an uneven heartbeat, or heart failure
  • Have problems with your adrenal glands or thyroid
  • Have low levels of potassium in your blood
  • Have an intolerance to any sugars
  • Are pregnant or are breastfeeding

You should not use Advair if you:

  • Are allergic to the active ingredients fluticasone and salmeterol
  • Are allergic to any of the other ingredients in Advair HFA
  • Have sudden breathing problems, like an asthma attack
  • Are under 12 years of age

You should talk to your doctor before using Advair if you:

  • Are taking any of the medications that could interact with Advair HFA
  • Have any problems with your immune system
  • Have any liver problems
  • Have any heart problems
  • Have diabetes
  • Have osteoporosis
  • Have high blood pressure
  • Have any thyroid problems
  • Have any eye problems, including cataracts or glaucoma
  • Have or have ever had any problems with your adrenal glands
  • Have any form of infection
  • Have recently been around someone who has measles or chickenpox
  • Have or have ever had a seizure
  • Are pregnant or are planning to become pregnant
  • Are breastfeeding or are planning to breastfeed

Dosage

2 puffs twice daily

Twice daily

Cost

1 inhalation aerosol (160 mcg-4.5 mcg/inh) 120 doses will cost around $280

Advair HFA inhalation aerosol (CFC free 115 mcg-21 mcg/inh) will cost around $240

 

FAQs

Having a good grasp of the medication you are taking and how it works will give you more confidence in managing your Asthma and Chronic Obstructive Pulmonary Disease (COPD). The number of prescription medications available to treat Asthma and (COPD) is long, plus the huge variety of inhalers available can make things confusing at first. No single asthma or COPD treatment is best for everyone and what works for one person may not work for another. Combination products, containing a corticosteroid and long-acting beta2-adrenergic agonists (LABA) to treat asthma and COPD are popular choices. Let us take a look at two combination medications Symbicort vs. Advair – how they both work, their common side effects, drug interactions, and more.

What is Symbicort?

Symbicort is the brand name of a drug manufactured by AstraZeneca. It is used to treat asthma and COPD in adults and children 12 years and above. Symbicort contains two active ingredients; budesonide and formoterol and are presented in a metered-dose inhaler.

What is Advair?

Advair is the brand name of an FDA-approved drug manufactured by GlaxoSmithKline. It contains two active ingredients; fluticasone propionate and salmeterol.

There are two varieties of Advair;

Advair HFA – is a metered-dose inhaler that delivers an inhalation aerosol into the lungs. The propellant helps the drug reach your lungs.

Advair Diskus – is a circular metered dose inhaler that delivers an inhalation powder that requires you to breathe in quickly and deeply to help the medication reach your lungs.

How do Symbicort and Advair work?

Symbicort and Advair work in the same way but contain different active ingredients. They are classed as combination products containing two different drugs. One drug is an inhaled corticosteroid (ICS) often referred to as a steroid, the other drug is a long-acting beta-agonist (LABA) often referred to as a bronchodilator. A corticosteroid works by reducing inflammation in the lungs and LABA’s works by relaxing the muscles around the airways in your lungs and easing your breathing.

The drug combination in Advair is fluticasone/salmeterol and comes in three different strengths. The drug combination in Symbicort is budesonide/formoterol and comes in two different strengths.

What conditions do Symbicort and Advair treat?

Symbicort is approved to treat:

  • Asthma in adults and patients 6 years and older
  • Maintenance treatment of COPD including chronic bronchitis and emphysema

Symbicort comes in two different strengths:

  • Budesonide 80 micrograms (mcg) / formoterol 4.5 mcg
  • Budesonide 160 mcg / formoterol 4.5 mcg (COPD)

Advair HFA is approved to treat:

  • Asthma in adults and children 12 years of age and older

Advair HFA comes in three different strengths:

  • Fluticasone 45 (mcg)  / 21 mcg salmeterol
  • Fluticasone 115 mcg  / 21 mcg salmeterol
  • Fluticasone 230 mcg  / 21 mcg salmeterol

Advair Diskus is approved to treat:

  • Asthma in adults and children 4 years of age and older
  • The maintenance treatment of COPD, and to reduce exacerbations

Advair Diskus comes in three different strengths:

  • Fluticasone 100 mcg  / 50 mcg salmeterol (children 4 to 11 years for asthma)
  • Fluticasone 250 mcg / 50 mcg salmeterol (COPD)
  • Fluticasone 500 mcg  / 50 mcg salmeterol

It is important to note that Symbicort and Advair are maintenance inhalers and should never be used as rescue inhalers. Your healthcare provider will provide you with a rescue inhaler containing a short-acting bronchodilator such as albuterol, which works immediately during an asthma attack.

Do Symbicort and Advair have the same side effects?

These drugs are usually very well-tolerated with few side effects as it is delivered directly to the lungs. Common side effects for both drugs include oral thrush and respiratory tract infections. Some differences between them:

Taking Advair may cause muscle and bone pain, hoarseness, cough, and bronchitis. Symbicort may cause sinusitis, stuffy nose, flu, back pain, and stomach issues. Symbicort and Advair can also cause problems if you have certain health issues such as

  • Heart problems
  • Depression (increased risk of cardiovascular effects with some antidepressants)
  • High blood pressure
  • Immune system problems
  • Glaucoma
  • Allergies to any drugs

This is not a complete list and medical advice should be taken from your healthcare provider. Always inform your doctor of medicines you use, including over-the-counter drugs, herbal products, and supplements. If you have trouble inhaling from any device your doctor can help you with your technique or provide you with a spacer.

Is Symbicort or Advair more effective?

These drugs are prescribed for daily use and are very effective when used this way. They work in similar ways to treat asthma and COPD but their active ingredients and the actual devices are different. There have not been any head-to-head studies done with these drugs but one randomized, double-blind clinical trial found that the active ingredients in Symbicort and Advair provide similar improvements in lung function, asthma control days, and asthma-related quality of life.

What is the difference between asthma and COPD?

Asthma and COPD are serious chronic diseases that require medication for people to continue to breathe properly. Asthma is a lung condition where the airways become inflamed which causes them to narrow and swell. This results in shortness of breath and wheezing. The cause of an asthma attack is usually an allergic reaction and normally develops in childhood. (COPD) is a group of lung diseases that cause breathing problems. The two most common are emphysema and chronic bronchitis. They normally occur later on in life and occur in people who smoke or those who used to smoke.

What other drugs are similar to Symbicort and Advair?

Other combination drugs that are similar to Symbicort and Advair are Dulera (mometasone/formoterol), and Breo (fluticasone/vilanterol). These inhalers may work similarly to Symbicort and Advair, but they are not considered their equivalents.

How often should you use your Symbicort inhaler?

Asthma and COPD are respiratory conditions that need long-term treatment to keep symptoms under control. Doctors normally prescribe Symbicort as two puffs twice a day, morning and evening, 12 hours apart. Symbicort is considered a maintenance medication.

Why must you rinse your mouth out after using Symbicort and Advair?

There is an increased risk of oral thrush due to the steroid drug in Symbicort and Advair. This is why you are advised to rinse your mouth with water after each use of the inhaler. Spacers are sometimes attached to metered-dose inhalers to help reduce the risk of oral thrush. Your pharmacist can show you how to use a spacer correctly.

The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.
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