From the Guidelines
Managing tachycardia in patients taking Symbicort requires a careful assessment and a stepwise approach, prioritizing the patient's morbidity, mortality, and quality of life. The first step is to determine if the tachycardia is directly related to the formoterol component of Symbicort, which is a long-acting beta-2 agonist that can increase heart rate as a side effect, as noted in a study on drug-induced atrial fibrillation 1. For mild tachycardia without symptoms, monitoring the patient closely and considering reducing the Symbicort dose if appropriate for their respiratory condition is a reasonable approach. However, for moderate tachycardia, consulting with the prescribing physician about potentially switching to an inhaled corticosteroid alone (like budesonide) without the formoterol component may be necessary, as the risk of atrial fibrillation is not observed for short-term use of inhaled steroids 1. In cases of severe or symptomatic tachycardia, temporarily discontinuing Symbicort and seeking immediate medical attention is crucial, as the risk of adverse cardiovascular events, including atrial fibrillation, is increased with the use of beta-2 agonists 1. Beta-blockers should be used with extreme caution in patients with respiratory conditions, as they may worsen bronchospasm, but cardioselective beta-blockers (like metoprolol) at low doses might be considered in some cases under close supervision, as recommended in the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1. Proper inhaler technique should also be evaluated, as improper use can lead to systemic absorption of medication and increased side effects. Patients should be educated to report palpitations or rapid heartbeat promptly, and those with pre-existing cardiovascular conditions require more frequent monitoring when using Symbicort. Key considerations include:
- Monitoring for signs of worsening heart rate or arrhythmias
- Adjusting Symbicort dosage or switching to alternative treatments as needed
- Close supervision when using beta-blockers or other medications that may interact with Symbicort
- Patient education on proper inhaler technique and recognition of adverse effects.
From the Research
Tachycardia with Symbicort
- Tachycardia is a potential side effect of Symbicort, which contains the long-acting beta(2)-agonist formoterol 2, 3.
- Formoterol can cause an increase in heart rate, which may lead to tachycardia in some patients 3.
- The study by 3 found that the mean peak increase in heart rate occurred 300 min after formoterol/budesonide, with a mean increase of 1.5 b/min.
Management of Tachycardia in Patients Taking Symbicort
- There is no direct evidence on how to manage tachycardia in patients taking Symbicort, but the studies suggest that the beneficial safety profiles and dose relationships of both budesonide and formoterol allow dose adjustments of Symbicort in response to variations in the patient's asthma 2.
- Adjustable dosing with Symbicort may help minimize the risk of tachycardia, as it allows patients to use the medication only as needed 4, 5.
- Patients with intermittent asthma and raised NO levels in exhaled air may benefit from as-needed use of Symbicort, which contains both a rapid-acting beta2-agonist and a corticosteroid 5.