From the Guidelines
Symbicort has several significant medical interactions that you should be aware of, including potential interactions with beta-blockers, strong CYP3A4 inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, QT-prolonging medications, diuretics, steroids, and xanthine derivatives. When using Symbicort, it is essential to avoid combining it with beta-blockers (like metoprolol or propranolol) as they can reduce Symbicort's effectiveness and potentially worsen asthma or COPD symptoms 1. Strong CYP3A4 inhibitors such as ketoconazole, itraconazole, ritonavir, and clarithromycin can increase budesonide levels in your blood, potentially causing side effects like increased bruising, muscle weakness, or elevated blood sugar 1.
Some key points to consider when taking Symbicort include:
- Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants can enhance the cardiovascular effects of formoterol, potentially causing dangerous increases in blood pressure or heart rate 1
- QT-prolonging medications (like certain antibiotics and antipsychotics) used with Symbicort may increase the risk of abnormal heart rhythms 1
- Diuretics, steroids, and xanthine derivatives can increase the risk of hypokalemia (low potassium) when combined with Symbicort 1
- The combination of Symbicort with other medications should be done with caution, and it is crucial to inform your healthcare provider about all medications you're taking, including over-the-counter drugs and supplements, to avoid potentially dangerous interactions with Symbicort 1.
It is also important to note that the working group recommends using ICS/LABA combinations, such as budesonide/formoterol, with a fast onset of action, like formoterol, for SMART therapy 1. However, the choice of ICS to use in combination with formoterol is less settled, and other ICSs could potentially be used in combination with formoterol 1. Always consult your healthcare provider before taking any medication, especially if you have any pre-existing medical conditions or are taking other medications.
From the FDA Drug Label
If additional adrenergic drugs are to be administered by any route, they should be used with caution because the pharmacologically predictable sympathetic effects of formoterol may be potentiated. Concomitant treatment with xanthine derivatives, steroids, or diuretics may potentiate any hypokalemic effect of adrenergic agonists The ECG changes and/or hypokalemia that may result from the administration of non-potassium sparing diuretics (such as loop or thiazide diuretics) can be acutely worsened by beta-agonists, especially when the recommended dose of the beta-agonist is exceeded Formoterol, as with other beta2-agonists, should be administered with extreme caution to patients being treated with monamine oxidase inhibitors, tricyclic antidepressants, or drugs known to prolong the QTc interval because the action of adrenergic agonists on the cardiovascular system may be potentiated by these agents Beta-adrenergic receptor antagonists (beta-blockers) and formoterol may inhibit the effect of each other when administered concurrently. Caution should be exercised when considering the coadministration of budesonide suspension inhalation with ketoconazole, and other known strong CYP3A4 inhibitors (e.g., ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin) because adverse effects related to increased systemic exposure to budesonide may occur
Significant Medical Interactions with Symbicort:
- Adrenergic drugs: Use with caution due to potential potentiation of sympathetic effects.
- Xanthine derivatives, steroids, or diuretics: May potentiate hypokalemic effect of adrenergic agonists.
- Non-potassium sparing diuretics: May worsen ECG changes and/or hypokalemia.
- Monamine oxidase inhibitors, tricyclic antidepressants, or drugs known to prolong the QTc interval: Use with extreme caution due to potential potentiation of cardiovascular effects.
- Beta-blockers: May inhibit the effect of each other when administered concurrently.
- Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, atazanavir, clarithromycin): Use with caution due to potential increased systemic exposure to budesonide. 2 3
From the Research
Significant Medical Interactions with Symbicort
When taking Symbicort (budesonide and formoterol), it is essential to be aware of potential medical interactions. These interactions can affect the efficacy and safety of the medication.
- Asthma and COPD Management: Symbicort is used for the management of asthma and Chronic Obstructive Pulmonary Disease (COPD) 4, 5, 6.
- Combination Therapy: The combination of budesonide (an inhaled corticosteroid) and formoterol (a long-acting beta2-agonist) in Symbicort provides complementary effects, treating both airway inflammation and obstruction 7.
- Pharmacological Interactions: There are no reported physico-chemical interactions between budesonide and formoterol when combined in a single inhaler 4.
- Comparison with Other Treatments: Studies have shown that Symbicort is more effective than double-dose corticosteroid therapy and at least as effective and safe as budesonide and formoterol given in separate inhalers 4, 7, 8.
- Safety Profile: The safety profile of Symbicort is similar to that of its individual components, with no unexpected pattern of abnormalities reported in clinical trials 8.
- Genetic Factors: The efficacy of Symbicort is not affected by the inheritance of the Gly16Arg polymorphism of the beta(2)-adrenergic receptor 8.
It is crucial to consult healthcare professionals for personalized advice on managing interactions with Symbicort, as individual responses to the medication may vary.