Should I rinse my mouth after using Symbicort (budesonide/formoterol)?

Mouth Rinsing After Symbicort Use

Yes, you should rinse your mouth after using Symbicort to prevent oral candidiasis (thrush) and other local side effects. 1

Why Rinsing Is Important

Symbicort contains budesonide, an inhaled corticosteroid (ICS) that can cause local side effects in the mouth and throat when residue remains after inhalation. Rinsing helps to:

• Prevent oral candidiasis (thrush), a fungal infection in the mouth 2
• Reduce the risk of hoarseness and sore throat 3
• Minimize potential systemic absorption of the medication 4

Proper Rinsing Technique

The FDA drug label for Symbicort specifically instructs:

1. Rinse your mouth with water after each dose (2 puffs) of Symbicort
2. Spit the water out rather than swallowing it 1

For optimal effectiveness:

• Rinse immediately after inhalation (timing is crucial) 4
• Use both gargling and rinsing for best results 4
• Repeat the process at least twice 5

Timing Considerations

Research shows that delaying mouth rinsing significantly reduces its effectiveness:

• Waiting just 1 minute after inhalation can reduce the amount of medication removed by 51-65%
• After 10 minutes, only 5-8% of the medication can be removed 4

Common Pitfalls to Avoid

1. Delaying rinsing: Always rinse immediately after using Symbicort 4
2. Only rinsing without gargling: Combining both techniques is more effective 4
3. Swallowing the rinse water: This can increase systemic absorption of the medication 1
4. Using mouthwash instead of water: Research shows that water is equally effective as alcohol-based mouthwashes for removing inhaled corticosteroids 6

Potential Complications of Not Rinsing

Failure to rinse properly after using inhaled corticosteroids like Symbicort can lead to:

• Oral candidiasis (thrush) - the most common local side effect 1
• Hoarseness and sore throat 3
• In rare cases, esophageal candidiasis has been reported even in patients who claimed to rinse regularly 7

Practical Implementation Tips

• Time your Symbicort use to occur just before tooth brushing twice a day 2
• For children using Symbicort, ensure adult supervision of the rinsing procedure 1
• Consider setting a reminder to rinse after each use if you frequently forget 3

Proper mouth rinsing is a simple but effective way to reduce the risk of adverse effects while maintaining the benefits of your Symbicort inhaler for asthma or COPD management.