Can Symbicort (budesonide and formoterol) and budesonide be used together?

Symbicort and Budesonide Should Not Be Used Together

Symbicort (budesonide/formoterol) and budesonide should not be used concurrently as this combination provides no additional therapeutic benefit while potentially increasing steroid-related side effects. 1

Rationale for Avoiding Concurrent Use

Symbicort already contains budesonide as one of its active ingredients, along with formoterol. Using additional budesonide would result in:

1. Duplicate therapy: Administering the same corticosteroid component twice
2. Increased risk of adverse effects: Higher cumulative dose of budesonide increases the likelihood of steroid-related side effects
3. No additional clinical benefit: No evidence supports improved outcomes with this combination

Understanding the Medications

Symbicort (Budesonide/Formoterol)

• Components: Contains budesonide (inhaled corticosteroid) and formoterol (long-acting beta2-agonist) 2
• Mechanism: Budesonide treats underlying airway inflammation while formoterol prevents and reverses airway obstruction 3
• Delivery: Available as dry powder inhaler (Turbuhaler) or pressurized metered-dose inhaler 4

Budesonide

• Class: Inhaled corticosteroid (ICS)
• Action: Anti-inflammatory effect in airways
• Forms: Available as separate inhaler, nebulizer solution, or as component in combination products 5

Potential Risks of Concurrent Use

Using both medications together would lead to:

• Systemic corticosteroid effects: Increased risk of adrenal suppression 5
• Local side effects: Higher rates of oral candidiasis, dysphonia, and pharyngeal irritation 5
• Long-term complications: Potential for osteoporosis, diabetes exacerbation, and other steroid-related adverse effects with higher cumulative doses 5

Clinical Management Recommendations

If a patient is prescribed both medications:

1. Identify the therapeutic intent: Determine why both were prescribed

   • For asthma management: Symbicort alone is typically sufficient 4
   • For inflammatory bowel disease: Budesonide may be used orally/rectally for this indication 5

2. Adjust therapy appropriately:

   • If higher ICS dose needed: Consider higher strength Symbicort formulation
   • If additional bronchodilation needed: Consider adding a different class of medication

3. Monitor for adverse effects if inadvertently using both:

   • Watch for signs of corticosteroid excess
   • Check for adrenal suppression if prolonged concurrent use has occurred

Special Considerations

• Different indications: If budesonide is being used for a non-respiratory condition (e.g., inflammatory bowel disease) while Symbicort is used for respiratory disease, this may be appropriate as they target different organ systems 5

• Transitioning between therapies: When switching between medications, ensure one is discontinued before starting the other to avoid overlap

Conclusion

The concurrent use of Symbicort and budesonide represents duplicate therapy that increases the risk of adverse effects without providing additional clinical benefit. Clinicians should select either Symbicort or budesonide alone based on the patient's specific respiratory needs.