Symbicort vs. Advair


What is Symbicort? What is Advair?

Symbicort is a Brand name for an inhalation aerosol preparation that contains a combination of 2 active substances: budesonide and formoterol. Budesonide is a corticosteroid drug that reduces inflammation in the body. Formoterol is a bronchodilator drug that works by relaxing airways muscle and improving breathing.


Advair is a Brand name for inhalation aerosol preparation that contains fluticasone and salmeterol as active ingredients. Fluticasone is a corticosteroid drug that reduces inflammation processes in the body. Salmeterol is a bronchodilator drug that works by relaxing airways muscles to improve breathing.

Symbicort 200-6 R


Are Symbicort and Advair same thing?

Symbicort and Advair are not the same thing, but they are very similar as they both contain a combination of steroid and bronchodilator. Symbicort and Advair should work the same, however their active ingredients are different and some people may find that one works better for them than the other. Both Advair and the Symbicort are maintenance inhalers.


They are taken every day whether or not patients have trouble breathing. Advair and Symbicort are not used for acute and short-term breathing problems such as an asthma attack. Symbicort is MDI, metered dose inhaler, traditional inhaler with traditional technique of use that can be also used with a spacer.

All strengths can be used for the treatment of asthma and COPD. However it can be only used in patients who are 12 years or older. Hand-breath coordination is needed when this inhaler is used, which can be troublesome for a new patient with asthma. Advair does not need Hand-breath coordination and does not need primed before using.

It also used for asthma and COPD, but compared to Symbicort it can be used in patients who are 4 years or older. However, Advair 250/50 is the only strength that can be used for the treatment of COPD. Advair cannot be used with a spacer and once opened it should be used within 1 month.

How do they work?

Symbicort active substances are budesonide and formoterol. Budesonide is a corticosteroid drug with potent glucocorticoid and weak mineralocorticoid effects. Budesonide binds to the glucocorticoid receptors with a higher affinity than prednisolone and cortisol.

After intravenous administration budesonide shows endogenous suppression of cortisol concentrations and impairment of the hypothalamus-pituitary-adrenal axis function. Budesonide inhaled formulations show decrease in airway reactivity to histamine and other mediators of inflammation.

Formoterol is a selective, long-acting agonist of beta-2 receptors. It has more than 200 times greater agonist activity to the beta2-receptors than at beta1- receptors. Inhaled formoterol shows local effects in the lung as a bronchodilator.

Advair active substances are fluticasone and salmeterol. Fluticasone acts by binding to human glucocorticoid receptor. It is highly retained in respiratory tissue. This substance has prolonged anti-inflammatory effect, which allows for once-daily dosing.

It does not have any effect on heart QTC interval. Studies showed that inhaled form of fluticasone does not affect the hypothalamic-pituitary-adrenal axis function in adolescent and adult patients with asthma.

Salmeterol is a long acting agonist of beta2-adrenoceptor. Lipophilic side chain of salmeterol molecule binds to exosites near beta2 receptors sites in the lungs and on smooth bronchiolar muscle, allowing the active parts of the molecule to remain at the receptor site, continually binding and releasing.

The results of salmeterol actions are: bronchodilation, relaxation of bronchial smooth muscle, and increased bronchial airflow. Inhaled salmeterol decreases the severity and number of asthma attacks. But, it is not for use for relieving an asthma attack that has already started.

Symbicort and Advair Uses

Symbicort is used for the prevention of bronchospasm in people with asthma or chronic obstructive pulmonary disease. Indication for asthma is only if asthma is severe enough or if it is not well-controlled after treatment of first-line asthma medicines.

Advair is used for prevention of asthma attacks. It is also used to prevent flare-ups or worsening of chronic obstructive pulmonary disease linked with chronic bronchitis and/or emphysema.

Symbicort and Advair available dosages and forms

Symbicort is a metered dose inhaler (MDI). MDI’s are pressurized, and deliver a certain amount of active substance using a propellant each time patient use the inhaler. Each dose of Symbicort has a combination of 80 mcg or 160 mcg of budesonide and 4.5 mcg of formoterol.

Advair is an inhalation powder inhaler that uses foil blister strips containing powder that patients breathe in through their mouth. Each dose has a combination of 100 mcg, 250 mcg, or 500 mcg of fluticasone propionate and 50 mcg of salmeterol.

Symbicort side effects

Advair side effects

  • Upper respiratory tract infection (8-11%)
  • Nasopharyngitis (7-11%)
  • Headache (7-11%)
  • Pharyngolaryngeal pain (6-9%)
  • Sinusitis (5-6%)
  • Stomach discomfort (1-7%)
  • Oral candidiasis (1-6%)
  • Bronchitis (5%)
  • Viral URTI (4%)
  • Backache (2-3%)
  • Influenza (2-3%)
  • Nasal congestion (2-3%)
  • Vomiting (1- 3%)
  • Upper respiratory tract infection (21-27%)
  • Headache (12-21%)
  • Pharyngitis (10-13%)
  • Candidiasis, nonspecific site (0-10%)
  • Throat irritation (7-9%)
  • Musculoskeletal pain (2-9%)
  • Bronchitis (2-8%)
  • Upper respiratory inflammation (4-7%)
  • Viral respiratory infections (4-6%)
  • Nausea or vomiting (4-6%)
  • Cough (3-6%)
  • Sinusitis (4-5%)
  • Hoarseness or dysphonia (2-5%)
  • Fever (3-4%)
  • Diarrhea (2-4%)
  • Gastrointestinal discomfort or pain (1-4%)
  • Oral candidiasis (1-4%)
  • Muscle cramps or spasms (3%)
  • Malaise or fatigue (2-3%)
  • Viral GI infections (0-3%)

Can you buy Symbicort and Advair over the counter?

Symbicort and Advair are available without prescription. Patients can buy these products over the counter.

Symbicort and Advair price

  • Symbicort 160/4.5 mcg 120 doses average price is about $60.00
  • Symbicort 80/4.5 mcg 120 doses average price is about $83.00
  • ·        Advair 100/50 mcg 60 doses average price is about $52.00
  • ·        Advair 250/50 mcg 60 doses average price is about $57.50
  • ·        Advair 500/50 mcg 60 doses average price is about $67.00

Who can use these products?

  • Symbicort and Advair should not be used if asthma attack has already begun.
  • Patients allergic to fluticasone, budesonide, salmeterol and formoterol or any of the ingredients in Advair or Symbicort product should not use these drugs.
  • During pregnancy, these medicines should be used only when clearly needed. Patients should discuss benefits and risks of using these drugs with their doctor. Babies may develop hormone problems if their mothers have used corticosteroids for a long time during pregnancy.
  • Budesonide and fluticasone can pass into breast milk. It is unknown if formoterol and salmeterol passes into breast milk. Patients should consult their doctor before breast-feeding.
  • Symbicort can be only used in patients who are 12 years or older.
  • Advair can be only used in patients who are 4 years or older

How should Symbicort and Advair be used?

To use Symbicort inhaler patients should follow next steps:

  1. Take your Symbicort out of the moisture-protective foil pouch before you use it for the first time and throw the foil away. Write the date that you open the foil pouch on the box.
  2. A counter is attached to the top of the metal canister. The counter will count down each time you release a puff of Symbicort. The arrow points to the number of inhalations (puffs) left in the canister. The counter will stop counting at zero (“0”).
  3. Use the Symbicort canister only with the red Symbicort inhaler supplied with the product. Parts of the Symbicort inhaler should not be used with parts from any other inhalation product.
  4. Shake your Symbicort inhaler well for 5 seconds right before each use. Remove the mouthpiece cover by squeezing gently at both sides, then pulling out. Check the mouthpiece for foreign objects before use.
  5. Before you use Symbicort for the first time, you will need to prime it. To prime Symbicort, hold it in the upright position. Shake the Symbicort inhaler well for 5 seconds. Hold your Symbicort inhaler facing away from you and then release a test spray. Then shake it again for 5 seconds and release a second test spray. Your Symbicort inhaler is now primed and ready for use. After you have primed the Symbicort inhaler for the first time, the counter will read either 120 or 60, depending on which size was provided to you.
  6. Shake your Symbicort inhaler well for 5 seconds. Remove the mouthpiece cover. Check the mouthpiece for foreign objects.
  7. Breathe out fully (exhale). Hold the Symbicort inhaler up to your mouth. Place the white mouthpiece fully into your mouth and close your lips around it. Make sure that the Symbicort inhaler is upright and that the opening of the mouthpiece is pointing towards the back of your throat.
  8. Breathe in (inhale) deeply and slowly through your mouth. Press down firmly and fully on the top of the counter on the Symbicort inhaler to release the medicine.
  9. Continue to breathe in (inhale) and hold your breath for about 10 seconds, or for as long as is comfortable. Before you breathe out (exhale), release your finger from the top of the counter. Keep the Symbicort inhaler upright and remove from your mouth.
  10. Shake the Symbicort inhaler again for 5 seconds and repeat steps 7 to 9.
  11. After use, close the mouthpiece cover by pushing until it clicks in place.
  12. After you finish taking Symbicort (two puffs), rinse your mouth with water. Spit out the water. Do not swallow it.

To use Advair inhaler patients should follow next steps:

1.      Make sure the canister fits firmly in the actuator. The counter should show through the window in the actuator. Shake the inhaler well for 5 seconds before each spray. Take the cap off the mouthpiece of the actuator. Look inside the mouthpiece for foreign objects, and take out any you see.

2.      Hold the inhaler with the mouthpiece down

3.      Breathe out through your mouth and push as much air from your lungs as you can. Put the mouthpiece in your mouth and close your lips around it.

  1. Push the top of the canister all the way down while you breathe in deeply and slowly through your mouth.
  2. After the spray comes out, take your finger off the canister. After you have breathed in all the way, take the inhaler out of your mouth and close your mouth.
  3. Hold your breath for about 10 seconds, or for as long as is comfortable. Breathe out slowly as long as you can. Wait about 30 seconds and shake the inhaler well for 5 seconds. Repeat steps 2 through 6.
  4. Rinse your mouth with water after breathing in the medicine. Spit out the water. Do not swallow it.
  5. Put the cap back on the mouthpiece after every time you use the inhaler. Make sure it snaps firmly into place.
  6. Take the cap off the mouthpiece. The strap on the cap will stay attached to the actuator. Do not take the canister out of the plastic actuator.
  7. Use a dry cotton swab to clean the small circular opening where the medicine sprays out of the canister. Carefully twist the swab in a circular motion to take off any medicine.
  8. Wipe the inside of the mouthpiece with a clean tissue dampened with water. Let the actuator air-dry overnight.
  9. Put the cap back on the mouthpiece after the actuator has dried.

How many times and how often can patients take Symbicort and Advair?

  • For patients who are 12 years of age and older, Symbicort dosage is 2 inhalations twice a day.
  • The maximum recommended dosage for Symbicort 160/4.5 mcg is twice a day.
  • Patients who do not respond successfully to the starting dose of Symbicort 80/4.5 after 1-2 weeks of therapy, replacement with Symbicort dosage of 160/4.5 may provide additional asthma control.
  • For patients with chronic obstructive pulmonary disease Symbicort dosage is 160/4.5, two inhalations twice a day.
  • For patients who are 12 years of age or older, Advair dosage is 2 inhalations twice a day.
  • The maximum recommended dosage of Advair 230/21 is twice a day.

How long does it take for Symbicort and Advair to be effective?

  • After inhaled administration of Symbicort the improvement in asthma control can start within 15 minutes after the beginning of treatment, although patients can expect the maximum benefit after 2 weeks or longer of the beginning of treatment. However, individual patients will experience a variable time to onset and degree of symptom relief.
  • After inhaled administration of Advair improvement on asthma control can occur within 30 minutes of beginning treatment, although the maximum benefit of Advair administration can be achieved for 1 week or longer after starting treatment

What if I overdose Symbicort and Advair?

  • Patients may experience next symptoms if they overdose Symbicort or Advair: trouble breathing, nervousness, runny nose, dry mouth, muscle cramps, nausea, vomiting, tremors, chest pain, fast or pounding heartbeats, sleep problems, fainting and seizure.
  • If patients recognize these symptoms after administration of these drugs, they should seek emergency medical attention immediately or call the Poison Help line at 1-800-222-1222.

What if I missed the dose of Symbicort or Advair?

Patients should take the missed dose as soon as they remember it. However, if it is almost time for the next dose, patients should skip the missed dose and continue with their regular dosing schedule. Patients should never use double dose to make up for a missed one.

Can I drink alcohol while taking Symbicort and Advair?

It is not known whether alcohol affects these drugs. Combining budesonide or fluticasone and alcohol is not expected to cause adverse effects. However, salmeterol and formoterol as bronchodilator drugs may cause increased heart rate.

Large amounts of alcohol in combination with bronchodilator drugs may increase the chances of rapid heartbeat and tachycardia. Consuming alcohol may increase the risk of dizziness and drowsiness after Symbicort or Advair usage. Patients who are already experiencing these side effects, alcohol can make them even worse.

When you cannot absolutely use Symbicort and Advair?

Absolute contraindications for Symbicort and Advair use are:

  • Status asthmaticus or other acute episodes of asthma or COPD where intensive measures are needed.
  • Hypersensitivity reactions to any of the ingredients in Symbicort and Advair products.

What are the alternatives for Symbicort and Advair?

  • Alternatives for Symbicort on the market that contain same active ingredient combination are: Symbicort 100 Turbuhaler, Symbicort 200 Turbuhaler and Symbicort Forte Turbuhaler
  • Alternatives for Advair on the market that contain same active ingredient combination are: Advair Diskus and Advairdiskus Diskus

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