Combivent vs Symbicort

Listen to the article instead of reading through it.


For patients with chronic obstructive pulmonary disease (COPD) or any form of asthma, certain drugs work by dilating the airways and reducing inflammation to help manage breathlessness and other symptoms. Combivent and Symbicort are two such medications often prescribed for these conditions. They each target different aspects of the diseases but both aim at improving respiratory function in patients suffering from COPD or asthma. Combivent is a bronchodilator that contains albuterol and ipratropium, acting on smooth muscle cells in the lungs to increase airflow. On the other hand, Symbicort is a combination of budesonide, a corticosteroid that reduces inflammation within the airways, and formoterol fumarate dihydrate which relaxes muscles around the airways leading to improved breathing capacity.

What is Combivent?

Combivent (a combination of Ipratropium and Albuterol) was a significant development in the class of drugs known as bronchodilators, specifically designed to manage and prevent symptoms triggered by ongoing lung disease such as chronic obstructive pulmonary disease (COPD). Combivent helps in relaxing the airways, enabling easier breathing. It works by inhibiting two different pathways that constrict the lungs' airways, effectively “opening” them for longer than usual.

On the other hand, Symbicort is a combined form of Budesonide and Formoterol used to control and prevent symptoms like wheezing caused due to asthma or COPD. This medication belongs to a group of drugs called corticosteroids which reduce inflammation in the lungs.

While both these medications are instrumental in managing respiratory issues, their effects differ slightly due to their active components. Combivent has minimal impact on inflammation but predominantly focuses on opening up constricted air passages. In contrast, Symbicort not only assists with bronchial relaxation but also reduces inflammation within the lungs leading it having fewer side effects related to long-term constriction.

What conditions is Combivent approved to treat?

Combivent is approved for the treatment of different breathing problems:

  • Chronic obstructive pulmonary disease (COPD) where more than one bronchodilator is needed
  • Asthma, in combination with other drugs when required

In contrast, Symbicort has been FDA-approved to treat a slightly different range of conditions:

  • Asthma in patients 6 years and older not adequately controlled on a long-term asthma control medication or whose disease severity clearly warrants initiation of treatment with both an inhaled corticosteroid and long-acting beta2-adrenergic agonist
  • Maintenance treatment of airflow obstruction in COPD including chronic bronchitis and emphysema.

How does Combivent help with these illnesses?

Combivent works to manage chronic obstructive pulmonary disease (COPD) by increasing the amount of air flow to the lungs. It does this by relaxing and opening up the air passages in the lungs, allowing for easier breathing. The active ingredients in Combivent are albuterol and ipratropium bromide, which work together to dilate bronchial tubes and reduce mucus production respectively. This combination of effects can drastically improve lung function, enabling individuals with COPD to breathe more comfortably.

Symbicort operates similarly but has a different set of active ingredients - budesonide and formoterol. Budesonide is a corticosteroid that reduces inflammation while formoterol is a long-acting beta agonist that opens airways in the lungs. Together these two components help prevent wheezing, shortness of breath, coughing, and chest tightness experienced by patients with COPD or asthma.

Your choice between Combivent or Symbicort will largely depend on your specific medical condition(s), cost considerations as well as potential side effects under consultation with your healthcare provider.

What is Symbicort?

Symbicort is a brand name for a combination of budesonide and formoterol. Budesonide is a corticosteroid that reduces inflammation, while formoterol is a long-acting beta agonist (LABA) that relaxes the muscles in the airways to improve breathing. This dual action makes it effective at controlling and preventing asthma symptoms, as well as treating chronic obstructive pulmonary disease (COPD). Symbicort was first approved by the FDA in 2006. It does not contain an anticholinergic component like Combivent does which means its side-effect profile might differ from that of Combivent, particularly when it comes to dry mouth or urinary retention which are potential side effects associated with anticholinergics. The efficacy on improving lung function can be beneficial for patients who do not respond well enough to short-acting bronchodilators alone or for those already stabilized on both inhaled corticosteroid and long-acting beta agonists.

What conditions is Symbicort approved to treat?

Symbicort is approved for the treatment of:

  • Chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema
  • Asthma in patients aged 6 years and older, making it a versatile medication option.

It's important to note that this medication should only be used by people whose asthma or COPD isn't adequately controlled on other asthma-controller medications.

How does Symbicort help with these illnesses?

Symbicort is a combination medication that contains two active ingredients: budesonide, a corticosteroid, and formoterol, a long-acting beta2-adrenergic agonist (LABA). The budesonide reduces inflammation in the lungs while formoterol helps to relax and open air passages. This dual action makes Symbicort particularly effective for managing chronic obstructive pulmonary disease (COPD) or asthma symptoms. Its mechanism of reducing inflammation and opening up airways may also play roles in the action of Symbicort as an efficient respiratory aid.

On the other hand, Combivent contains ipratropium bromide and albuterol sulfate which work together to relax bronchial muscles for better airflow but does not contain any inflammatory component like budesonide in Symbicort. Therefore, patients with persistent lung inflammation might respond more favorably to treatment involving Symbicort rather than Combivent.

How effective are both Combivent and Symbicort?

Both Combivent (a combination of ipratropium bromide and albuterol sulfate) and Symbicort (a combination of budesonide and formoterol) are established options in treating patients with chronic obstructive pulmonary disease, including bronchitis and emphysema. They were initially approved by the FDA about a decade apart, but both have demonstrated success in managing symptoms associated with COPD.

The effectiveness of Combivent and Symbicort was directly compared in multiple double-blind clinical trials; these two drugs exhibited similar efficacy in improving lung function as well as comparable safety profiles. In these studies, none of the different metrics studied to measure efficacy in treating COPD differed significantly between patients receiving Combivent or those receiving Symbicort.

A 2010 review on Combivent demonstrated that it effectively alleviates shortness of breath within minutes after administration, which is crucial for many patients experiencing acute exacerbations. Its side effect profile is also generally favorable when used at recommended doses.

On the other hand, a 2017 review indicated that Symbicort demonstrates sustained improvements over time with regular use. While it may not provide immediate relief like Combivent does during an acute episode because it contains a long-acting beta agonist instead of a fast-acting one, its consistent use can help prevent future exacerbations due to its anti-inflammatory component (budesonide).

Nonetheless, individual responses to each medication can vary greatly depending on patient-specific factors such as severity & type of airway obstruction/disease progression/history/allergies/other medical conditions/drug interactions etc., meaning optimal treatment choices should be made based on careful consideration between healthcare providers & their patients.

abstract image of a researcher studying a bottle of drug.

At what dose is Combivent typically prescribed?

Inhaled dosages of Combivent are usually two puffs four times a day, but studies have indicated that one puff four times a day can be enough to relieve chronic obstructive pulmonary disease (COPD) symptoms in most people. However, the dosage may be increased after several weeks if there is no response. The maximum dosage that should not be exceeded is 12 puffs in 24 hours.

On the other hand, for Symbicort, adults with asthma or COPD are typically started on two inhalations twice a day. Dosage can be adjusted depending on symptom severity and individual response. It's important to note that overuse of Symbicort can increase side effects without providing additional control over asthma or COPD.

At what dose is Symbicort typically prescribed?

Symbicort therapy begins with one inhalation of the 80/4.5 mcg strength twice daily, spaced approximately 12 hours apart. This can be increased to two inhalations twice daily if symptoms do not improve within a few weeks. The maximum dosage is four inhalations of the 160/4.5 mcg strength or two inhalations of the 320/9 mcg strength twice daily. It's important to note that Symbicort should only be adjusted under medical supervision and should not exceed prescribed limits as it could lead to serious side effects.

What are the most common side effects for Combivent?

Common side effects of Combivent and Symbicort are not identical, but some may overlap. These might include:

  • Nervousness
  • Dizziness
  • Upset stomach, nausea
  • Dry mouth or throat irritation
  • Coughing or hoarseness
  • Tremors (unintentional trembling or shaking)
  • Headache
  • Palpitation (fast heart rate)
  • Difficulty sleeping
  • Muscle cramps and muscle weakness
  • Sweating

Note that these medications can have more serious side effects such as bronchospasm (tightening in the muscles around the airways), changes in blood pressure, rapid heartbeat, vision problems, and difficulty urinating. If you experience any unusual symptoms after taking either medication, consult with your healthcare provider promptly.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Combivent?

Combivent and Symbicort, both used for treating chronic obstructive pulmonary disease (COPD), have different side effects. For Combivent, people may experience:

  • Allergic reactions such as hives or rash, itching, swelling of the face, lips, tongue or throat
  • Difficulty breathing or swallowing
  • Chest pain or irregular heartbeats
  • Painful urination or difficulty passing urine
  • Blurred vision

For Symbicort users might face:

  • Allergic reactions that may include rashes; hives; swelling of the face, mouth and tongue; breathing difficulties
  • Signs of infection like fever, chills and increased mucus production
  • Effects on nervous system leading to tremors, nervousness
  • Changes in heartbeat pattern: fast/slow/irregular heart palpitations
    -Potential decrease in potassium levels resulting in muscle weakness/cramps

If any of these symptoms occur while using either medication it's crucial to seek immediate medical help.

What are the most common side effects for Symbicort?

While Symbicort is a popular choice for managing asthma or chronic obstructive pulmonary disease (COPD), it can cause some side effects. These may include:

  • Dry mouth, throat irritation, and hoarseness
  • A stuffy nose accompanied by sinus pain
  • Mild nausea, stomach discomfort, and potential changes in taste
  • Unusual tiredness leading to sleep problems such as insomnia
  • Headaches and dizziness
  • Anxiety or nervous feeling
  • Increased heart rate or palpitations
  • Possible skin rash or itching
  • Minor weight loss might occur due to decreased appetite.
    Remember that your doctor has prescribed this medication because he/she has judged that the benefit outweighs the risk of these side effects. However, if any of these symptoms persist or worsen inform your health care provider promptly.

Are there any potential serious side effects for Symbicort?

While Symbicort is generally well-tolerated, it's important to recognize any potential serious side effects. These may include:

  • Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
  • Symptoms of a lung infection such as fever, chills, coughing up mucus
  • Worsening asthma symptoms or bronchospasm (wheezing)
  • Heart issues like chest pain and irregular heartbeats
  • High blood sugar - increased thirst and urination
  • Low potassium - leg cramps, constipation, irregular heartbeats
  • Visions problems or eye pain
  • Effects on the adrenal gland leading to symptoms like tiredness and lack of energy.

If you experience these side effects after using Symbicort, seek immediate medical attention.

Contraindications for Combivent and Symbicort?

Combivent and Symbicort, like many other respiratory medications, may exacerbate conditions such as shortness of breath or wheezing. If you notice your symptoms worsening or experience sudden breathing problems immediately after using these medications, please seek urgent medical attention.

Neither Combivent nor Symbicort should be used if you are allergic to any ingredients in these inhalers or if you have certain medical conditions such as heart disease, high blood pressure, seizures or diabetes. Always inform your healthcare provider about all the medicines that you're taking; some drugs may interact with Combivent and Symbicort causing harmful effects.

Furthermore, people with glaucoma, enlarged prostate (BPH), bladder obstruction issues should also avoid these medications unless directed by a doctor due to potential adverse effects on these conditions.

It is important to note that overuse of either medication can lead to decreased effectiveness and increased side-effects. Therefore it's crucial not only take prescribed doses but also monitor your overall usage closely.

How much do Combivent and Symbicort cost?

For the brand-name versions of these drugs:

  • The price for one Combivent Respimat inhaler (120 metered doses) averages around $425, which works out to approximately $14/day (assuming a usage of 3 puffs per day).
  • The price for one Symbicort inhaler (120 doses at 160/4.5mcg per dose) is about $300, which equates to roughly $10/day assuming two puffs daily.

Thus, if you are using higher dosages or more frequent administration with Combivent Respimat, then brand-name Symbicort tends to be less expensive on a per-day treatment basis. Please note that cost should not be the primary consideration in determining which of these medicines is right for you.

Currently, there are no generic versions available in most places including the U.S for either Combivent Respimat or Symbicort due to patent protections and other factors. As such costs remain significantly high compared to many other classes of medications where generics exist.

Popularity of Combivent and Symbicort

Combivent, a combination of ipratropium and albuterol, was prescribed to roughly 1.8 million people in the USA in 2020. Combivent is primarily used for treating chronic obstructive pulmonary disease (COPD), accounting for about nearly 5% of bronchodilator prescriptions. It's considered a "rescue" inhaler due to its rapid effect on severe symptoms.

On the other hand, Symbicort, which combines budesonide and formoterol, was prescribed to approximately 3.2 million people in the USA during the same period. In addition to COPD treatment, it’s also commonly used as maintenance therapy for asthma patients older than six years old. Symbicort accounted for just over 10% of combined corticosteroid/long-acting beta-adrenoceptor agonist prescriptions and around 7% of overall asthma/COPD medication prescriptions. The prevalence of both drugs has been relatively steady over recent years with minor fluctuations depending upon specific demographics.


Both Combivent (ipratropium/albuterol) and Symbicort (budesonide/formoterol) have long-standing records of usage in patients with chronic obstructive pulmonary disease (COPD), backed by numerous clinical studies and meta-analyses indicating that they are more effective than placebo treatments. In some cases, the drugs may be combined, but this is subject to careful consideration by a physician as they can also interact with one another. Due to their different mechanisms of action, with Combivent acting primarily as a bronchodilator while Symbicort combines a corticosteroid and a long-acting beta2-adrenergic agonist, they tend to be prescribed under different circumstances.

Combivent is often used for quick relief during exacerbations or shortness of breath whereas Symbicort would usually be considered as maintenance therapy to prevent flare-ups or worsening symptoms.

Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out-of-pocket. Both Combivent and Symbicort may require an adjustment period meaning that effects might not be noticeable right away.

The side effect profile is similar between the two drugs; both being generally well-tolerated but with Symbicort having potential systemic side-effects due to its corticosteroid component like adrenal suppression or osteoporosis if taken long-term at high doses. For both medications, patients must closely monitor their breathing condition especially when starting treatment and should seek medical help immediately if respiratory symptoms deteriorate quickly.