Spiriva vs Symbicort

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For patients with chronic obstructive pulmonary disease (COPD) or other types of respiratory illnesses, certain medications that expand the airways and reduce inflammation can help in managing symptoms. Spiriva and Symbicort are two such drugs that are prescribed for these conditions. They each have different mechanisms but both aim to improve lung function and breathing in patients with respiratory diseases. Spiriva is a bronchodilator, specifically an anticholinergic drug which works by relaxing the muscles around the airway, helping them to stay open. On the other hand, Symbicort is a combination of two medications: a long-acting beta agonist which relaxes muscles in the airways, and a corticosteroid which reduces inflammation within them.

What is Spiriva?

Tiotropium (the generic name for Spiriva) was a significant advancement in the class of bronchodilator drugs known as anticholinergics, which were developed to treat chronic obstructive pulmonary disease (COPD). Tiotropium received FDA approval in 2004. It works by blocking the action of acetylcholine on airways and lung muscles, allowing them to relax and improving airflow into the lungs. Spiriva is often prescribed for long-term maintenance treatment of COPD symptoms.

On the other hand, Symbicort is a combination medication containing budesonide, a corticosteroid that reduces inflammation, and formoterol, a long-acting beta2-adrenergic agonist (LABA) that helps open up airways in the lungs. This dual-action approach makes it more effective at controlling severe asthma or COPD but also has potential side effects associated with both components.

While both medications are designed to manage respiratory conditions, they have different mechanisms of action and potentially different side effect profiles due to their distinct active ingredients.

What conditions is Spiriva approved to treat?

Spiriva and Symbicort are both approved for the treatment of different respiratory disorders:

  • Chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema
  • Asthma, in patients aged 12 years and older (Symbicort only)
  • Reduction of COPD exacerbations in patients with a history of exacerbations (Spiriva)

How does Spiriva help with these illnesses?

Spiriva helps to manage symptoms of chronic obstructive pulmonary disease (COPD) by relaxing and opening the airways, making it easier for patients to breathe. It does this through an active ingredient called tiotropium bromide, which is a type of medication known as a long-acting muscarinic antagonist (LAMA). This works by blocking the action of acetylcholine on specific receptors in lung muscle cells known as M3 receptors. Acetylcholine is a neurotransmitter that causes bronchoconstriction when it acts on these receptors. By blocking them, Spiriva prevents this constrictive effect and thus widens the airways.

The primary role of acetylcholine in the lungs is regulating airway constriction and mucus secretion, amongst other things. Individuals with COPD have impaired airflow due to damage or inflammation in their lungs' smallest passageways - the bronchioles. Therefore, by inhibiting acetylcholine's action on these pathways, Spiriva can limit adverse effects associated with COPD and aid patients in managing their condition more effectively.

What is Symbicort?

Symbicort, a brand name for the combination of budesonide and formoterol, is both an inhaled corticosteroid (ICS) and a long-acting beta2-adrenoceptor agonist (LABA). This means it reduces inflammation in the lungs while also relaxing muscles around the airways. It was first approved by the FDA in 2006. As Symbicort is not just an ICS medication, it does not only reduce inflammation but also opens up air passages. Its dual-action profile makes its side effects different from those of ICS medications like Spiriva; specifically, it may cause palpitations and tremors due to its LABA component. The combined effect on reducing inflammation and opening air passages can be beneficial for treating conditions like asthma and chronic obstructive pulmonary disease (COPD), particularly when patients do not respond well to typical single-mechanism drugs such as Spiriva.

What conditions is Symbicort approved to treat?

Symbicort is approved for the management of chronic conditions like:

  • Asthma in patients six years old and above (it's important to note that Symbicort should not be used as a "rescue" inhaler.)
  • Chronic obstructive pulmonary disease (COPD), including bronchitis and emphysema. It helps decrease inflammation, relaxes muscles around your airways to allow easier breathing, and can help prevent exacerbations or flare-ups.

How does Symbicort help with these illnesses?

Symbicort plays an essential role in managing chronic obstructive pulmonary disease (COPD) and asthma. It operates by combining two active ingredients, budesonide and formoterol. Budesonide is a steroid that reduces inflammation in the body, while formoterol belongs to a class of drugs known as long-acting beta agonists which relax muscles around the airways to improve breathing. Together, they work synergistically to reduce inflammation and open up airways for better respiratory function.

In contrast with Spiriva, which primarily functions as a bronchodilator by relaxing muscles in the airway passages, Symbicort offers both anti-inflammatory effects (from budesonide) and bronchodilation (from formoterol). This dual action can often result in more effective symptom relief for patients suffering from COPD or severe asthma. Hence, if Spiriva alone isn't controlling symptoms adequately or if there's also an asthmatic component involved - then Symbicort may be considered as it provides comprehensive treatment.

How effective are both Spiriva and Symbicort?

Both tiotropium (Spiriva) and budesonide/formoterol fumarate dihydrate (Symbicort) have established histories of success in treating patients with chronic obstructive pulmonary disease (COPD), and they were initially approved by the FDA within a few years of each other. Since they act on different physiological pathways, they may be prescribed under different circumstances; Spiriva acts as an anticholinergic bronchodilator while Symbicort is a combination product containing both a corticosteroid (budesonide) and long-acting beta agonist (formoterol).

A 2012 randomized controlled trial directly compared the effectiveness of these drugs in alleviating symptoms of COPD. Both treatments exhibited similar efficacy in improving lung function, quality of life, and reducing exacerbations. In this study, none of the different metrics studied to measure efficacy in treating COPD differed significantly between patients receiving Spiriva or Symbicort.

A 2008 review showed that Spiriva is effective at relieving symptoms from the first week of treatment onwards, has fewer side effects than many other bronchodilators due to its once-daily dosing regimen which minimizes systemic exposure, and is well-tolerated even among elderly populations. The same study reports that it has become widely used globally for managing moderate-to-severe COPD.

On the other hand, Symbicort's dual-action formulation seems more effective than placebo or single-agent therapy at controlling symptoms and preventing exacerbations according to a 2015 meta-analysis. However, its use often involves careful monitoring given potential side effects related to long-term steroid use such as osteoporosis or cataract formation. Nonetheless due its unique pharmacology combining anti-inflammatory properties with bronchodilation capabilities, Symbicort may provide benefit for patients needing stronger control over their COPD symptoms when monotherapy isn't sufficient.

abstract image of a researcher studying a bottle of drug.

At what dose is Spiriva typically prescribed?

Inhaled dosages of Spiriva consist of one inhalation (18 mcg) once a day. Research indicates that this dosage is effective for treating chronic obstructive pulmonary disease in most patients, including asthma. Alternatively, Symbicort has variable dosing depending on the severity of the condition: For adults and adolescents over 12 years old, recommended doses range from 2 inhalations twice daily (80/4.5 mcg or 160/4.5 mcg). In either population, if there is no significant improvement or control of symptoms within two weeks, it may be necessary to adjust the dose or switch drugs altogether under medical supervision. The maximum dosage should not exceed four inhalations twice a day.

At what dose is Symbicort typically prescribed?

Symbicort treatment typically starts at a dosage of 2 inhalations twice daily. Each inhalation contains either 80/4.5 mcg or 160/4.5 mcg of budesonide/formoterol, depending on the severity of your asthma or COPD condition. This dose can then be increased to as many as four inhalations twice daily for patients with severe symptoms that are not controlled by lower doses. For most people, however, two inhalations twice daily will provide significant symptom relief within fifteen minutes after administration and last up to twelve hours apart between morning and evening doses. If there is no response to treatment at this level after a few weeks, it may be necessary to reassess the patient's condition and consider other therapeutic options.

What are the most common side effects for Spiriva?

Typical side effects of Spiriva can include:

  • Dry mouth
  • Upper respiratory tract infection
  • Sinusitis (inflammation of the sinus cavities in the head)
  • Sore throat
  • Non-specific chest pain
  • Urinary tract infection
  • Indigestion

Meanwhile, common side effects associated with Symbicort may involve:

  • Nasopharyngitis (common cold symptoms)
  • Headache
  • Upper respiratory tract infection
  • Pharyngolaryngeal pain (pain in the throat and larynx)
  • Sinusitis -Tremor or nervousness due to its bronchodilator component

It's crucial to report any unusual or severe side effects to a healthcare professional.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Spiriva?

While Spiriva and Symbicort are both used to manage chronic obstructive pulmonary disease (COPD) and asthma, they do have different potential side effects. For Spiriva, you should be aware of:

  • An allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
  • Worsening bronchospasm (chest tightness, wheezing)
  • Blurred vision and eye pain
  • Sores or white patches on your mouth or lips
  • Painful urination

In case of using Symbicort these symptoms might occur:

  • Signs of infection - fever, chills, body aches
  • Chest discomfort or heavy feeling
  • Tremors
  • Nervousness -Possible adrenal gland problems - tiredness that doesn't go away; lack of energy; loss of appetite; weight loss
    If you experience any unusual symptoms while taking either medication contact your doctor immediately.

What are the most common side effects for Symbicort?

When using Symbicort, you may experience the following side effects:

  • Throat irritation and hoarseness
  • Headache or migraine
  • Rapid heartbeat or palpitations
  • Nervousness or agitation
  • Muscle and joint pain
  • Stomach discomfort and nausea
  • Possible urinary tract infections due to increased urination
  • Difficulty sleeping (insomnia)
  • Potential vision disturbances like blurred vision.

If any of these symptoms persist, it's essential to consult your healthcare provider for advice.

Are there any potential serious side effects for Symbicort?

While Symbicort is generally considered safe, it can cause serious side effects in rare cases. These include:

  • Signs of an allergic reaction: hives, itching, rash; difficulty breathing; swelling of the face, lips, tongue or throat
  • White patches inside your mouth or on your lips (signs of oral thrush)
  • Blurred vision and/or eye pain
  • Chest pain and rapid heart rate
  • Tremors or nervousness
  • Low potassium level symptoms such as leg cramps, constipation, irregular heartbeats

If you experience any of these symptoms while using Symbicort, seek medical attention immediately. It's important to remember that while this list includes some potential side effects it does not encompass all possible scenarios. Always consult with a healthcare provider for personalized advice.

Contraindications for Spiriva and Symbicort?

Both Spiriva and Symbicort are medications used in the management of chronic obstructive pulmonary disease (COPD) and asthma. If you notice your respiratory symptoms worsening, or experience severe side effects such as chest pain, rapid heartbeat, tremors, or increased blood pressure, please seek immediate medical attention.

Neither Spiriva nor Symbicort should be taken if you have a severe allergy to milk proteins or any other components of these drugs. Always inform your physician about any allergies that you have; reactions can range from rashes and itching to severe breathing problems.

Spiriva is not recommended for use in children under 6 years old whereas Symbicort is not typically used for children under 12 years old. These medications may interact with others including antifungal drugs and certain antidepressants so always ensure your doctor knows all the medicines you are currently taking.

In case of an overdose on either of these medications which might result in blurred vision, nausea or vomiting contact immediately a health care professional.

It's important to remember that people with certain conditions such as narrow-angle glaucoma, enlarged prostate gland and bladder obstruction need to consult their healthcare provider before initiating therapy with either Spiriva or Symbicort due to potential worsening of these conditions.

How much do Spiriva and Symbicort cost?

For the brand name versions of these drugs:

  • The price for one inhaler of Spiriva (18 mcg) averages around $450, which works out to approximately $15/day considering that each inhaler lasts about a month.
  • The price for one inhaler of Symbicort (160/4.5 mcg) is roughly $350 on average. Since each canister provides 120 doses and typical dosages are twice daily, this amounts to an approximate cost of $6/day.

Therefore, if you're using both medications as directed, then brand-name Symbicort is less expensive on a per-day treatment basis than Spiriva. However, it's important to note that cost should not be your primary consideration in determining which medication is right for you – effectiveness and side effects should also play a crucial role.

As for generic versions: Currently, there isn't a generic version available in the United States for either Spiriva (tiotropium bromide) or Symbicort (budesonide/formoterol). Therefore costs remain relatively high compared with many other maintenance treatments used in respiratory disease management.

Popularity of Spiriva and Symbicort

Tiotropium, which is also available under the brand name Spiriva, was estimated to have been prescribed to about 3.4 million people in the United States in 2020. Tiotropium accounted for approximately 30% of long-acting anticholinergic prescriptions in the US and has been steadily increasing in prevalence since its approval.

Budesonide/formoterol, including brand versions such as Symbicort, was prescribed to around 2.5 million people in the USA during that same period. In terms of combination inhaler prescriptions, budesonide/formoterol makes up around a quarter of all filled scripts and accounts for nearly half of all dual bronchodilator prescriptions. The use of this medication has remained pretty steady within the past decade.


Both Spiriva (tiotropium) and Symbicort (budesonide/formoterol) have a well-established history of use in managing chronic obstructive pulmonary disease (COPD) and asthma, with extensive clinical research demonstrating their effectiveness over placebo treatments. While both medications can be used concurrently, it's crucial that this is under the guidance of a healthcare professional due to potential interactions between them. Their differing mechanisms of action mean they're often prescribed for different scenarios: Spiriva is an anticholinergic bronchodilator that helps keep airways open by relaxing muscles in the lungs, while Symbicort combines two medicines - budesonide, an anti-inflammatory corticosteroid, and formoterol, a long-acting beta2-adrenergic agonist bronchodilator.

Generic versions are available for both drugs which can offer significant cost savings particularly for patients paying out-of-pocket. Both Spiriva and Symbicort may take some time before their effects become noticeable.

Similar side effect profiles exist between these two medications; however there are differences. Both are generally well-tolerated but instances of dry mouth or throat irritation might be more common with Spiriva whereas increased heart rate could occur more frequently with Symbicort due to its beta2-adrenergic agonist component. As always when starting treatment like these respiratory medications, patients should carefully monitor any changes especially worsening symptoms or breathing difficulties and contact their healthcare provider immediately if such concerns arise.