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Key takeaways
Symbicort and Advair are both FDA-approved maintenance inhalers containing an inhaled corticosteroid and a long-acting beta agonist for treating asthma and COPD, but they differ in active ingredients and dosages.
Both medications are effective at preventing and controlling symptoms by reducing inflammation and improving airflow in the lungs.
Symbicort and Advair have similar side effects, including the risk of oral thrush (rinsing with water and spitting after using the inhaler can reduce this risk) and the possibility of severe reactions like paradoxical bronchospasm and anaphylaxis.
While Symbicort and Advair are usually covered by insurance and Medicare, their costs can vary, with available generic versions and discount programs potentially reducing expenses for patients.
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Symbicort and Advair are two brand-name medications used to treat asthma and chronic obstructive pulmonary disease (COPD). Asthma and COPD are conditions that affect the lungs and cause inflammation in the airways. Symptoms of asthma and COPD include trouble breathing, wheezing, and cough.
Symbicort and Advair are maintenance inhalers that combine an inhaled corticosteroid (ICS) with a long-acting beta agonist (LABA). These inhalers are used daily to help control inflammation in the lungs and keep the airways open. They are not used as rescue inhalers for acute symptoms of asthma or COPD. Despite their similarities, Symbicort and Advair have some differences in active ingredients and recommended dosage.
What are the main differences between Symbicort and Advair?
Symbicort and Advair contain a corticosteroid, which has anti-inflammatory effects in the lungs. Symbicort contains the corticosteroid budesonide while Advair contains the corticosteroid fluticasone. Symbicort and Advair also contain a long-acting bronchodilator, which helps keep the airways open; Symbicort contains formoterol while Advair contains salmeterol.
Symbicort is used as a maintenance treatment for COPD, and it can be used to treat asthma in individuals aged 6 years and older. Advair is also used as a maintenance treatment for COPD, and it can be used to treat asthma in individuals aged 4 years and older. The typical dosage of Symbicort is two inhalations twice daily while the typical dosage of Advair is one inhalation twice daily.
Symbicort comes as an inhalation aerosol with a strength of either 80/4.5 mcg or 160/4.5 mcg of budesonide/formoterol. Advair is available as an inhalation aerosol and an inhalation powder, but the inhalation aerosol is only approved to treat asthma while the inhalation powder can treat both asthma and COPD. Advair HFA is a metered-dose inhaler that delivers an inhalation aerosol in strengths of 45/21 mcg, 115/21 mcg, or 230/21 mcg of fluticasone/salmeterol. Advair Diskus delivers an inhalation powder with a strength of 100/50 mcg, 250/50 mcg, or 500/50 mcg of fluticasone/salmeterol.
| Main differences between Symbicort and Advair | ||
|---|---|---|
| Symbicort | Advair | |
| Drug class | ICS (inhaled corticosteroid) and LABA (long-acting beta2-adrenergic agonist) | ICS (inhaled corticosteroid) and LABA (long-acting beta2-adrenergic agonist) |
| Brand/generic status | Brand and generic version available | Brand and generic version available |
| What is the generic name? | Budesonide and formoterol fumarate dihydrate | Fluticasone propionate and salmeterol |
| What form(s) does the drug come in? | Inhalation aerosol (metered-dose inhaler) | Inhalation aerosol (metered-dose inhaler) Inhalation powder (diskus) |
| What is the standard dosage? | Treatment of asthma in patients aged 12 years and older: 2 inhalations of Symbicort 80/4.5 or 160/4.5 twice daily
Treatment of asthma in patients aged 6 years old to less than 12 years old: 2 inhalations of Symbicort 80/4.5 twice daily Maintenance treatment of COPD: 2 inhalations of Symbicort 160/4.5 twice daily |
Advair Diskus Treatment of asthma in patients aged 12 years and older: 1 inhalation of Advair Diskus 100/50, 250/50, or 500/50 twice dailyTreatment of asthma in patients aged 4 years old to 11 years old: 1 inhalation of Advair Diskus 100/50 twice dailyMaintenance treatment of COPD: 1 inhalation of Advair Diskus 250/50 twice dailyAdvair HFA Treatment of asthma in patients aged 12 years and older: 2 inhalations of Advair HFA 45/21, 115/21, or 230/21 twice daily |
| How long is the typical treatment? | Long-term | Long-term |
| Who typically uses the medication? | Adults and children 6 years and older | Adults and children 4 years and older |
Conditions treated by Symbicort and Advair
Symbicort and Advair are both FDA-approved to treat asthma and COPD. However, Advair Diskus is approved to treat asthma and COPD while Advair HFA is only approved to treat asthma. Symbicort and Advair are used as maintenance treatment inhalers that are used daily to control and prevent COPD and asthma symptoms, such as shortness of breath and wheezing.
When used long-term, these medications can also help reduce the severity and frequency of COPD and asthma attacks, or exacerbations. For the immediate control of acute symptoms of COPD or asthma, a healthcare provider will prescribe a rescue inhaler like albuterol, which is also known by brand names like Ventolin and ProAir.
| Condition | Symbicort | Advair |
| Asthma | Yes | Yes |
| COPD | Yes | Yes |
Is Symbicort or Advair more effective?
Both Symbicort and Advair are effective inhalers when taken consistently. They both contain similar active ingredients that help reduce inflammation in the lungs and open up the airways. Talk to a healthcare provider to find the best inhaler that works for you.
According to a meta-analysis, an inhaler with both an inhaled corticosteroid and a long-acting bronchodilator is more effective for reducing COPD exacerbations than an inhaler containing only a long-acting bronchodilator. No head-to-head trials that directly compared the active ingredients in Symbicort and Advair were reviewed in the analysis. However, the study found that, in general, combination maintenance inhalers are similarly effective.
One randomized, double-blind clinical trial found that the active ingredients in Symbicort and Advair provide similar improvements in lung function, asthma control days, and asthma-related quality of life. Both medications also decreased the risk of hospitalizations or emergency-room visits caused by worsening of asthma symptoms. The study was conducted across 2,866 individuals aged 16 years and older.
Coverage and cost comparison of Symbicort vs. Advair
Symbicort is usually covered by most Medicare and insurance plans. It is also available as a generic medication, which may be cheaper than the brand-name version. The average retail price of Symbicort is around $550. You may be able to purchase Symbicort for approximately $250 with a savings program or discount card, like the SingleCare card.
Advair is also typically covered by Medicare and insurance plans. Like Symbicort, Advair comes in a generic form. Compared to Symbicort, the average retail price of Advair HFA may be higher at approximately $584. The average price of Advair Diskus is around $494. You can save on the cost of Advair HFA or Advair Diskus with a SingleCare coupon card at participating pharmacies.
| Symbicort | Advair | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare Part D? | Yes | Yes |
| Quantity | 1 inhaler | 1 inhaler |
| Typical Medicare copay | $19-$399 | $2-$425 |
| SingleCare cost | $248+ | $288+ |
Common side effects of Symbicort vs. Advair
Both Symbicort and Advair share similar side effects. Both medications can cause side effects like headache, nasopharyngitis, upper respiratory tract infections, bronchitis, and nasal congestion. Other side effects can include nausea, vomiting, hoarseness, and back pain.
The steroid component of Symbicort and Advair can increase the risk of oral thrush, or fungal infections in the mouth. For this reason, it is important to rinse the mouth with water after each use of the inhaler. A device called a spacer can also be attached to metered-dose inhalers to help reduce the risk of oral thrush.
Possible severe side effects of ICS/LABA medications include paradoxical bronchospasm and anaphylaxis. The cause of paradoxical bronchospasm is not clearly understood. However, it may occur as a sudden onset of wheezing, shortness of breath, and cough after using an inhaler medication. Anaphylaxis may occur due to an allergy to any ingredients in Symbicort or Advair. Seek immediate medical attention if you experience severe rash, swelling, or trouble breathing after using a combination inhaler.
| Symbicort | Advair | |||
| Side effect | Applicable? | Frequency | Applicable? | Frequency |
| Headache | Yes | 7% | Yes | 12% |
| Nasopharyngitis | Yes | 11% | Yes | * |
| Upper respiratory tract infection | Yes | 8% | Yes | 27% |
| Bronchitis | Yes | 5% | Yes | 2% |
| Nasal congestion | Yes | 3% | Yes | * |
| Oral thrush | Yes | 1% | Yes | 1% |
| Nausea | Yes | * | Yes | 4% |
| Vomiting | Yes | 1% | Yes | 4% |
| Hoarseness | Yes | * | Yes | 5% |
| Back pain | Yes | 3% | Yes | * |
*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Symbicort), DailyMed (Advair)
Drug interactions of Symbicort vs. Advair
Caution is advised when using Symbicort or Advair with medications that are CYP3A4 inhibitors, such as ritonavir, ketoconazole, and clarithromycin. Taking a CYP3A4 inhibitor with Symbicort or Advair may cause increased blood levels of the corticosteroid component, which can lead to adverse effects.
Using monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants with Symbicort or Advair may increase the cardiovascular effects of the beta-agonist component in either medication. On the other hand, beta blockers may decrease the effects of the beta-agonist in the lungs. Diuretics may cause electrocardiographic changes or low potassium levels (hypokalemia) when used with Symbicort or Advair.
| Drug | Drug class | Symbicort | Advair |
| Ritonavir Atazanavir Ketoconazole Clarithromycin Indinavir Itraconazole Nefazodone Nelfinavir Saquinavir |
CYP3A4 inhibitors | Yes | Yes |
| Selegiline Rasagiline Phenelzine Isocarboxazid |
Monoamine oxidase inhibitors (MAOIs) | Yes | Yes |
| Amitriptyline Nortriptyline |
Tricyclic antidepressants | Yes | Yes |
| Metoprolol Atenolol Bisoprolol Nebivolol Propranolol |
Beta blockers | Yes | Yes |
| Furosemide Bumetanide Torsemide Chlorthalidone |
Diuretics | Yes | Yes |
Consult a healthcare professional for other possible drug interactions.
Warnings of Symbicort and Advair
Because they contain a corticosteroid, Symbicort and Advair may cause an increased risk of infections or decreased bone mineral density. However, compared to systemic corticosteroids, inhaled corticosteroids have a lower risk of these side effects. Adrenal suppression may also occur when using high doses of Symbicort or Advair.
Long-term use of Symbicort or Advair may increase the risk of glaucoma or cataracts. An eye specialist may need to be consulted if eye symptoms develop over time with the use of either of these medications.
The use of Symbicort or Advair should be monitored in patients with cardiovascular problems, central nervous system disorders, convulsive disorders, and diabetes. Talk to a healthcare provider for other possible warnings and precautions before using Symbicort or Advair.
Frequently asked questions about Symbicort vs. Advair
What is Symbicort?
Symbicort is a brand-name medication manufactured by AstraZeneca. It contains budesonide and formoterol, which help prevent and control symptoms of asthma and COPD. Symbicort is approved to treat asthma in patients aged 6 years and older. It is available as an inhalation aerosol that is used twice daily.
What is Advair?
Advair is a brand-name medication manufactured by GlaxoSmithKline. It contains fluticasone and salmeterol. Advair is FDA approved to prevent and control symptoms of COPD and asthma. It is approved to treat asthma in patients aged 4 years and older. Advair is available as an inhalation powder (Advair Diskus), which can treat asthma and COPD, and an inhalation aerosol (Advair HFA), which is approved to treat asthma. Both formulations are used twice daily.
Are Symbicort and Advair the same?
Symbicort and Advair are used to treat asthma and COPD. However, they contain different active ingredients. Symbicort contains budesonide and formoterol while Advair contains fluticasone and salmeterol. Symbicort can treat asthma in patients aged 6 years and older while Advair can treat asthma in patients aged 4 years and older. Advair is also available as an inhalation powder or aerosol while Symbicort is only available as an inhalation aerosol.
Is Symbicort or Advair better?
Both Symbicort and Advair are effective for treating COPD and asthma symptoms. Because they are maintenance medications, they should be used daily for maximum effectiveness. The best maintenance inhaler should be determined by considering factors such as potential side effects, dosage, and cost.
Can I use Symbicort or Advair while pregnant?
There is no sufficient research to suggest that Symbicort or Advair is safe or harmful during pregnancy. According to the Asthma and Allergy Foundation of America (AAFA), long-acting beta agonists are not recommended as first-line treatments for asthma in pregnant patients. Instead, a short-acting bronchodilator may be recommended instead. Consult a healthcare provider for medical advice on COPD and asthma treatment options while pregnant.
Can I use Symbicort or Advair with alcohol?
Alcohol is not known to interact with Symbicort or Advair. Chronic alcohol consumption may interfere with the immune system’s ability to fight off infections, which can develop as a result of worsening asthma or COPD. Talk to a healthcare provider about whether it is safe to drink alcohol while using Symbicort or Advair.
What inhaler is equivalent to Symbicort?
A generic version of Symbicort is available. The generic version, which contains budesonide and formoterol, is equivalent to Symbicort. The generic version may also be a cheaper alternative to the brand name inhaler. Similar inhalers to Symbicort include Advair (fluticasone/salmeterol), Dulera (mometasone/formoterol), and Breo (fluticasone/vilanterol). These inhalers may work similarly to Symbicort, but they are not considered equivalents of Symbicort.
What is the safest inhaler for COPD?
ICS/LABA combination inhalers are considered effective and safe for treating COPD. However, inhaled corticosteroids carry an increased risk of pneumonia in people with advanced COPD. LAMA/LABA combination inhalers are considered effective and safer than ICS/LABA combination inhalers for this reason. LAMA/LABA combination inhalers include Anoro (umeclidinium/vilanterol), Stiolto (tiotropium/olodaterol), and Bevespi (glycopyrrolate/formoterol).