Spiriva vs. Symbicort

Spiriva HandiHaler (tiotropium bromide) and Symbicort (budesonide and formoterol fumarate dihydrate) are prescribed to prevent bronchospasm (narrowing of the airways in the lungs) in people with bronchitis, emphysema, or COPD (chronic obstructive pulmonary disease).

The medications are from different drug classes. Spiriva Inhalation Powder is an anticholinergic drug and Symbicort is a combination of a steroid and a long-acting bronchodilator.

Common side effects of Spiriva HandiHaler include:

• dry mouth,
• constipation,
• upset stomach,
• vomiting,
• cold symptoms (stuffy nose, sneezing, sore throat),
• nosebleed, or
• muscle pain.

• nausea,
• tiredness,
• flu-like symptoms (e.g., fever, chills, muscle/joint aches),
• cough,
• dizziness,
• headache,
• vision problems,
• diarrhea,
• constipation,
• joint or muscle pain, or
• injection site reactions (pain, redness, swelling).

Common side effects of Symbicort include:

• headache,
• throat irritation,
• nausea,
• vomiting,
• stomach upset,
• diarrhea,
• back pain,
• stuffy nose,
• muscle or joint pain, or
• changes in your voice.

Tell your doctor if you experience unlikely but serious side effects of Symbicort including:

• white patches on tongue or in mouth,
• signs of infection (such as fever, persistent sore throat),
• mental/mood changes (such as nervousness),
• trouble sleeping,
• vision problems (such as blurred vision),
• increased thirst or urination,
• muscle cramps, or
• shaking (tremors).

Spiriva Handihaler is a prescription medicine used each day (a maintenance medicine) to control symptoms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

Spiriva Handihaler helps make your lungs work better for 24 hours. Spiriva Handihaler relaxes your airways and helps keep them open. You may start to feel like it is easier to breathe on the first day, but it may take longer for you to feel the full effects of the medicine. Spiriva Handihaler works best and may help make it easier to breathe when you use it every day.

Spiriva Handihaler reduces the likelihood of flare-ups and worsening of COPD symptoms (COPD exacerbations). A COPD exacerbation is defined as an increase or new onset of more than one COPD symptom such as cough, mucus, shortness of breath, and wheezing that requires medicine beyond your rescue medicine.

Symbicort (budesonide and formoterol fumarate dihydrate) is a combination of a steroid and a long-acting bronchodilator used to prevent bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD).

Symbicort combines an inhaled corticosteroid medicine, budesonide and a LABA medicine, formoterol.

• Inhaled corticosteroids help to decrease inflammation in the lungs. Inflammation in the lungs can lead to breathing problems.
• LABA medicines are used in people with chronic obstructive pulmonary disease (COPD) and asthma. LABA medicines help the muscles around the airways in your lungs stay relaxed to prevent symptoms such as wheezing, cough, chest tightness, and shortness of breath. These symptoms can happen when the muscles around the airways tighten. This makes it hard to breathe. In severe cases, wheezing can stop your breathing and may lead to death if not treated right away.

Spiriva may interact with different drugs. Spiriva may interact with atropine, belladonna, cimetidine, clidinium, dicyclomine, glycopyrrolate, hyoscyamine, mepenzolate, methantheline, methscopolamine, propantheline, or scopolamine.

Symbicort may interact with antibiotics, antifungal medication, MAO inhibitor, antidepressants, beta-blockers, or diuretics (water pills). Tell your doctor all medications you are taking. During pregnancy, Symbicort should be used only when prescribed. Budesonide passes into breast milk. It is unknown if formoterol passes into breast milk. Consult your doctor before breastfeeding.

• Use Spiriva Handihaler exactly as prescribed. Use Spiriva Handihaler one time every day.
• Read the “Instructions for Use” at the end of this leaflet before you use Spiriva Handihaler. Talk with your doctor if you do not understand the instructions.
• Do not swallow SPIRIVA capsules.
• Only use SPIRIVA capsules with the HANDIHALER device.
• Do not use the HANDIHALER device to take any other medicine.
• Spiriva Handihaler comes as a powder in a SPIRIVA capsule that fits the HANDIHALER device. Each SPIRIVA capsule, containing only a small amount of SPIRIVA powder, is one full dose of medicine.
• Separate one blister from the blister card. Then take out one of the SPIRIVA capsules from the blister package right before you use it.
• After the capsule is pierced, take a complete dose of Spiriva Handihaler by breathing in the powder by mouth two times, using the HANDIHALER device (take 2 inhalations from one SPIRIVA capsule). See the “Instructions for Use” at the end of this leaflet.
• Throw away any SPIRIVA capsule that is not used right away after it is taken out of the blister package. Do not leave the SPIRIVA capsules open to air; they may not work as well.
• If you miss a dose, take it as soon as you remember. Do not use Spiriva Handihaler more than one time every 24 hours.
• If you use more than your prescribed dose of Spiriva Handihaler, call your doctor or a poison control center.

What should I avoid while using Spiriva Handihaler?

• Do not let the powder from the SPIRIVA capsule get into your eyes. Your vision may get blurry and the pupil in your eye may get larger (dilate). If this happens, call your doctor.
• Spiriva Handihaler can cause dizziness and blurred vision. Should you experience these symptoms you should use caution when engaging in activities such as driving a car or operating appliances or other machines.

• Use Symbicort exactly as prescribed. Do not use Symbicort more often than prescribed. Symbicort comes in 2 strengths. Your healthcare provider has prescribed the strength that is best for you. Note the differences between Symbicort and your other inhaled medications, including the differences in prescribed use and physical appearance.
• Children should use Symbicort with an adult's help, as instructed by the child's healthcare provider.
• Symbicort should be taken every day as 2 puffs in the morning and 2 puffs in the evening about 12 hours apart.
• If you miss a dose of Symbicort, you should take your next dose at the same time you normally do.
• Rinse your mouth with water and spit the water out after each dose (2 puffs) of Symbicort. Do not swallow the water. This will help to lessen the chance of getting a fungus infection (thrush) in the mouth and throat.
• If you take too much Symbicort, call your healthcare provider or go to the nearest hospital emergency room right away if you have any unusual symptoms, such as worsening shortness of breath, chest pain, increased heart rate, or shakiness.
• Do not spray Symbicort in your eyes. If you accidentally get Symbicort in your eyes, rinse your eyes with water, and if redness or irritation persists, consult your healthcare provider.
• Do not change or stop any medicines used to control or treat your breathing problems. Your healthcare provider will change your medicines as needed.
• While you are using Symbicort 2 times each day, do not use other medicines that contain a LABA for anyreason. Ask your healthcare provider or pharmacist if any of your other medicines are LABA medicines.
• Symbicort does not relieve sudden symptoms. Always have a rescue inhaler medicine with you to treat sudden symptoms. If you do not have a rescue inhaler, call your healthcare provider to have one prescribed for you.
• Call your healthcare provider or get medical care right away if:
• your breathing problems worsen with Symbicort.
• you need to use your rescue inhaler medicine more often than usual.
• your rescue inhaler medicine does not work as well for you at relieving symptoms.
• your peak flow meter results decrease. Your healthcare provider will tell you the numbers that are right for you.
• your symptoms do not improve after using Symbicort regularly for 1 week.

For patients 12 years of age and older, the dosage of Symbicort is 2 inhalations twice daily (morning and evening, approximately 12 hours apart).