Why Combining Breo and Symbicort Is Dangerous
Breo Ellipta and Symbicort are both combination inhalers prescribed for the long-term maintenance treatment of asthma and chronic obstructive pulmonary disease (COPD). However, their active ingredients overlap, making it unsafe to use them simultaneously.
- Breo Ellipta contains the inhaled corticosteroid (ICS) fluticasone and the long-acting beta-agonist (LABA) vilanterol.
- Symbicort (or its generic, budesonide/formoterol) contains the ICS budesonide and the LABA formoterol.
Combining these two medications effectively doubles the dose of both a LABA and an ICS, which can lead to a dangerous overdose. Health guidelines and prescribing information explicitly warn against using Breo with other inhaled medicines containing a LABA. The maximum number of concurrently taken ICS medicines is usually limited to one.
The Risks of a Dangerous Double Dose
Doubling up on the ingredients in Breo and Symbicort can cause a range of serious adverse effects, from cardiovascular problems to systemic issues.
Cardiovascular Risks
Excessive amounts of LABAs, such as vilanterol and formoterol, can overstimulate the heart and nervous system.
- Increased heart rate and blood pressure: An overdose of these drugs can cause palpitations, tachycardia, and hypertension.
- Irregular heart rhythm: The potential for a serious, irregular heart rhythm is significantly increased, especially for individuals with a pre-existing heart condition.
- Hypokalemia: Both LABAs and corticosteroids can cause low potassium levels (hypokalemia), and combining them increases this risk. Severe hypokalemia can lead to dangerous heart arrhythmias.
Corticosteroid Overdose
Taking a double dose of inhaled corticosteroids (fluticasone and budesonide) can lead to an accumulation of steroids in the body, which can suppress the adrenal glands.
- Adrenal suppression: This can cause a range of symptoms, including fatigue, muscle weakness, and in severe cases, adrenal crisis.
- Hypercorticism: In rare cases, high cortisol levels can occur, with symptoms like weight gain in the midsection, a rounded face, and easy bruising.
- Increased infection risk: Inhaled corticosteroids can weaken the local immune response in the airways, and a double dose could further increase the risk of infections like oral thrush or pneumonia.
Breo vs. Symbicort: A Comparison
Your healthcare provider will determine which inhaler is right for you based on your specific condition, severity, and medical history. Here is a comparison of their key differences.
| Feature | Breo Ellipta (fluticasone/vilanterol) | Symbicort (budesonide/formoterol) |
|---|---|---|
| Active Ingredients | Fluticasone furoate (ICS) and Vilanterol (LABA) | Budesonide (ICS) and Formoterol fumarate (LABA) |
| Delivery Method | Dry powder inhaler (Ellipta) | Metered-dose inhaler (MDI) |
| Dosing Schedule | One puff once daily | Two puffs twice daily |
| FDA Approval for Children | FDA-approved for asthma in adults 18+ and children 5+ | FDA-approved for asthma in adults and children 6+ |
| Generic Availability | No generic currently available | A generic version is available |
| Key Difference | Once-daily dosing may improve adherence. | Long-established, twice-daily regimen. Generic option can be more affordable. |
What to Do Instead of Taking Both
If you find your current inhaler is not effectively controlling your symptoms, the solution is never to add another combination inhaler like Breo or Symbicort. Instead, you should:
- Consult Your Doctor: Before making any changes to your medication regimen, speak with your healthcare provider. They can assess your symptoms and determine if an adjustment is needed.
- Switch, Don't Combine: Your doctor may decide to switch you from one medication to the other to see which is more effective. This process must be carefully managed to avoid adverse effects.
- Consider Alternatives: For some patients with COPD that is not well-controlled by a single ICS/LABA, a triple therapy inhaler, such as Breztri or Trelegy, may be considered. These contain a third medication called a long-acting muscarinic antagonist (LAMA).
- Use Your Rescue Inhaler: Always have a short-acting beta-agonist (SABA), like albuterol, on hand for sudden breathing problems. Breo and Symbicort are not rescue inhalers and will not provide immediate relief.
Conclusion: Prioritizing Patient Safety
The fundamental principle of safe medication use for respiratory conditions is to avoid combining long-acting combination inhalers like Breo and Symbicort. Both medications already provide the two cornerstone therapies—an ICS to reduce inflammation and a LABA to relax airways—making it redundant and dangerous to double the dosage by using both. The severe risks, including dangerous cardiovascular effects and steroid overdose, far outweigh any perceived benefit. Always follow your doctor's instructions and never alter your medication plan without their guidance.
For more detailed medication information and potential interactions, you can also consult reliable sources like the NIH.
