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Can you take Trelegy and Symbicort together?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 21, 2020.

Official Answer

by Drugs.com

No, you should NOT take Trelegy and Symbicort together due to the risk of dangerous and possibly fatal side effects. Both of these medicines contain a long-acting beta-2 agonist (LABA) bronchodilator medicine used to help improve your breathing. Using LABA medicines together may lead to an overdose and an increased risk for high blood pressure or changes in your heart rate or heart rhythm.

  • Product labeling from the manufacturers states that these medications should not be used more often than recommended, at higher doses than recommended, or in conjunction with other therapies containing LABA, as an overdose may result.
  • Clinically significant cardiovascular (heart) effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs.
  • Patients using Trelegy or Symbicort should not use another therapy containing a LABA (e.g., salmeterol, formoterol fumarate, arformoterol tartrate, olodaterol, indacaterol, vilanterol) for any reason.

Tell your doctor if you have a history of high blood pressure, abnormal or irregular heart rate or rhythm, or other types of heart disease.

Talk to your doctor if you have any questions or concerns. Do not stop any medicines with first speaking to your doctor.

What are Trelegy and Symbicort?

Trelegy Ellipta and Symbicort are inhaled medicines approved for the maintenance treatment of asthma or chronic obstructive pulmonary disease (COPD). Both inhalers contain a long-acting beta-2 agonist (LABA), as well as other medications, to help with long-term breathing problems.

  • The LABA in Trelegy is vilanterol and the LABA in Symbicort is formoterol.
  • Trelegy also contains fluticasone, an inhaled corticosteroid, and umeclidinium, a long-acting inhaled anticholinergic bronchodilator in addition to the LABA (vilanterol).
  • Symbicort also contains budesonide, an inhaled corticosteroid in addition to the LABA (formoterol).

You should use either Trelegy or Symbicort if prescribed by your doctor, but not both. Use your medicine only as prescribed by your doctor.

Using vilanterol together with formoterol (or other LABAs) may increase cardiovascular side effects such as elevations in heart rate and blood pressure or irregular heart rhythm. These medicines should not be used together.

In addition, using vilanterol or formoterol (or other LABAs) alone for asthma treatment (without the addition of an inhaled corticosteroid) may increase the risk of death in people with asthma. This risk is a class effect for LABA therapy when used as a single treatment (monotherapy) in asthma. If you're taking a LABA without an inhaled corticosteroid for asthma, check with your doctor immediately.

If your doctor recommends a LABA and an inhaled corticosteroid for asthma, they will most likely prescribe a single inhaler that combines both a corticosteroid and a LABA for convenience. Examples of these products include:

  • Fluticasone and salmeterol (Advair Diskus, Wixela Inhub, others)
  • Budesonide and formoterol (Symbicort)
  • Mometasone and formoterol (Dulera)
  • Fluticasone and vilanterol (Breo Ellipta)

Children who need both a LABA and a corticosteroid should take them only as a combination medication in one inhaler.

Which common medicines contain long-acting beta-2 agonist (LABAs)?

The following list includes medicines contain LABAs alone or combined with other medicines such as orally inhaled corticosteroids or anticholinergic bronchodilators.

  • arformoterol (Brovana)
  • formoterol (Bevespi, Breztri, Duaklir, Dulera, Foradil, Perforomist, Symbicort)
  • indacaterol (Arcapta, Utibron - discontinued in US)
  • olodaterol (Striverdi Respimat, Stiolto Respimat)
  • salmeterol (Advair, AirDuo, Serevent, Wixela Inhub)
  • vilanterol (Anoro, Breo, Trelegy)

This may not be a full list of medicines that contain long-acting beta-2 agonist (LABA) bronchodilators. Other single or combination brand name products may exist; check with your doctor or pharmacist if you are not sure if your medicine contains a LABA.

Why can’t LABAs be used alone for asthma treatment?

For patients with asthma, LABAs should always be used with inhaled corticosteroids.

  • Inhaled corticosteroid medicines (for example, fluticasone or budesonide) help decrease inflammation in the lungs that can lead to breathing problems.
  • LABAs (for example, vilanterol or formoterol) help to relax the muscles around the airways to prevent symptoms such as wheezing, cough, chest tightness, and shortness of breath.
  • If LABAs they are used alone (without an orally inhaled corticsoteroid) it may increase the risk for asthma-related death.
  • In addition, LABAs as used alone (monotherapy) increase the risk of asthma-related hospitalization in pediatric and adolescent patients.

Talk to your doctor and view the FDA’s Boxed Warnings (for example: see the salmeterol warning) about the use of LABAs alone in asthma.

It is also important to tell your doctor and pharmacist about all of the medications you use, including prescription, over-the-counter (OTC), vitamins and herbal products.

Do not stop taking any medications without first talking to your doctor.

Can I use Trelegy or Symbicort as rescue inhalers?

No, Trelegy or Symbicort are NOT approved by the FDA to control sudden breathing problems like a bronchospasm or an asthma attack. You should use a rescue inhaler, such as albuterol (brand names: ProAir HFA, Proventil HFA, Ventolin HFA) or levalbuterol (brand name: Xopenex HFA) for sudden breathing problems.

If you do not have a rescue inhaler, speak with your doctor as soon as possible about getting a prescription. Seek emergency medical treatment or call 911 if your breathing problems get worse quickly.

Bottom Line

  • You should NOT take Trelegy and Symbicort together due to the risk of an excessive dose and dangerous heart side effects.
  • Both of these medicines contain a long-acting beta agonist (LABA) medicine to help open your airways for breathing. Excessive doses of LABA medicines may lead to dangerous heart side effects.
  • Take your medications exactly as prescribed by your doctor. Do not stop treatment without contacting your doctor first.

This is not all the information you need to know about Trelegy Ellipta and Symbicort for safe and effective use. Review the full Trelegy Ellipta and Symbicort information at these links, and discuss this information with your doctor or other health care provider.

References
  • FDA Drug Safety Communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta agonists (LABAs) used in combination with inhaled corticosteroids (ICS). FDA. Dec. 20, 2017. Accessed September 21, 2020 at https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-finds-no-significant-increase-risk-serious-asthma-outcomes
  • Trelegy Ellipta [Prescribing Information]. GlaxoSmithKline. Research Triangle Park, NC. Accessed Sept. 21, 2020 at  https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Trelegy/pdf/TRELEGY-ELLIPTA-PI-PIL-IFU.PDF
  • Symbicort [Prescribing Information]. July 2019. AstraZeneca Pharmaceuticals. Wilmington, DE. Accessed Sept. 21, 2020 at https://www.azpicentral.com/symbicort/symbicort.pdf#page=1
  • LABAs for asthma — Should I stop taking them? Mayo Clinic FAQs. Drugs.com. Accessed Sept. 21, 2020 at https://www.drugs.com/mcf/labas-for-asthma-should-i-stop-taking-them

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