Symbicort vs. Singulair

See how Symbicort and Singulair compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Symbicort is an inhaled steroid-LABA combination taken twice daily, while Singulair is a once-daily pill that blocks leukotrienes instead of using a steroid.

  • Symbicort carries a boxed warning for LABA-related asthma death risk, while Singulair carries a boxed warning for serious neuropsychiatric side effects.

  • Singulair also treats seasonal and perennial allergic rhinitis, and Symbicort is FDA-approved for COPD, so the right choice depends on the specific condition being managed.

Symbicort vs. Singulair Drug Summary

Symbicort

Symbicort combines an inhaled corticosteroid (budesonide) with a long-acting bronchodilator (formoterol) in one inhaler. It's FDA-approved for maintenance asthma treatment in patients 6 and older and for COPD. It's taken as two inhalations twice daily and is not meant for sudden asthma attacks.

Singulair

Singulair is a leukotriene receptor antagonist that blocks inflammatory chemicals involved in asthma and allergies. It's taken as a tablet, chewable, or packet of granules once daily for chronic asthma control, exercise-induced bronchoconstriction, and allergic rhinitis. It is not used to stop an asthma attack already in progress.

Symbicort vs. Singulair Side Effects

Symbicort

Most common
Headache (≥3%)
Nasopharyngitis (≥3%)
Upper respiratory tract infection (≥3%)
Pharyngolaryngeal pain (≥3%)

Singulair

Most common
Headache (≥5%)
Upper respiratory infection (≥5%)
Fever (≥5%)
Pharyngitis (≥5%)

Symbicort vs. Singulair Dosage

Symbicort

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 inh 80/4.5mcg twice/day At the start
Maximum dose 2 inh 160/4.5mcg twice/day If needed
Dose changes 1 increase As tolerated

Singulair

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 4 mg once daily At the start
Maximum dose 10 mg once daily If needed
Dose changes 2 increases As tolerated

Symbicort vs. Singulair Indications

Symbicort

Symbicort is approved for long-term control of asthma symptoms in people 6 and older, and for maintenance treatment of COPD, including chronic bronchitis and emphysema. It reduces both airway inflammation and airway constriction with regular twice-daily use. It doesn't replace a rescue inhaler for sudden symptoms.

  • Maintenance asthma treatment, ages 6+

  • Maintenance COPD treatment (chronic bronchitis/emphysema)

  • Reduces COPD exacerbations

  • Not for acute bronchospasm relief

Singulair

Singulair is approved for ongoing asthma control, preventing exercise-induced bronchoconstriction, and relieving seasonal and perennial allergic rhinitis symptoms. It works by blocking leukotrienes, chemicals that trigger airway inflammation and allergy symptoms. It is not intended to treat an asthma attack that has already started.

  • Chronic asthma prophylaxis and treatment

  • Prevents exercise-induced bronchoconstriction

  • Relieves seasonal allergic rhinitis symptoms

  • Relieves perennial allergic rhinitis symptoms

Symbicort vs. Singulair Pros and Cons

Symbicort

Symbicort pairs a steroid with a long-acting bronchodilator, giving it broader coverage for both asthma and COPD in a single device. It requires correct inhaler technique and carries a boxed warning tied to its LABA component. Coverage and preferred strength vary by plan and severity of disease.

Pros

  • Treats both asthma and COPD

  • Combines anti-inflammatory and bronchodilator action in one inhaler

  • Approved for asthma in children as young as 6

  • Two strengths allow dose escalation for COPD control

Cons

  • Boxed warning for LABA-related asthma death risk

  • Requires proper inhaler technique

  • Twice-daily dosing

  • Not usable for sudden asthma symptoms

Singulair

Singulair offers steroid-free daily control as a pill, chewable, or granule packet, which can suit people who prefer not to use an inhaler. It also covers allergic rhinitis, a use Symbicort does not have. Its boxed warning concerns neuropsychiatric effects rather than airway risks.

Pros

  • No inhaler technique required

  • Once-daily oral dosing

  • Also relieves seasonal and perennial allergic rhinitis

  • Chewable and granule forms available for young children

Cons

  • Boxed warning for suicidal thoughts and behavior

  • Not a steroid, so may be less effective for significant airway inflammation

  • Not approved for COPD

  • Risk of Churg-Strauss syndrome reported

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