Experience with Singulair and Symbicort...

[Ironhyde]

Last week my doctor prescribed me Singulair and Symbicort for Exercise Induced Bronchospasms. Has anyone else used either or both of these medications? If so, did you notice a decrease in appetite or weight loss? Any other noticeable side effects you found undesirable? I've been on it for right at a week and I have lost about 5lbs with no changes in diet. I am also feeling less hungry during the day, especially after breakfast. I seem to get more hungry as the day goes, perhaps as the first dose of Symbicort is out of my system. I don't take the second dose until bedtime, so I obviously don't notice any changes in my eating habits or appetite.

I'm taking 320mcg Symbicort 2x/day and 10mg Singulair 1x/day. I appreciate any feedback.

 

[PublicEnemy]

Has anyone else used either or both of these medications? If so, did you notice a decrease in appetite or weight loss? Any other noticeable side effects you found undesirable?

Haven't used either of them. Although a quick look at their MoA's would explain some of the side effects you are experiencing. BTW I am not a doctor and this does not constitute medical advice. There. Disclaimer taken care of.

Anyways my educated guess would point to the Symbicort. Symbicort is a combination of budesonide, a glucocorticoid steroid, and formoterol, a long acting Beta2 Adrenergic receptor agonist.

The formoterol is the cause of this. Agonizing the Beta2 adrenergic receptor would result in smooth muscle relaxation, specifically the bronchi, which is what this is being prescribed for. But activation of the Beta2 adrenergic receptor would also result in other systemic side effects, which you are experiencing, specifically hunger suppression and increased lipolysis (fat loss). To put this into perspective, clenbuterol, as formoterol, are both long acting Beta2 adrenergic agonists. So they would exert similiar, but not always the same effects in the body. Which explains the appetite suppression and weight loss.

Honestly, wikipedia is the ****.

 

[punxweb]

I was on Symbicort and Advair for my asthma. All I can say is I will NEVER touch them again. When I went on Symbicort, I put on 30 lbs in 3 months and have been having hormonal issues ever since. I have adrenal fatigue, thyroid problems and low test after using these inhailers. I know I may be a special case, but I will never touch them again. I now use Serovent only as a long acting bronchodilator. It has worked out well.

 

[Ironhyde]

Haven't used either of them. Although a quick look at their MoA's would explain some of the side effects you are experiencing. BTW I am not a doctor and this does not constitute medical advice. There. Disclaimer taken care of.

Anyways my educated guess would point to the Symbicort. Symbicort is a combination of budesonide, a glucocorticoid steroid, and formoterol, a long acting Beta2 Adrenergic receptor agonist.

The formoterol is the cause of this. Agonizing the Beta2 adrenergic receptor would result in smooth muscle relaxation, specifically the bronchi, which is what this is being prescribed for. But activation of the Beta2 adrenergic receptor would also result in other systemic side effects, which you are experiencing, specifically hunger suppression and increased lipolysis (fat loss). To put this into perspective, clenbuterol, as formoterol, are both long acting Beta2 adrenergic agonists. So they would exert similiar, but not always the same effects in the body. Which explains the appetite suppression and weight loss.

Honestly, wikipedia is the ****.

Haha! Thanks for the info!

 

[Ironhyde]

I was on Symbicort and Advair for my asthma. All I can say is I will NEVER touch them again. When I went on Symbicort, I put on 30 lbs in 3 months and have been having hormonal issues ever since. I have adrenal fatigue, thyroid problems and low test after using these inhailers. I know I may be a special case, but I will never touch them again. I now use Serovent only as a long acting bronchodilator. It has worked out well.

Do you think your problems were more a result of the Symbicort or Advair, or both? Do you know if Serovent can be used to treat EIB?

 

[punxweb]

Iron, I could not really tell you. I started with Advair and then went to Symbicort. Both of them had me putting on weight. I have exercise induced asthma and allergy induced asthma symptoms. Since I have been on Serovent alone, I have only used my emergency inhalers when I am around things that I have severe allergies to.

 

[PublicEnemy]

Do you think your problems were more a result of the Symbicort or Advair, or both? Do you know if Serovent can be used to treat EIB?

IMO Serevent could be used to treat EIB. Probably preferable to Symbicort or Advair, which I'll get into in a second. The only active in Serevent is Salmeterol, which is also a long acting Beta2 Adrenergic Receptor. So its the same sub class of drugs as Clen, Formoterol (Symbicort), and Salmeterol (Advair).

When I went on Symbicort, I put on 30 lbs in 3 months and have been having hormonal issues ever since. I have adrenal fatigue, thyroid problems and low test after using these inhailers. I know I may be a special case, but I will never touch them again.

The interesting thing about Symbicort and Advair is that they are a combination of a long acting bronchidilator and a corticosteroid. The active in Symbicort being Budenoside and the active in Advair being Fluticasone propionate. Both of these are going to work synergistically (in terms of effects, not method of action) with the long acting bronchidilators to alleviate asmtha and allergy symptoms.

The problem with Corticosteroids is that with chronic use, you will experience suppression of endogenous corticosteroid production. Just like if you were running a cycle, natural Test production will slow and eventually cease because of the administration of an exogenous androgen. Prednisone is also an example of a corticosteroid, so if you are familiar with it then the side effects should sound familiar. It doesn't surprise me at all that you experienced such horrendous side effects after using for 3 months. Did your doc who prescribed this give you a tapering protocol before you stopped to help avoid withdrawals?

List of Possible sides associated with Corticosteroids (courtesy Wikipedia once again)
* immunosuppression
* hyperglycemia due to increased gluconeogenesis, insulin resistance, and impaired glucose tolerance ("steroid diabetes"); caution in those with diabetes mellitus
* increased skin fragility, easy bruising
* negative calcium balance due to reduced intestinal calcium absorption
* Steroid-induced osteoporosis: reduced bone density (osteoporosis, osteonecrosis, higher fracture risk, slower fracture repair)
* weight gain due to increased visceral and truncal fat deposition (central obesity) and appetite stimulation
* adrenal insufficiency (if used for long time and stopped suddenly without a taper)
* muscle breakdown (proteolysis), weakness; reduced muscle mass and repair
* expansion of malar fat pads and dilation of small blood vessels in skin
* anovulation, irregularity of menstrual periods
* growth failure, pubertal delay
* increased plasma amino acids, increased urea formation; negative nitrogen balance
* excitatory effect on central nervous system (euphoria, psychosis)
* glaucoma due to increased cranial pressure
* cataracts

Also something to research would be Cushing's Syndrome; which is an endocrine disorder marked by high levels of cortisol in the blood, in this relevant case caused by glucocorticoid administration.

Corticosteroids definitely have medical validity, but IMO have horrendous side effects on the body. In your case Ironhyde, I'd try to switch to just a long acting bronchidilator and see if that works. IMO there is no need to put corticosteroids in your body if you can get by without them.

 

[oufinny]

I have taken both and am not a doctor but I will tell you my experience and what my doc told me about Singulair. Symbicort works for a select few and is used in Europe as a rescue inhaler, why I have no clue; my opinion is it sucks donkey balls. Singulair is an allergy medication that is commonly given if allergies exacerbate your asthma. I took it for years and all I got were terrible nightmares. The drug company has done a great job of covering up the fact it is nearly as dangerous for that as Chantix... trust me, if you are one who has this side effects you won't be happy. I would demand they prove you have allergies as opposed to giving you a prescription you most likely don't need; i.e. get allergy shots that are specific to your region.

As for Advair, this is an excellent drug and I don't know anyone who has issues with it. It is two medications in one and has a very long half life so you are good all day with a morning/night dose schedule. Plus, there are three common dosages and a few new delivery methods (don't know specifics since I use the discus). I would seriously question the choice of Symbicort, it is new and the doctor is prescribing to line his pocket not because it is the best. Advair is fastly coming off patent and will be very inexpensive soon, hence all of the advertisements to get people on it before the high price runs out. BTW - it is not cheap so if you have bad/no insurance, sorry but you may be put off by the price.

 

[oufinny]

Do you think your problems were more a result of the Symbicort or Advair, or both? Do you know if Serovent can be used to treat EIB?

Serovent is the main ingredient in Advair... that and a long acting albuterol.

 

[oufinny]

The interesting thing about Symbicort and Advair is that they are a combination of a long acting bronchidilator and a corticosteroid. The active in Symbicort being Budenoside and the active in Advair being Fluticasone propionate. Both of these are going to work synergistically (in terms of effects, not method of action) with the long acting bronchidilators to alleviate asmtha and allergy symptoms.

The problem with Corticosteroids is that with chronic use, you will experience suppression of endogenous corticosteroid production. Just like if you were running a cycle, natural Test production will slow and eventually cease because of the administration of an exogenous androgen. Prednisone is also an example of a corticosteroid, so if you are familiar with it then the side effects should sound familiar. It doesn't surprise me at all that you experienced such horrendous side effects after using for 3 months. Did your doc who prescribed this give you a tapering protocol before you stopped to help avoid withdrawals?

List of Possible sides associated with Corticosteroids (courtesy Wikipedia once again)
* immunosuppression
* hyperglycemia due to increased gluconeogenesis, insulin resistance, and impaired glucose tolerance ("steroid diabetes"); caution in those with diabetes mellitus
* increased skin fragility, easy bruising
* negative calcium balance due to reduced intestinal calcium absorption
* Steroid-induced osteoporosis: reduced bone density (osteoporosis, osteonecrosis, higher fracture risk, slower fracture repair)
* weight gain due to increased visceral and truncal fat deposition (central obesity) and appetite stimulation
* adrenal insufficiency (if used for long time and stopped suddenly without a taper)
* muscle breakdown (proteolysis), weakness; reduced muscle mass and repair
* expansion of malar fat pads and dilation of small blood vessels in skin
* anovulation, irregularity of menstrual periods
* growth failure, pubertal delay
* increased plasma amino acids, increased urea formation; negative nitrogen balance
* excitatory effect on central nervous system (euphoria, psychosis)
* glaucoma due to increased cranial pressure
* cataracts

Also something to research would be Cushing's Syndrome; which is an endocrine disorder marked by high levels of cortisol in the blood, in this relevant case caused by glucocorticoid administration.

Corticosteroids definitely have medical validity, but IMO have horrendous side effects on the body. In your case Ironhyde, I'd try to switch to just a long acting bronchidilator and see if that works. IMO there is no need to put corticosteroids in your body if you can get by without them.

So based on this information, my natural test producing system is completely shut down now that I have taken Advair for ~15 years. I beg to differ. Granted, I do respond well to test boosters and there may be some suppression but based on this argument we we would all be estrogen loaded and have visible signs of it too.

 

[PublicEnemy]

Serovent is the main ingredient in Advair... that and a long acting albuterol.

Agreed, the bronchodilator in Serovent is the same as Advair. Salmeterol could be called in layman's terms a long acting albuterol, but the two compounds are different.

So based on this information, my natural test producing system is completely shut down now that I have taken Advair for ~15 years. I beg to differ. Granted, I do respond well to test boosters and there may be some suppression but based on this argument we we would all be estrogen loaded and have visible signs of it too.

I'm sorry if that poorly phrased as that was not what I was implying. I was trying to give the analogy that, just as exogenous androgen administration suppresses endogenous androgen production, exogenous corticosteroid administration suppresses endogenous corticosteroid production. I wasn't trying to say that taking any of these corticosteroid/long acting bronchodilator combinations would suppress natural test production, simply that they would suppress the body's own corticosteroid production.

I'm not an endocrinologist, so I have no authoritative answer, but from my own base of knowledge I wouldn't rule out the possibility that there could be some impact on sex hormone levels, as they both are steroids and the levels of both are mediated through the hypothalamus and pituitary gland. Although they differ on accounts of sex hormones also being mediated through the gonads and corticosteroids through the adrenals.

If it seems that I'm biased, its because my own and immediate family's experiences with corticosteroids haven't been the best.

 

[oufinny]

Agreed, the bronchodilator in Serovent is the same as Advair. Salmeterol could be called in layman's terms a long acting albuterol, but the two compounds are different.



I'm sorry if that poorly phrased as that was not what I was implying. I was trying to give the analogy that, just as exogenous androgen administration suppresses endogenous androgen production, exogenous corticosteroid administration suppresses endogenous corticosteroid production. I wasn't trying to say that taking any of these corticosteroid/long acting bronchodilator combinations would suppress natural test production, simply that they would suppress the body's own corticosteroid production.

I'm not an endocrinologist, so I have no authoritative answer, but from my own base of knowledge I wouldn't rule out the possibility that there could be some impact on sex hormone levels, as they both are steroids and the levels of both are mediated through the hypothalamus and pituitary gland. Although they differ on accounts of sex hormones also being mediated through the gonads and corticosteroids through the adrenals.

If it seems that I'm biased, its because my own and immediate family's experiences with corticosteroids haven't been the best.

I will share this with you, when I was 235 and out of shape my sexual prowess was lackluster. Diet, exercise and a focus on healthy fats did change that over a period of a year and I have no issues since that time. I will say that when I have sore joints, they stay that way for longer than most peoples, I assume it is related to long term steroid use from inhalers. Moreover, my dentist is going to make a fotune off of whitening my teeth sooner than later... one of the not so known side effects.

 

[PublicEnemy]

The FASEB Journal, Vol 5, 3047-3054, Copyright © 1991 by The Federation of American Societies for Experimental Biology

REVIEWS
Corticosteroids, receptors, and the organ-specific functions of 11 beta- hydroxysteroid dehydrogenase

C Monder
Population Council, Center for Biomedical Research, New York, New York 10021.

Reversible oxidation of the biologically active corticosteroids to the inactive 11-dehydrocorticosteroids is catalyzed by 11 beta- hydroxysteroid dehydrogenase (11 beta HSD). The properties of the enzyme based on clinical observations of individuals with defective 11 beta HSD expression, and laboratory studies of the properties and behavior of the enzyme, are consistent with separate 11 beta- dehydrogenase and 11-oxoreductase species. However, recombinant enzyme expressed in mammalian cells retain both activities, leading to the conclusion that 11 beta HSD is a unique, reversible enzyme. 11 beta HSD is present in most tissues, but its specific functions in most tissues are unknown. How the enzyme may mediate corticosteroid-receptor interaction is illustrated by studies using kidney, testis, and brain. In kidney, 11 beta HSD prevents glucocorticoids from competing inappropriately with aldosterone for mineralocorticoid receptor (MR). Lack of enzyme in humans due to natural causes or inhibition by pharmacological agents results in maximum activation of MR by glucocorticoids, leading to the clinical symptoms of apparent mineralocorticoid excess. Leydig cells of the testes synthesize testosterone, a process that is suppressed by events initiated by the binding of corticosteroid to glucocorticoid receptors (GR). Depletion of active steroid mediated by 11 beta HSD may initiate testosterone production at puberty and affect testosterone production during adult life, as for example during periods of stress. The heterogeneous distribution of MR and GR in the brain reflects the specific regional effects of glucocorticoids and mineralocorticoids on neural function. Colocalization of 11 beta HSD and corticosteroid receptors in brain may be important in controlling the specificity of corticosteroid interaction with GR and MR. The patterns of 11 beta HSD-steroid- receptor interaction illustrated with these three tissues may provide models applicable to other tissues in which corticosteroid receptors and 11 beta HSD coexist.

I'd like to have someone with authoritative experience comment on this, but this would lead me to believe that they would have an inhibitory effect on testosterone production.

Link: http://www.fasebj.org/cgi/content/abstract/5/15/3047

 

[PublicEnemy]

I will share this with you, when I was 235 and out of shape my sexual prowess was lackluster. Diet, exercise and a focus on healthy fats did change that over a period of a year and I have no issues since that time. I will say that when I have sore joints, they stay that way for longer than most peoples, I assume it is related to long term steroid use from inhalers. Moreover, my dentist is going to make a fotune off of whitening my teeth sooner than later... one of the not so known side effects.

I never knew that about their effect on teeth.... huh, learn something new everyday! Although now it does make sense to me, one of the marked side effects of these types of steroids are their effects on bone density.

The sore joints I can identify with. I came down with Bells Palsy September of 2008 and had to take a combination of Prednisone and Valtrex (Valaciclovir) for a couple of weeks to counteract the swelling and paralysis in my face. This made me absolutely hate Prednisone and corticosteroids in general. I was diagnosed with depression in Jan of 2009 but I've had it my whole life; couple that with the wild mood swings I'd get from Pred and I was one unhappy mother****er. Along with the whole plethora of other sides; achy joints, slower recovery, increased weight gain. It was a great way to start off my freshman year at the U.

 

[Flaw]

My Dr. recently prescribed me singulair for exercised induced asthma. He also prescribed me flovent inhalor. I started out taking singulair and the first couple days were fine. Within a day I noticed a difference. My heart rate dramatically dropped when I was doing cardio so this told me my lungs were working better. The second day was even better but as the days went on I became more and more fatigued. So fatigued I had all the classic symptoms of depression. My joints were hurting and I felt like I was cramping. My attitude changed cause of the tiredness. Very moody. I decided this probably isn't working for me but I wanted to see it's real effectiveness so I ran outside to see if my asthma would be effected as normally. Well my asthma kicked in hard and I felt like I was gonna pass out so it seemed to do nothing for outdoor use. Seemed to work well inside. In conclusion, it was making me sooo tired I couldn't even exercise to my potential and didn't even wanna exercise so what's the point in taking it? None. So I stopped after a week. Haven't gone to the inhalors yet, I'm still trying to figure out what I'm going to do. I've been messing with different things. I use bronkaid but I need something for the inflammation. I'm messing with higher dosage fish oil right now and I'm going to try some herbs and other supplements.