Synbicort / spiriva: insomnia and tachycardia

[NorthernKitten]

Hi all,

Following my latest hospitalisation, I’ve had a full drug overview. To get rid of the stupidly high dose of seretide I was one, the respo nurses moved me over onto seretide (2x 2 puffs, an and pm) plus spiriva respinat (2 puffs, am), plus retaining my montelukast. The eventual goal is to drop to as low as possible on the symbicort, with or without the additional spiriva / Monte depending on how things are.

My pred has now finished, but the last couple of nights have been horrendous. It’s taken hours to sleep, and when I do I wake up not long after. My heart starts thundering within seconds of taking the symbicort, which isn’t concerning, but doesn’t help restless sleep!!

Anyone else get this? I have a GP review booked for 2 weeks time, and a hospital review in Jan. i was wondering about either dropping to 2 in the morning and 1 in the evening, or even 2 morning, 1 lunch and 1 earlier in the evening, so the effects are earlier. Reluctant to drop down, as peak flows are definitely heading in the right direction.

[twinkly29]

So you were on seretide and now on symbicort?

If so it may be worth discussing the tachycardia with the nurse as presumably you didn't have that on seretide, which is a different steroid and also a different long-acting bronchodilator (LABA) to symbicort. The pred you have just had will probably increase your HR a bit but if it's happening after taking the symbicort it's more likely to be that I would have thought.

The insomnia I would guess was the pred tablets though.

[NorthernKitten in reply to twinkly29]

Yes, was on seretide 250 (3x2) so they changed to symbicort 400/12 (2x2).

Hadn’t connected pred and insomnia until another post - but would it make sense that the insomnia started on day 5, when the pred stopped?

Thanks for the response

[twinkly29 in reply to NorthernKitten]

Not sure.....but my body does weird things so a delay wouldn't surprise me! It takes 48 hours at least for any steroids to kick in for me so 5 days would be mid course in terms of effectiveness so maybe? Sorry that's not helpful really.

EmmaF91 might know though..... Or Lysistrata or Js706

[Lysistrata Administrator Community Ambassador in reply to twinkly29]

Not sure I can say anything useful about the predsomnia!

But I did get a lot of palpitations and shakiness on high dose Symbicort. I'm on Fostair Nexthaler now and it definitely seems reduced - but then I think my dose is lower. I can see how it might affect sleep.

You could ask if there's an alternative you could take perhaps? I was ok with Symbicort but it is a relief not to have the palpitations like that.

[mylungshateme]

Prednisolone insomnia 🤦‍♀️🤦‍♀️😱😱 also I had awful tachycardia with spiriva didn't realise was that until stopped. But not everyone on spiriva has this, different meds work differently on people.

[Poobah]

I would try staggering the 4 doses of Symbicort over the day so that you're spreading the side effect of the Formoterol. Seretide has a different long acting bronchodilator that works slower than Formoterol, hence the side effects you're experiencing.Spriva can affect the potassium levels so if you can, check you blood pressure now and again in 2 or 3 months, just to make sure it's not affecting your BP. There are other LAMA inhalers if it doesn't suit you. My asthma nurse took my BP before prescribing Spiriva so I had a baseline to work from when I checked my BP later.

I take my evening dose of inhalers by 8pm as they affect my ability to drop off to sleep if I take them too close to bedtime. Same goes for Montelukast.

[NorthernKitten in reply to Poobah]

I took it at 7 last night (figuring that was 12h since the morning dose) and had the best night’s sleep I’ve had in months - don’t know if sheer exhaustion; pred wearing off; or earlier meds, but I’ll stick with it and see

[Sunflower36]

I can relate. The sleeplessness must have been frustrating but taking the dose earlier definitely helps. I have tachycardia with or without taking an inhaler so was given Seretide. But sometimes to help with the racing heart I take my meds early.

[wiserlady]

I used to ask the doctor for advice about all of these bits and pieces but now I advise myself. If I can tell that taking the dose I am on will give me some sort of nasty side effect I lower it, that is more important to me than the spiro figures. Especially as it can take up to six months to ask their advice. And they are, after all, just guessing. Anyway I now insist on discussing it with my local doctor, if I need their input, that way I can speak to someone within days on the phone, rather than wait up to six months to be given an appointment to go to the hospital twenty miles away to ask the same question.