Basic information: Symbicort inhaler is a prescription corticosteroid used for preventing asthma attacks and shortness of breath
- Brand Name: Symbicort
- Generic Name: budesonide / formoterol fumarate dihydrate
- Preparation: Inhalers: 160/4,5mcg
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Instruction for Symbicort Inhaler Usage
Symbicort Inhaler is combined medication of anti-inflammatory and bronchodilator action. It is used as inhalation for asthma treatment and prevention.
Pharmaceutical Form and Composition
Symbicort Inhaler online is produced in form of dosed powder for inhalation, consisting of almost white or almost white granules which have generally rounded form (dosage 80 / 4.5 and 160 mg / 4.5 mg – 60 or 120 dose inhalers in plastic “turbuhaler”, one inhaler in a cardboard package, dosage 320/9 mcg – 60 doses in a plastic inhaler “Symbicort”, one inhaler in a cardboard bundle).
Composition 1 Dose
- Active ingredients: micronized budesonide – 80 mcg, 160 mcg or 320 mcg, formoterol fumarate dihydrate – 4.5 micrograms (mcg budesonide 80 mcg and 160) or 9 mcg (320 mcg budesonide);
- Auxiliary components: lactose monohydrate.
Asthma is adequately controlled by inhaled β2-agonists and glucocorticosteroids (GCS) with long-acting effect, or inadequately controlled by inhaled β2-agonists and short-acting corticosteroids – as on demand treatment.
Symbicort Inhalers in a dosage of 80 / 4.5 mcg and 160 / 4.5 mcg can be used for rapid relief of asthma symptoms as well as maintenance therapy.
Chronic obstructive pulmonary disease (COPD) – symptomatic treatment of disease’s severe forms with forced expiratory volume (FEV) is less than 1/2 of estimated calculated level, and regularly repeated exacerbations in history, if signs of disease persist despite treatment with long-acting bronchodilators.
- children younger than 6 years old;
- children age under 12 years (for the dosage form containing 320 mcg of budesonide formoterol 9 g);
- hypersensitivity to any drug component.
Relative (Symbicort Inhaler should be used with caution):
- active or inactive forms of tuberculosis;
- presence of viral, bacterial or fungal infections of respiratory system;
- severe hypertension;
- aneurysm of any localization;
- uncontrolled hypokalemia;
- idiopathic hypertrophic subaortic stenosis;
- lengthening of QT interval;
- severe heart failure;
- cardiac ischemia;
Dosage and Administration
The drug is not intended for initial mild asthma treatment of intermittent (episodic) and persistent flow. Dose is adjusted individually based on severity of disease. In cases where patient requires a combination of active ingredients doses other than those which are in Symbicort Inhalers, corticosteroids and/or β2-agonists are administered separately in different inhalers.
In bronchial asthma, there are two schemes of drug administration: use only as a constant maintenance therapy (for cupping additionally it is used short-acting β2-adrenoceptor agonist). Use as a maintenance therapy and cupping as a permanent and on-demand therapy, when symptoms develop.
It is prescribed for use as continuous maintenance treatment for adolescents from 12 to 17 years and adult patients from 18 years and older. It is appointed 1-2 inhalation drug twice a day (at a dose of 80 / 4.5 mcg, or 160 / 4.5 mcg ). If necessary, in patients over 18 years, dose can be increased to 4 inhalations twice a day. Children aged 6-11 years are appointed 1-2 inhalation at a dose of 80 / 4.5 mcg twice a day.
When reaching asthma symptoms control during treatment with Symbicort Inhaler online twice a day it is recommended to reduce dose to the lowest effective. If doctor decides that maintenance treatment should be carried out in combination with long-acting bronchodilators, you must start drug reception once a day. In such a case you are welcome to place an order and buy inhalers via Asthma Inhalers Online.
When used as maintenance therapy and cupping patient should always have Symbicort with in reach. Do not use drug for asthma treatment and seizures relief in children and adolescents up to 18 years.
The recommended dose for adults: 2 inhalations per day – one inhalation in the morning and one in the evening; or two inhalations in the morning or in the evening. For inhalation drug should be used at a dosage of 80 / 4.5 mcg, or 160 / 4.5 mcg. Some patients may have the demand to increase dose to 2 inhalations of Symbicort 160 / 4.5 mcg twice daily. When asthma attack symptoms are present one additional inhalation is prescribed, if symptoms increase for a few minutes another inhalation is appointed, but just for attack relief no more than 6 inhalations are carried out.
The maximum number of inhalations per day are usually not more than 8, but sometimes for a short time, it is possible to increase number of daily inhalations to 12. Patients who use more than 8 inhalations per day should contact physician to review therapy.
Symbicort Inhaler 320/9 micrograms at a dosage is prescribed only for patients older than 12 years, recommended dose – 1 inhalation twice a day (persons over 18 years of age can increase dose to 2 inhalations twice a day). By achieving control of symptoms dose should be reduced to minimum effective dose.
When COPD Symbicort is prescribed only for adult patients: 2 inhalations twice daily (the drug at a dose of 160 / 4.5 mcg) or 1 inhalation twice daily (drug at a dose of 320/9 micrograms). At elderly patients dose adjustment is not required.
Instructions for Use
Before the first inhalation Symbicort should be prepared for work. To do this, unscrew and remove the cap, and then hold the inhaler upright, turn dispenser until it stops first in one direction, and then also the way to another. This procedure should be performed twice. During dispenser rotation it can not hold for mouthpiece. The procedure for preparation for work is carried out once, it is not necessary to be repeated before each inhaler use.
For one dose inhalation patient should perform the following manipulations: unscrew and remove the cap, and then hold inhaler upright, turn dispenser until it stops first in one direction, and then also the way to another (a click is heard).
Exhale, insert mouthpiece into your mouth tightly around lips and breathe deeply through his mouth. Do not exhale, remove inhaler from mouth.
If time is required than one dose, repeat above steps. After inhalation close inhaler cap. To prevent development of oropharynx fungal infections after each inhalation it is recommended to rinse mouth with water.
- Respiratory system: often – pharynx mucous membrane and oral cavity candidiasis, hoarseness, cough, slight throat irritation; rarely – bronchospasm;
- Cardiovascular System: Frequent – palpitations; less often – tachycardia; rarely – beats, supraventricular tachycardia, atrial fibrillation; very rarely – fluctuations in blood pressure, angina pectoris;
- Central nervous system and sensory organs: often – headache; less often – dizziness, nausea, agitation, sleep disturbances, anxiety; very seldom – taste disturbance, behavioral disturbances (mainly in children), depression;
- Musculoskeletal system: often – tremor; less frequently – convulsions;
- Metabolism: rarely – hypokalemia; very rarely – effect of GCS system symptoms (including adrenal glands hypofunction, decreased bone mineral density, growth retardation in children, glaucoma and cataract), hyperglycemia; dermatological and allergic reactions: less often – bruises;
- Rarely – dermatitis, urticaria, pruritus, rash, angioedema, anaphylactic reactions.
- Systemic glucocorticosteroids action for inhalation application often is observed when high doses of drug are appointed over a long time. When applying β2-agonists blood glycerol, free fatty acids, insulin and ketone derivatives may be increased.
It is not recommended abrupt drug withdrawal. If treatment is no longer required, dose should be reduced gradually. Symbicort Inhaler in a dosage of 80 / 4.5 mg and 320/9 mg is not intended for severe asthma treatment.
Maintenance dose should be taken regularly, even in absence of symptoms. Symbicort Turbuhaler is not recommended during bronchial asthma exacerbation or significant deterioration. During treatment you should monitor glucose concentration in people with diabetes.
In a single dose formulation contains less than 1 mg of lactose that is not critical for patients with lactose intolerance. Symbicort does not affect ability to drive a motor vehicle or other transport means and do work associated with high concentration of attention.
However, it should take into account some of drug’s side effects (eg, dizziness) and to use caution in their development.
Drug appointment with ketoconazole or other potent CYP3A4 inhibitors should be observed increase in interval between their methods as possible increase in plasma concentrations of budesonide. It is not recommended simultaneous application of β-blockers (including eye drops), because they can weaken formoterol effect.
When coadministered with disopyramide, phenothiazines, quinidine, procainamide, antihistamines, tricyclic antidepressants and monoamine oxidase inhibitors it is possibly lengthening QTc interval and increase in likelihood of ventricular arrhythmia. Oxytocin, levothyroxine, ethanol, levodopa can reduce heart muscle tolerance to β2-adrenoceptor agonists.
With simultaneous Symbicort usage with procarbazine, furazolidone, and monoamine oxidase inhibitors may increase:
- blood pressure;
- with xanthine derivatives, diuretics, corticosteroids and mineral derivatives – hypokalemic effect of β2-agonists can be enhanced;
- with other β-adrenoceptor agonists – side effects of formoterol may be increased.
During general anesthesia with halogenated hydrocarbons in patients taking Symbicort, increases risk of arrhythmia. Budesonide does not interact with other drugs used to treat asthma.
Terms and Storage Conditions
Store at temperatures not exceeding 30 ° C out of reach of children. Expiratory period is 2 years.