Symbicort Turbuhaler

For asthma treatment, budesonide - formoterol can be used for maintenance therapy or for maintenance plus reliever therapy.

The starting dose of budesonide - formoterol is based on control of your symptoms. After asthma symptoms are controlled, your doctor will adjust your dose to the lowest regular dose that prevents asthma symptoms.

Symbicort Turbuhaler is inhaled into the lungs through the mouth, using the device that contains the medications (Turbuhaler®). Your health care professional should show you how to use the device. If you are not sure about how to use the device, contact your doctor or pharmacist for advice.

For maintenance therapy, the recommended dose for adults and adolescents over 12 years of age is 100 µg to 400 µg of budesonide, which is equivalent to 1 to 2 inhalations (or puffs) of Symbicort® 100 or Symbicort® 200, 1 or 2 times daily. If you need fast relief from asthma symptoms, use your fast-acting "reliever" (or "rescue") medication such as formoterol, terbutaline, or salbutamol. The maximum recommended daily maintenance dose is 4 inhalations. When asthma is worsening, the dose can temporarily be increased to a maximum of 4 inhalations twice daily.

With the higher-strength product, Symbicort® Forte, a 400 µg dose is achieved with 1 puff, which may be inhaled 1 or 2 times a day. The maximum daily dose of this product is 2 puffs (800 µg) inhaled twice daily.

For maintenance and reliever therapy, the recommended dose for adults and adolescents over 12 years of age is 1 to 2 inhalations 2 times daily or 2 inhalations once daily. If you need fast relief from asthma symptoms, use 1 additional inhalation as needed and repeat after a few minutes (to a maximum of 6 inhalations) if symptoms persist. The maximum recommended total daily dose is 8 inhalations. Symbicort® Forte should not be used as a reliever medication.

When used as COPD therapy, the recommended dose is 400 µg of budesonide (2 inhalations of Symbicort® 200 or 1 inhalation of Symbicort® Forte), inhaled 2 times daily. The maximum recommended daily dose is 800 µg of budesonide.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

When used regularly, Symbicort Turbuhaler can reduce the number and severity of episodes of difficulty breathing. Regular daily use is important for its effectiveness.

Budesonide - formoterol turbuhaler should be used regularly, even when you are not experiencing any symptoms.

It is important to use Symbicort Turbuhaler exactly as prescribed by your doctor. If you miss a dose, use it as soon as possible and then continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Symbicort Turbuhaler at room temperature with the cover on tight, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause an infection of the mouth or throat, known as thrush; it may cause headaches; it may cause hoarseness; it may cause palpitations (rapid and strong heart beat); it may irritate your throat; it may cause shakiness. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Symbicort 100 Turbuhaler
Each dry powder inhaler contains 100 µg of budesonide and 6 µg of formoterol fumarate dihydrate per dose. It also contains lactose, which acts as a "carrier." The amount added does not normally cause problems for lactose-intolerant people.

Symbicort 200 Turbuhaler
Each dry powder inhaler contains 200 µg of budesonide and 6 µg of formoterol fumarate dihydrate per dose. It also contains lactose, which acts as a "carrier." The amount added does not normally cause problems for lactose-intolerant people.

Symbicort Forte Turbuhaler
Each dry powder inhaler contains 400 µg of budesonide and 12 µg of formoterol fumarate dihydrate per dose. It also contains lactose, which acts as a "carrier." The amount added does not normally cause problems for lactose-intolerant people.

Do not use Symbicort Turbuhaler if you are allergic to budesonide, formoterol, or inhaled lactose.

There may be an interaction between budesonide - formoterol turbuhaler and any of the following:

• Aldesleukin
• Alfuzosin
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• Atomoxetine
• azole antifungals (e.g., ketoconazole, itraconazole, fluconazole, Voriconazole)
• beta-blockers, including eye drops (e.g., Carvedilol, Labetalol, Metoprolol, Propranolol, Timolol eye drops)
• Betahistine
• caffeine
• cannabinoid-containing medications (e.g., cannabis, Nabilone)
• Cobicistat
• decongestant cold medications (e.g., phenylephrine, Pseudoephedrine)
• decongestant eye drops and nose sprays (e.g., naphazoline, oxymetazoline, xylometazoline)
• Deferasirox
• Desmopressin
• dexmethylphenidate
• Disopyramide
• diuretics (e.g., Furosemide, Hydrochlorothiazide, Spironolactone)
• Dronedarone
• Epinephrine
• fast-acting bronchodilators (e.g., salbutamol, terbutaline)
• Hepatitis C antivirals (e.g., dasabuvir, ombitasvir, paritaprevir)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• hyaluronidase
• Levothyroxine
• Linezolid
• lithium
• long-acting bronchodilators (e.g., formoterol, salmeterol)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• Methadone
• Methylphenidate
• mifepristone
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, Phenelzine, Rasagiline, Selegiline, Tranylcypromine)
• Modafinil
• Primaquine
• procainamide
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, Norfloxacin)
• rilpivirine
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• Tamoxifen
• Theophylline (e.g., Aminophylline, Oxtriphylline, theophylline)
• Trazodone
• tricyclic antidepressants (e.g., Amitriptyline, Doxepin, Nortriptyline)
• tyrosine kinase inhibitors (e.g., Ceritinib, Idelalisib)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Symbicort Turbuhaler. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Symbicort Turbuhaler.

Asthma attacks: Symbicort Turbuhaler works by decreasing the frequency and severity of asthma attacks, and it can be used as a "reliever" medication. If you start developing asthma symptoms, be sure to use your "reliever" medication or an additional inhalation (or puff) of Symbicort Turbuhaler for rapid relief of your asthma symptoms. It is very important that you have your "reliever" medication available with you at all times, whether you're using Symbicort Turbuhaler or another rescue medication. If you persistently use more of your "reliever" medication, contact your doctor.

Budesonide - formoterol is not intended to be used before exercise to prevent difficulty breathing as a result of exercise.

Asthma-related deaths: Formoterol, as with other long-acting bronchodilators, may increase the risk of asthma-related deaths. It is not clear whether using corticosteroids, such as budesonide, reduces this risk. If you have concerns, speak with your doctor.

Bone health: Long-term use of inhaled corticosteroids has been associated with a decrease in bone density. This may lead to brittle bones or Osteoporosis. If you have risk factors for thinning or brittle bones, such as a slight build; long-term, regular alcohol use; poor nutrition; or a family history of osteoporosis, you may be at a greater risk of thinning bones. Discuss with your doctor how Symbicort Turbuhaler may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Symbicort Turbuhaler, and whether any special monitoring is needed.

Diabetes: Budesonide - formoterol may cause changes in blood sugar levels (may cause a loss of blood glucose control) and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using Symbicort Turbuhaler.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Symbicort Turbuhaler may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Symbicort Turbuhaler, and whether any special monitoring is needed.

Eye problems: Budesonide may increase the risk of developing cataracts or Glaucoma. If you are at risk of developing either of these conditions, have your eyes checked by your doctor before starting long-term treatment with Symbicort Turbuhaler. You should have your eyes monitored at regular intervals while using Symbicort Turbuhaler. Report any changes in vision to your doctor as soon as possible while you are taking Symbicort Turbuhaler.

Heart disease: If you have heart disease or high blood pressure, discuss with your doctor how Symbicort Turbuhaler may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Symbicort Turbuhaler, and whether any special monitoring is needed.

Infections: Thrush infections of the inside of the mouth and throat may occur with use of Symbicort Turbuhaler. If an infection develops, call your doctor. You can reduce the risk of infection by rinsing your mouth out with water after each dose and by practicing good oral hygiene. Also, tell your doctor if you are exposed to Chickenpox or Measles while using Symbicort Turbuhaler, as you may be more prone to infection.

People using budesonide - formoterol to treat COPD may be more likely to develop lung infections, such as pneumonia. If you experience new or worsening shortness of breath or cough, fever, or other symptoms of infection at any time while you are taking Symbicort Turbuhaler, contact your doctor as soon as possible.

Liver function: Liver disease or reduced liver function may cause Symbicort Turbuhaler to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Symbicort Turbuhaler may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Symbicort Turbuhaler, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Symbicort Turbuhaler.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Medical conditions: If you have Epilepsy or low blood potassium, discuss with your doctor how Symbicort Turbuhaler may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Symbicort Turbuhaler, and whether any special monitoring is needed.

Steroid medication use: If you have taken or are still taking steroid medication over the last several months, talk to your doctor before using Symbicort Turbuhaler. In times of stress or during a severe asthma attack, your doctor may want you to start your steroid medication again.

Stopping medication: Do not stop Symbicort Turbuhaler abruptly, as this may cause your condition to get worse. When Symbicort Turbuhaler is stopped, it should be stopped gradually as directed by your doctor.

Thyroid disease: If you have thyroid disease, discuss with your doctor how Symbicort Turbuhaler may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Symbicort Turbuhaler, and whether any special monitoring is needed.

Pregnancy: Symbicort Turbuhaler should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Symbicort Turbuhaler, contact your doctor immediately.

Breast-feeding: Budesonide passes into breast milk. It is not known if formoterol passes into breast milk. If you are a breast-feeding mother and are using Symbicort Turbuhaler, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of Symbicort Turbuhaler for the treatment of asthma have not been established for children younger than 12 years of age. Adolescents may experience slowing of growth while using Symbicort Turbuhaler. Your doctor will monitor for this. Talk to your doctor if you have any concerns.

Symbicort Turbuhaler should not be used to treat chronic bronchitis or emphysema for anyone younger than 18 years of age.

This product must be inhaled by mouth. Carefully follow the package's instructions. If needed, ask your pharmacist for additional information or for a demonstration. This medication is typically used twice a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your pharmacist first. Using this product may cause throat irritation and coughing. You can avoid these problems by thoroughly rinsing your mouth and gargling after each dose. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up.