Symbicort

Symbicort is a combination inhaler from AstraZeneca that contains two active ingredients: the inhaled corticosteroid budesonide and the long-acting bronchodilator formoterol.

Like Foster, Symbicort can be used within the MART concept both as maintenance therapy and as needed. The Turbuhaler is a dry powder inhaler that does not require coordination between releasing the puff and breathing in.

Symbicort is approved for asthma and COPD.

Symbicort works through two complementary mechanisms:

Budesonide (corticosteroid):

• Strong local anti-inflammatory effect
• Reduces airway inflammation
• Reduces mucosal swelling
• Lowers bronchial hyperresponsiveness

Formoterol (LABA):

• Rapid onset of action (1-3 minutes)
• Long-lasting bronchodilation (12 hours)
• Relaxes the bronchial muscles
• Improves lung function

Advantages of the combination:

• Better asthma control than with the individual active ingredients
• Fewer asthma exacerbations
• Suitable for MART thanks to the rapid onset of action of formoterol

Symbicort is suitable for:

• Adults and adolescents aged 12 years and older with asthma
• Children aged 6 to 11 years with asthma only with the 80/4.5 µg strength and not as MART
• When an inhaled corticosteroid alone is not sufficient
• As MART therapy
• COPD in adults

Particularly suitable for:

• Moderate to severe asthma
• Frequent asthma attacks on monotherapy
• The wish for one inhaler for everything (MART)

Not suitable:

• As the only treatment for an acute asthma attack
• For mild, only occasional asthma
• As a sole reliever without maintenance therapy

Symbicort Turbuhaler:

• 80/4.5 µg (budesonide/formoterol)
• 160/4.5 µg
• 320/9 µg

Symbicort Rapihaler (metered-dose inhaler):

• 80/4.5 µg
• 160/4.5 µg

Dosage for asthma:

• Maintenance therapy: 1-2 inhalations 2x daily
• MART (80/4.5 and 160/4.5 only, from 12 years of age): 1 inhalation 2x daily + as needed
• Maximum with MART: 6 inhalations per occasion and normally 8 inhalations/day, up to 12 inhalations/day for a limited period
• If you need more than 8 inhalations a day, you are strongly advised to seek medical advice

For COPD:

• 2 inhalations 2x daily

Turbuhaler: 1. Unscrew the protective cap 2. Hold the inhaler upright 3. Turn the grip first to the right, then to the left (click) 4. Breathe out deeply (not into the inhaler!) 5. Close your lips firmly around the mouthpiece 6. Breathe in forcefully and deeply 7. Hold your breath for 10 seconds 8. Rinse your mouth after inhalation

Important notes:

• Do not shake (dry powder inhaler)
• Store in a dry place
• Use regularly, even when you have no symptoms
• Always rinse your mouth (to prevent oral thrush)

Do not use in case of:

• Hypersensitivity to budesonide, formoterol or lactose

Use with caution in case of:

• Active pulmonary tuberculosis
• Fungal, viral or bacterial infections
• Severe cardiovascular diseases
• Hyperthyroidism
• Diabetes mellitus
• Hypokalemia
• Osteoporosis

Pregnancy: Only use if the benefit outweighs the possible risks. The lowest effective dose of budesonide needed to adequately control asthma symptoms should be used.

Common (1-10%):

• Oral thrush
• Hoarseness
• Headache
• Tremor
• Palpitations
• Cough

Uncommon:

• Muscle cramps
• Restlessness
• Nausea
• Sleep disturbances

Rare:

• Systemic corticosteroid effects (with long-term high-dose use)
• Paradoxical bronchospasm
• Behavioral changes

Prevention: Rinse your mouth and spit out after each inhalation.

Caution with:

• Beta blockers (including eye drops)
• QT-prolonging medications
• Strong CYP3A4 inhibitors (ketoconazole, ritonavir)
• Potassium-lowering medications

Not recommended:

• Concomitant use of other LABAs
• Non-selective beta blockers in asthma