Symbicort

What it is for

Symbicort Turbohaler is an inhaler for asthma. You use it every day, even when you feel well. That is how it keeps your symptoms from coming back.

It contains two medicines. Budesonide is a steroid that reduces and prevents swelling and inflammation in your lungs. Formoterol relaxes the muscles in your airways, so you can breathe more easily.

Next step: for people already using Symbicort for asthma - repeat supply only. Start our health questions when you order. Your inhaler is only sent once a prescriber has checked your answers.

• Contact your doctor straight away if your breathing is getting worse or you often wake at night with asthma. Do the same if your chest feels tight in the morning or for longer than usual. Keep using Symbicort. These can mean your asthma is not under control and you need different treatment now.

Which Symbicort Turbohaler do you use?

Symbicort Turbohaler comes in three strengths. Order the one you already use.

The numbers are the strength. 200/6 means 200 micrograms of budesonide and 6 micrograms of formoterol in each dose.

The Turbohaler 100/6 is licensed from age 6, and the 200/6 and 400/12 from age 12.

Is it right for you?

Do not use Symbicort if you:

• are allergic to budesonide or formoterol
• are allergic to any of the other ingredients - that is lactose, which contains small amounts of milk protein

Talk to our prescriber before you use it if you:

• have diabetes
• have a lung infection, or have had tuberculosis (TB)
• have high blood pressure, or have ever had a heart problem - such as an uneven heartbeat, a very fast pulse, narrowed arteries or heart failure
• have thyroid or adrenal gland problems
• have low potassium in your blood
• have severe liver problems
• are pregnant, planning a pregnancy or breastfeeding
• are going to have a general anaesthetic, for an operation or dental work

Lactose is a type of sugar. The small amount in the Turbohaler does not normally cause problems if you are lactose intolerant. But if a doctor has told you that you cannot digest some sugars, check with our prescriber first.

How it works

Budesonide is a corticosteroid, a type of steroid. It calms the swelling and inflammation inside your airways, which is what keeps symptoms coming back.

Formoterol is a long-acting bronchodilator, a medicine that opens up your airways. It starts to work within 1 to 3 minutes, and one dose lasts at least 12 hours. That quick start is why the 100/6 and 200/6 can be used as a reliever. Whether yours is depends on what your prescriber has set up.

How to use it

There are three ways Symbicort can be prescribed for asthma. Your pharmacist's label tells you which one is yours. Do not switch between them on your own.

1. Every day, with a separate reliever inhaler. You take a fixed dose of Symbicort each day. When you get symptoms, you use your other reliever inhaler, not Symbicort. Keep that reliever with you at all times.

2. Every day, and also as your reliever (maintenance and reliever therapy, sometimes called MART). Symbicort is your only asthma inhaler. You take a daily dose, and you also take extra inhalations when you get symptoms. Turbohaler 100/6 and 200/6 only. Never 400/12.

3. Only when you need it, for mild asthma (reliever-only use). You take Symbicort when you get symptoms, and have no daily dose. Turbohaler 200/6 only.

The doses below are the adult doses.

Turbohaler 100/6

If you use it every day, with a separate reliever:

• 1 or 2 inhalations twice a day. Your doctor may raise this to 4 inhalations twice a day.

If you use it every day and as your reliever (MART):

• 2 inhalations a day. Take 1 in the morning and 1 in the evening, or 2 in the morning, or 2 in the evening.
• When you get symptoms, take 1 inhalation and wait a few minutes. Still not better? Take another.
• Take no more than 6 inhalations at any one time.
• Never more than 12 inhalations in 24 hours.
• If you are regularly using 8 or more a day, see your doctor or nurse soon. Your treatment may need to change.
• Do not use this strength just before exercise to stop symptoms coming on. If you get symptoms while you exercise, use it as above.

Turbohaler 200/6

If you use it every day, with a separate reliever:

• 1 or 2 inhalations twice a day. Your doctor may raise this to 4 inhalations twice a day.

If you use it every day and as your reliever (MART):

• 2 inhalations a day: 1 in the morning and 1 in the evening, or 2 in the morning, or 2 in the evening. Your doctor may raise this to 2 inhalations twice a day.
• When you get symptoms, take 1 inhalation and wait a few minutes. Still not better? Take another.

If you use it only when you need it, for mild asthma (reliever-only use):

• You have no daily dose. When you get symptoms, take 1 inhalation and wait a few minutes. Still not better? Take another.

Limits for both reliever uses:

• No more than 6 inhalations at any one time.
• More than 8 inhalations a day is not normally needed. Your doctor may allow up to 12 a day for a short time.
• Never more than 12 inhalations in 24 hours.
• If you regularly need 8 or more a day, book to see your doctor or nurse.
• If your doctor agrees, you can also use it to prevent symptoms, for example before exercise or when you will be near something you are allergic to.

Turbohaler 400/12

This strength is a daily inhaler only. Always use a separate reliever when you get symptoms. Never use the 400/12 as your reliever.

• 1 inhalation twice a day. Your doctor may raise this to 2 inhalations twice a day.

If your asthma is well controlled, your doctor may cut your daily dose to once a day. Do not change or stop your dose without talking to your doctor or asthma nurse first.

• If Symbicort does not relieve your asthma symptoms, or they get worse even though you are using it, get medical advice urgently. Always keep the inhaler you use as your reliever with you.

Using the Turbohaler

Before you use a new Turbohaler for the first time:

1. Unscrew the cover and lift it off. You may hear a rattle.
2. Hold it upright, red grip at the bottom.
3. Turn the red grip as far as it goes one way, then as far as it goes back. You should hear a click.
4. Do this a second time. It is now ready.

Each time you take a dose:

1. Unscrew the cover and lift it off.
2. Hold the Turbohaler upright, red grip at the bottom. Do not hold the mouthpiece.
3. Load a dose: turn the grip fully one way, then fully back, until it clicks. Only load it when you are about to use it.
4. Hold it away from your mouth and breathe out gently. Never breathe out into the Turbohaler.
5. Put the mouthpiece between your teeth and close your lips. Breathe in as deeply and as hard as you can. Do not bite the mouthpiece.
6. Take it out of your mouth and breathe out gently.
7. For a second inhalation, repeat steps 2 to 6.
8. Screw the cover back on tightly.
9. After your morning or evening daily dose, rinse your mouth with water and spit it out.

The dose is very small, so you may not taste anything. If you followed the steps, you have taken it.

The window on the side counts down your doses. When you first see a red mark at its edge, about 20 doses are left. When the "0" on a red background reaches the middle of the window, start a new inhaler. The grip still clicks when it is empty, and the rattle you hear is a drying agent, not the medicine.

If you load it twice by mistake, you still only get one dose. Wipe the outside of the mouthpiece once a week with a dry tissue. Never use water on it.

If you forget a dose or take too much

Forgot a dose? Take it as soon as you remember. If your next dose is nearly due, skip the missed one. Never take a double dose.

Taken too much? You may get trembling, a headache or a fast heartbeat. Contact your doctor or pharmacist for advice.

Stopping, and steroid tablets

Do not stop using Symbicort suddenly. Talk to your doctor first - if you stop, your symptoms may come back or get worse.

If you take steroid tablets, your doctor may lower them. While they come down you may feel generally unwell, even as your chest gets better. You might get a stuffy or runny nose, weakness, joint or muscle pain, or a rash (eczema). Contact your doctor straight away if these bother you, or if you get a headache, tiredness, feeling sick or being sick.

During a time of stress, such as a chest infection or before an operation, your doctor may add steroid tablets for a while.

Other medicines

Tell our prescriber about every medicine you use, including eye drops and anything you buy without a prescription. Tell them especially if you take:

• Beta-blockers, such as atenolol or propranolol for blood pressure, or timolol eye drops for glaucoma. They can weaken the effect of formoterol.
• Some medicines for HIV or infections, such as ritonavir, ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin or telithromycin. They can raise the amount of budesonide in your body. If you take one of these, using Symbicort as your reliever as well is not recommended.
• Heart medicines, such as quinidine for a fast or uneven heartbeat, or digoxin for heart failure.
• Water tablets (diuretics), such as furosemide.
• Steroid tablets, such as prednisolone.
• Theophylline or aminophylline, and other airway-opening medicines such as salbutamol.
• Some antidepressants, such as amitriptyline or nefazodone, and MAOIs.
• Phenothiazines, such as chlorpromazine or prochlorperazine.
• Levodopa for Parkinson's disease, or levothyroxine for your thyroid.

Pregnancy and breastfeeding

If you are pregnant or planning to get pregnant, talk to your doctor before you use Symbicort. Only use it if your doctor tells you to. If you get pregnant while using it, do not stop - talk to your doctor straight away. If you are breastfeeding, talk to your doctor first.

Driving

Symbicort has no or very little effect on your ability to drive or use machines.

What it will not do

• The Turbohaler 400/12 is not a reliever. Do not use it to treat symptoms that come on suddenly.
• It does not replace your asthma reviews. Your doctor or nurse will keep checking your dose, aiming for the lowest one that controls your symptoms.
• We do not start you on Symbicort. If you have not used it before, talk to your GP or asthma nurse.

Looking for a reliever inhaler, or a steroid-only preventer? See our asthma range.