Symbicort Online UK

Symbicort is a combination inhaler.

It contains two medicines: budesonide, an inhaled corticosteroid (ICS) that calms swelling in the airways, and formoterol, a long-acting beta-2 agonist (LABA) that opens the airways.

So one inhaler tackles two problems at once. It eases airway inflammation and relaxes tight airways.

What sets Symbicort apart from other ICS/LABA inhalers is that formoterol acts fast, within 1-3 minutes. So you can use it both as a daily preventer and as a reliever when you need quick help.

This way of using it is called MART (Maintenance And Reliever Therapy). NICE and BTS/SIGN guidelines recommend it at step 3 and above.

With MART, you use one Symbicort inhaler as your preventer and your reliever. So you may not need a separate short-acting beta-2 agonist (SABA).

Clinical trials (STAY, COMPASS, AHEAD) showed that MART cuts flare-ups better than a fixed-dose ICS/LABA used with a separate SABA reliever. Symbicort is licensed for asthma and COPD.

It comes in the Turbohaler dry powder device in several strengths.

Maintenance-only use: Inhale the prescribed number of doses twice daily. Take them in the morning and evening, 12 hours apart. Use a separate SABA reliever for sudden symptoms.

MART regimen (Symbicort 200/6 only): Take one inhalation twice daily as your regular dose. Take extra inhalations when you need symptom relief, up to a total of 8 inhalations per day.

To use the Turbohaler: twist the base to load a dose. Breathe out away from the inhaler. Then breathe in hard and deeply through the mouthpiece. Hold your breath for up to 10 seconds.

Rinse your mouth with water after each maintenance dose. This lowers the risk of oral candidiasis (a mouth fungal infection). Keep the Turbohaler dry and put the cap back after use.

The dose counter shows how many doses are left. Replace the device when the counter reaches 0.

Asthma maintenance therapy: Symbicort 100/6 or 200/6 - 1-2 inhalations twice daily. Symbicort 400/12 - 1 inhalation twice daily for severe asthma.

MART (Symbicort 200/6 only): 1 inhalation twice daily as your regular dose, plus 1 extra inhalation as needed for symptoms.

The maximum total daily dose is 8 inhalations (1,600 mcg budesonide/48 mcg formoterol).

COPD: Symbicort 200/6 or 400/12 - 2 inhalations twice daily.

Use the lowest maintenance dose that works for you. After 3 months of steady asthma control, your prescriber may consider lowering the dose.

You do not need a dose change for mild to moderate kidney or liver problems. Avoid strong CYP3A4 inhibitors (medicines that slow how your body clears budesonide) with high-dose budesonide.

These side effects are grouped by how often they happen, based on the SmPC (the official product information).

Common (≥1/100 to <1/10): Oral candidiasis (mouth thrush), headache, tremor (shaking), palpitations (a racing heartbeat), mild throat irritation, cough after inhaling, and a hoarse voice (dysphonia).

Uncommon (≥1/1,000 to <1/100): Fast heartbeat (tachycardia), muscle cramps, feeling agitated, restless or nervous, trouble sleeping, dizziness, nausea, bruising, and rash.

Rare (≥1/10,000 to <1/1,000): Paradoxical bronchospasm (the airways tighten instead of opening), adrenal suppression (the glands make less of their own steroid), slowed growth in children, and changes in behaviour such as anxiety, depression or aggression, especially in children.

Other rare effects are high blood sugar (hyperglycaemia), low blood potassium (hypokalaemia), an irregular heartbeat (atrial fibrillation), swelling under the skin (angioedema), cataracts, and glaucoma.

Rinsing your mouth lowers the chance of oral candidiasis. Tremor and palpitations from formoterol are usually mild and linked to the dose.

At high doses used for a long time, the steroid can affect the whole body.

In the MART regimen, Symbicort is not meant to be used as a reliever on its own. It works as both your preventer and your reliever.

If you need more than 6 extra MART inhalations in one day, or more than 4 extra inhalations a day on a regular basis, your asthma control needs an urgent review.

Do not take more than 8 inhalations in total per day with MART. If you are moving from oral corticosteroids (steroid tablets), you need a slow reduction and checks for adrenal insufficiency.

The MHRA advises patients on high-dose ICS to carry a steroid emergency card. Beta-blockers, including eye drops, can reduce how well formoterol opens the airways. Avoid them if you have asthma.

Check bone density in patients on high-dose ICS for a long time. Formoterol may cause a short-lived drop in blood potassium (hypokalaemia).

Take care if you also use medicines that lower potassium, such as diuretics (water tablets) or theophylline.

Do not use Symbicort if you are allergic to budesonide, formoterol, or lactose. The Turbohaler contains lactose, which may hold trace amounts of milk protein.

LABA on its own, without an ICS, must not be used for asthma. Symbicort should not be your first asthma treatment unless you have first tried an ICS on its own.