Symbicort includes Formoterol and Budesonide preparations, which have a different mechanism of action and show an additive effect on reducing the frequency of exacerbations of asthma.
Symbicort is produced by AstraZeneca.
Budesonide is a corticosteroid-type preparation for improving the permeability of respiratory tracts.
Its action is based on the relaxing effect on the smooth muscles of the airways.
Formoterol is a selective β2-adrenoreceptor agonist that, when inhaled, leads to a rapid and prolonged relaxation of the smooth muscles of the bronchi in patients with reversible airway obstruction.
Bronchodilating effect is dose-dependent, the drug begins to act for 1-3 min. The duration of action is not less than 12 hours after a single dose.
Clinical Efficacy And Safety
Clinical studies in adult patients have shown that the addition of formoterol to budesonide alleviates the symptoms of asthma, improves lung function and reduces the frequency of exacerbations.
The use of budesonide / formoterol for maintenance therapy and to alleviate symptoms provided a statistically and clinically significant reduction in the incidence of severe exacerbations of asthma when compared with other therapies. In studies with patients who required medical attention in connection with the presence of acute asthma symptoms, the use of budesonide / formoterol provided a quick and effective relief of bronchospasm symptoms similar to salbutamol and formoterol.
Inhaled formoterol is rapidly absorbed. The maximum plasma concentration is reached within 10 minutes after inhalation. In studies, the average distribution in the lungs of formoterol after inhalation through a powder inhaler ranged from 28 to 49% of the dose received. Systemic bioavailability is about 61% of the dose received.
Symbicort Turbuhaler is prescribed for adults and children aged 6 years for regular treatment of asthma in case of appropriate combination therapy.
Symbicort is prescribed for patients whose condition is not adequately controlled by inhaled corticosteroids and fast acting β2-adrenergic receptor agonists, if necessary, or for patients who are properly controlled by inhaled GCS and long-acting β2-adrenergic agonists.
Symbicort is not prescribed for initial treatment of asthma. Doses of Symbicort components are selected individually, and they must be adjusted in accordance with the severity of the disease. This should be taken into account not only at the beginning of the use of combined preparations, but also in the correction of the maintenance dose. If a combination of doses other than those in a combined inhaler is required, appropriate doses of β2-adrenergic agonists and / or corticosteroids in separate inhalers should be given.
The dose should be titrated to the minimum dose, which allows you to effectively control the symptoms of the disease. Patients should regularly undergo repeated examinations with a doctor who prescribes the drug, so that the dose of Symbicort remains optimal. After achieving a long-term control of symptoms with the minimum recommended dose, you should try to control symptoms only with the help of an inhaled GCS.
There are two options for using Symbicort.
- For maintenance therapy. Symbicort is used for regular maintenance therapy in combination with a separate fast acting bronchodilator, used as an emergency.
- For maintenance therapy and relief of symptoms. Symbicort is used for regular maintenance therapy, as well as if necessary - to relieve symptoms.
Use Symbicort for maintenance therapy
Patients should be advised to always carry a separate high-speed bronchodilator for use as an emergency.
Recommended doses: Adults (from 18 years old): 1-2 inhalations 2 times a day; for a dosage of 320 mcg / dose + 9 mcg / dose - 1 inhalation 2 times a day. Some patients may require up to 4 inhalations twice a day (for a dosage of 320 mcg / dose + 9 mcg / dose - up to 2 inhalations 2 times a day).
Adolescents (aged 12-17 years): 1-2 inhalations 2 times a day; for a dosage of 320 mcg / dose + 9 mcg / dose - 1 inhalation 2 times a day.
Children (aged 6 years): 2 inhalations 2 times a day. For use in children aged 6-11 years, there is a dosage form of 80 mg / dose + 4.5 μg / dose.
Usually after achieving control over the symptoms of the disease with the drug 2 times a day, the dose is titrated to the minimum effective dose, up to the application of Symbicort 1 time per day, in cases when, in the opinion of the doctor, the patient needs maintenance therapy in combination with a long-acting bronchodilator .
More frequent use of an additional high-speed bronchodilator indicates a worsening of the patient's condition and the need to review the treatment of asthma.
Use Symbicort For Maintenance Therapy And Relief Of Symptoms
Take a daily maintenance dose of Symbicort, and in addition to apply Symbicort in case of relief of symptoms. Patients should always be advised to have Symbicort along with them for immediate use.
Patients who often and in large quantities apply Symbicort inhalations, if necessary, should be carefully monitored regarding the development of dose-related adverse events.
Recommended doses. For maintenance therapy and symptom relief with Symbicort, dosage forms are used (160 μg / 4.5 μg / dose and 80 μg / 4.5 μg / dose). Adults (at the age of 18 years) the recommended maintenance dose is 2 inhalations per day - 1 inhalation in the morning and evening or 2 inhalations only in the morning or only in the evening. If necessary, use 1 additional inhalation for symptoms. If symptoms persist after a few minutes, additional inhalation should be given. In any particular case, do not use more than 6 inhalations.
Usually a total of not more than 8 inhalations are required per day; however, for a limited period, the total daily dose may be up to 12 inhalations. Patients who take more than 8 inhalations per day are strongly advised to consult a doctor. They need to undergo a second examination and review supportive therapy.
Children and adolescents under the age of 18: children and adolescents are not recommended to use Symbicort for maintenance therapy and relief of symptoms.
Since Symbicort contains budesonide and formoterol, there may be side effects that develop when using each of the compounds separately. Simultaneous use of both substances did not increase the incidence of adverse reactions. The most common adverse reactions are the pharmacologically expected effects of β2-adrenergic agonists, such as tremor and palpitation. They are usually weak and go through several days of treatment.
- Candidiasis of the mouth and throat
- Headache, tremor
- Increased heart rate
- Minor irritation in the throat, cough, hoarseness
Candidiasis of the oropharynx is the result of sedimentation of the drug in the oral cavity. It is recommended that the patient be instructed to rinse the mouth with water after each inhalation of a maintenance dose in order to minimize the risk of developing oral candidiasis.
If it is necessary to stop treatment it is recommended to gradually reduce the dose, rather than abruptly cancel therapy.
If, in the patient's opinion, treatment is ineffective, or if the maximum daily dose of Symbicort is exceeded, the patient should be strongly advised to consult a doctor
Patients should be reminded of the need to continue the supportive use of Symbicort in accordance with prescription, even in the absence of symptoms.
Symbicort Therapy should not be started during a period of exacerbation of asthma, acute manifestation or significant deterioration of its course.