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Dosage considerations for asthma and COPD1

There are different dosing instructions according to indication and strength of inhaler. The SYMBICORT TURBUHALER dosage strengths in Canada include:

  • SYMBICORT 100 TURBUHALER: 100 µg budesonide and 6 µg formoterol fumarate dihydrate.
  • SYMBICORT 200 TURBUHALER: 200 µg budesonide and 6 µg formoterol fumarate dihydrate.
  • SYMBICORT FORTE TURBUHALER: 400 µg budesonide and 12 µg formoterol fumarate dihydrate.

Please see the Product Monograph for complete dosing and administration instructions.

Dosage for asthma1

The appropriate SYMBICORT TURBUHALER dosage for adults and adolescents should be selected on an individualized basis according to disease severity.

Mild persistent asthma

SYMBICORT TURBUHALER Anti-Inflammatory Reliever therapy

Dosing instructions for SYMBICORT TURBUHALER are as follows:

  • 1 inhalation of SYMBICORT 200 TURBUHALER should be taken as needed in response to symptoms. If symptoms persist, an additional inhalation should be taken.
  • No more than 6 inhalations should be taken on any single occasion.
  • The maximum recommended total daily dose is 8 inhalations.

Patients should be advised to always have their SYMBICORT TURBUHALER available for the rapid relief of symptoms. A persistent increase in the use of SYMBICORT TURBUHALER as needed indicates a deterioration of asthma control, and the patient’s condition should be re-evaluated to determine the appropriate treatment.

Moderate or severe asthma

SYMBICORT TURBUHALER Anti-Inflammatory Reliever plus Maintenance therapy

Dosing instructions for SYMBICORT TURBUHALER are as follows:

  • 1 or 2 inhalations of SYMBICORT 100 TURBUHALER should be taken twice daily or 2 inhalations once daily

OR

  • 1 or 2 inhalations of SYMBICORT 200 TURBUHALER should be taken twice daily or 2 inhalations once daily.
  • Additional doses can be used as needed to provide rapid symptom relief and improve asthma control as follows: 1 additional inhalation should be taken as needed in response to symptoms. If symptoms persist, an additional inhalation should be taken.
  • No more than 6 inhalations should be taken on any single occasion.
  • The maximum recommended total daily dose is 8 inhalations.

When control has been achieved, the SYMBICORT TURBUHALER dose should be titrated to the lowest dose at which effective control of symptoms is maintained. Patients should be advised to always have their SYMBICORT TURBUHALER available for the rapid relief of symptoms. A persistent increase in the use of SYMBICORT TURBUHALER as needed indicates a deterioration of asthma control, and the patient’s condition should be re-evaluated to determine the appropriate treatment.

Moderate or severe asthma

SYMBICORT TURBUHALER maintenance therapy

Dosing instructions for SYMBICORT TURBUHALER are as follows:

  • 1 or 2 inhalations of SYMBICORT 100 TURBUHALER* or SYMBICORT 200 TURBUHALER should be taken once or twice daily

OR

  • 1 inhalation of SYMBICORT FORTE TURBUHALER* should be taken once or twice daily.
  • The maximum recommended total daily maintenance dose is 4 inhalations.

When control has been achieved, the SYMBICORT TURBUHALER dose should be titrated to the lowest dose at which effective control of symptoms is maintained. Patients should be advised to always have their separate short-acting bronchodilator available for rapid relief of symptoms. During periods of worsening asthma, the dose may be temporarily increased up to a maximum of 4 inhalations of SYMBICORT 100 TURBUHALER or SYMBICORT 200 TURBUHALER twice daily or 2 inhalations of SYMBICORT FORTE TURBUHALER twice daily.

Missed doses for asthma patients

  • If a daily maintenance dose of SYMBICORT TURBUHALER is missed, it should be taken as soon as possible, and the patient should then resume their regular schedule.
  • A double dose of SYMBICORT TURBUHALER should not be taken to make up for daily maintenance doses that are missed.

Dosage for COPD1

SYMBICORT TURBUHALER dosing instructions are as follows:

  • 2 inhalations of SYMBICORT 200 TURBUHALER twice daily. The maximum recommended total daily dose is 4 inhalations.

OR

  • 1 inhalation of SYMBICORT FORTE TURBUHALER twice daily.The maximum recommended total daily dose is 2 inhalations.

SYMBICORT TURBUHALER should not be initiated to treat acute symptoms of COPD. For optimal benefit, patients should be instructed to take their daily maintenance dose of SYMBICORT TURBUHALER, even when asymptomatic.

Dosing precautions and considerations1

Use in special populations

  • Children icon

    SYMBICORT TURBUHALER is not currently recommended in children younger than 18 years of age for the treatment of COPD or younger than 12 years of age for the treatment of asthma.

  • Elderly icon

    There are no special dosage requirements for elderly patients.

  • Liver and kidney icon

    There are no data available for the use of SYMBICORT TURBUHALER in patients with hepatic or renal impairment.

    • As budesonide and formoterol are primarily eliminated via hepatic metabolism, an increased exposure can be expected in patients with severe liver disease.

Overdose1

There are no data available from clinical trials on overdose with SYMBICORT TURBUHALER.

  • No safety concerns were raised when a metered dose of 120 µg formoterol was administered during 3 hours in patients with acute bronchial obstruction and when given 3 times daily (total of 54 µg/day) for 3 days to stable asthmatics. An overdose of formoterol would likely lead to effects that are typical for beta2-adrenergic agonists (tremor, headache, palpitations, and tachycardia). Supportive and symptomatic treatment may be indicated.
  • Acute overdosage with budesonide, even in excessive doses, is not expected to be a clinical problem. When used chronically in excessive doses, systemic glucocorticosteroid effects, such as hypercorticism and adrenal suppression, may appear.

Administration in asthma and COPD1

SYMBICORT TURBUHALER is for oral inhalation only. Patients should be instructed on how to use the TURBUHALER correctly and ensure they are doing the following:

  • Breathe in forcefully and deeply through the mouthpiece.
  • Never breathe out through the mouthpiece.
  • Replace the cover of the SYMBICORT TURBUHALER after use.
  • Rinse their mouths out with water after inhaling the dose to prevent the occurrence of candidiasis.

Guidance for patient administration

Access the following tools to help inform your patients about administering their SYMBICORT TURBUHALER, including how to prepare a new inhaler and how to take a dose.

  • How to Use SYMBICORT TURBUHALER Guide thumbnail

    How to use SYMBICORT TURBUHALER Guide

    Download

  • How to Use SYMBICORT TURBUHALER Video thumbnail

    How to use SYMBICORT TURBUHALER Video

    Watch

  • How to Use SYMBICORT TURBUHALER Guide thumbnail

    How to use SYMBICORT TURBUHALER Guide

    Download

  • How to Use SYMBICORT TURBUHALER Video thumbnail

    How to use SYMBICORT TURBUHALER Video

    Watch

BID: twice daily; COPD: chronic obstructive pulmonary disease; PRN: as needed.

* SYMBICORT 100 TURBUHALER and SYMBICORT FORTE TURBUHALER should not be used as SYMBICORT Anti-Inflammatory Reliever therapy.

Reference:

  1. Symbicort® Turbuhaler® Product Monograph. AstraZeneca Canada Inc. February 8, 2021.
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