Symbicort Rapihaler Dosage/Direction for Use

Asthma: Symbicort Rapihaler is not intended for the initial management of asthma. The dosage of the components of Symbicort Rapihaler is individual and should be adjusted to the severity of the disease. This should be considered not only when treatment with combination products is initiated but also when the maintenance dose is adjusted. If an individual patient should require a combination of doses other than those available in the combination inhaler, appropriate doses of β₂ adrenoceptor agonists and/or corticosteroids by individual inhalers should be prescribed.
When control has been achieved, the dose should be titrated to the lowest dose at which effective control of symptoms is maintained.
Symbicort maintenance therapy: Patients use Symbicort Rapihaler for a daily maintenance dose and use a separate rapid-acting bronchodilator for symptom relief. Patients should be advised to have this rapid-acting bronchodilator available at all times. (See Table 1.)

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Children under 6 years: Symbicort is not recommended for children under 6 years of age.
Patients should be regularly reassessed by a doctor, so that the dosage of Symbicort Rapihaler remains optimal. The dose should be titrated to the lowest dose at which effective control of symptoms is maintained. When control of symptoms is maintained with the lowest recommended dosage, then the next step could include a test of inhaled corticosteroid alone.
In usual practice when control of symptoms is achieved with the twice daily regimen, titration to the lowest effective dose could include Symbicort Rapihaler given once daily, when in the opinion of the prescriber, a long acting bronchodilator should be required to maintain control.
A separate inhaler for rescue use is required. Patients should be advised to have their rapid acting bronchodilator available at all times. Increasing use of rescue bronchodilators indicates a worsening of the underlying condition and warrants a reassessment of the asthma therapy.
COPD: See Table 2.

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General information: The patients should be instructed that Symbicort Rapihaler must be used even when asymptomatic for optimal benefit.
There are no special dosing requirements for elderly patients.
There are no data available for use of Symbicort 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 diseases.
Instructions for correct use of Symbicort Rapihaler: On actuation of Symbicort Rapihaler, a volume of the suspension is expelled from the canister at high velocity. When the patient inhales through the mouthpiece at the same time as actuating the inhaler, the substance will follow the inspired air into the airways.
Note: It is important to instruct the patient to: Carefully read the instructions for use in the monograph which is packed together with each inhaler.
Shake the inhaler gently prior to each use to mix its contents properly.
Prime the inhaler by actuating it twice into the air when the inhaler is new, has not been used for more than one week or if it has been dropped.
Place the mouthpiece in the mouth. While breathing in slowly and deeply, press the device firmly to release the medication. Continue to breathe in and hold the breath for approximately 10 seconds or as long as is comfortable.
Shake the inhaler again and repeat.
Rinse the mouth with water after inhaling the maintenance dose to minimise the risk of oropharyngeal thrush.
Clean the mouthpiece of the inhaler regularly, at least once a week with a clean dry cloth.
Do not put the inhaler into water.
For instructions on the correct use of Symbicort with Spacer Device to enable patients with difficulty in coordinating inhalation with actuation, such as young children or the elderly, see Instructions for use, handling and disposal under Cautions for Usage.