Symbicort
In this article, you can read the instructions for using the drug Symbicort. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Symbicort in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Symbicort with available structural analogues. Use for the treatment of bronchial asthma and chronic obstructive pulmonary disease (COPD) in adults, children, as well as in pregnancy and lactation. Composition of the preparation.
Symbicort - A combined preparation for the treatment of bronchial asthma. Contains formoterol and budesonide, which have different mechanisms of action and show an additive effect in reducing the frequency of exacerbations of bronchial asthma.The special properties of Budesonide and formoterol make it possible to use their combination at the same time as maintenance therapy and for relief of seizures, or as a supporting therapy for bronchial asthma.
Budesonide - glucocorticosteroid (GCS), after inhalation has a rapid (for several hours) and a dose-dependent anti-inflammatory effect on the respiratory tract, reducing the severity of symptoms and the frequency of exacerbations of bronchial asthma. With the appointment of budesonide in the form of inhalations, there is a lower incidence of serious adverse effects than with systemic GCS. Reduces the severity of edema of the bronchial mucosa, mucus production, sputum formation and airway hyperreactivity. The exact mechanism of anti-inflammatory action of GCS is unknown.
Formoterol is a selective beta2-adrenergic receptor agonist. After inhalation causes a rapid and prolonged relaxation of the smooth muscles of the bronchi in patients with reversible airway obstruction. Broncholytic action is dose-dependent, occurs within 1-3 min after inhalation and remains for at least 12 h after taking a single dose.
Symbicort Turbuhaler: budesonide + formoterol
Bronchial asthma
Clinical efficacy of Symbicort as maintenance therapy
With the combined use of formoterol and budesonide, the symptoms of bronchial asthma decrease, lung function improves and the frequency of exacerbations of the disease decreases.
The action of Symbicort Turbuhaler on lung function corresponds to the action of a combination of mono preparations of budesonide and formoterol and exceeds the action of one budesonide. In all cases, beta2-adrenostimulator of short action was used to stop seizures. There was no decrease in the anti-asthmatic effect over time. The drug is characterized by good tolerability.
On the background of receiving Symbicort Turbuhaler as maintenance therapy for 12 weeks in children aged 6 to 11 years (two inhalations of 80 / 4.5 μg / inhalation twice a day) lung function improved and a good tolerance of the drug was noted, compared with corresponding dose of Budesonide Turbuhaler.
Clinical efficacy of Symbicort as maintenance therapy and for relief of attacks
In a follow-up of 4,447 patients treated with Symbicort as maintenance therapy and to relieve seizures for 6 to 12 months, there was a statistically and clinically significant decrease in the number of severe exacerbations, an increase in the period before the onset of the first exacerbation compared with a combination of Symbicort or budesonide as maintenance therapy and beta2-adrenostimulator for relief of attacks. There was also effective control over the symptoms of the disease, pulmonary function and a reduction in the frequency of administration of inhalations for relief of attacks. There was no development of tolerance to prescribed therapy. In patients who have applied for medical help in connection with the development of an acute attack of bronchial asthma, after the inhalation of Symbicort, the relief of symptoms (removal of bronchospasm) came about as quickly and effectively as after the appointment of Salbutamol and formoterol.
COPD
In patients with severe COPD (FEV1 = 36% before the commencement of Symbicort therapy), when the preparation of Symbicort Turbuhaler was taken, there was a significant decrease in the frequency of exacerbations of the disease compared with patients,received as therapy only formoterol or placebo (average frequency of exacerbations 1.4 compared with 1.8-1.9 in the placebo / formoterol group). There was no difference between the use of Symbicort turbuhaler and formoterol in relation to FEV1 values.
Composition
Budesonide micronized + Formoterol fumarate dihydrate + excipients.
Pharmacokinetics
Symbicort Turbuhaler is bioequivalent to the corresponding mono preparations (budesonide and formoterol) with respect to their systemic action. Despite this, there was a slight increase in cortisol suppression after taking Symbicort Turbuhaler compared with mono preparations. This difference does not affect clinical safety. There is no evidence of pharmacokinetic interaction between budesonide and formoterol. Pharmacokinetic parameters of budesonide and formoterol were comparable after their administration as monopreparations and as part of Symbicort Turbuhaler.
When using the combined preparation of AUC, budesonide was somewhat larger, the drug was absorbed faster and the C max value was higher; Cmax formoterol coincided with that for the mono drug.Inhaled budesonide is rapidly absorbed and reaches Cmax after 30 minutes. The average dose of budesonide, trapped in the lungs after inhalation through the turbuhaler, is 32-44% of the delivered dose. Systemic bioavailability is approximately 49% of the delivered dose. In children aged 6 to 16 years, the average dose of budesonide, trapped in the lungs after inhalation through a turbuhaler, does not differ from that in adult patients (the final concentration of the drug in the blood plasma was not determined).
Inhaled formoterol is rapidly absorbed and reaches Cmax 10 minutes after the inhalation. In studies it was shown that the average dose of formoterol, which got into the lungs after inhalation through the turbuhaler, is 28-49% of the delivered dose. Systemic bioavailability is about 61% of the delivered dose.
Binding to plasma proteins budesonide is approximately 90%, formoterol - 50%.
Budesonide undergoes intensive biotransformation (about 90%) with "first passage" through the liver to form metabolites with low glucocorticoid activity. Metabolism budesonide is carried out mainly with the participation of the enzyme CYP3A4.Glucocorticoid activity of the main metabolites - 6-beta-hydroxybudesonide and 16-alpha-hydroxyprednisolone - does not exceed 1% of the analogous activity of budesonide.
Formoterol is metabolized mainly in the liver by conjugation to form active O-demethylated metabolites, mainly in the form of inactivated conjugates.
There is no evidence for the interaction of metabolites or substitution reactions between budesonide and formoterol.
Budesonide is excreted in the urine in the form of metabolites or in the form of conjugates and only in a small amount - in unchanged form. Budesonide has a high system clearance (about 1.2 l / min).
After inhalation, 8-13% of the delivered dose of formoterol is excreted unchanged in the urine. Formoterol has a high system clearance (approximately 1.4 l / min); T1 / 2 is an average of 17 hours.
The pharmacokinetics of formoterol in children and in patients with renal insufficiency has not been studied.
The concentration of budesonide and formoterol in blood plasma can be increased in patients with liver disease.
Indications
- bronchial asthma (insufficiently controlled by the use of inhaled glucocorticosteroids (GCS) and short-acting beta2-adrenergics as therapy on demand,or adequately controlled by inhaled GCS and long-acting beta2-adrenomimetics). Symbicort Turbuhaler 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose can be used as maintenance therapy and for relief of attacks;
- COPD (symptomatic therapy in patients with severe COPD (FEV less than 50% of the estimated calculated level) and with repeated exacerbations in the anamnesis, in the presence of severe symptoms of the disease, despite the therapy with long-acting bronchodilators).
Forms of release
Powder for inhalation dosed turbuhaler 80 mcg + 4.5 mcg (60 doses and 120 doses), 160 mcg + 4.5 mcg (60 doses and 120 doses), 320 mcg + 9 mcg (60 doses).
Other dosage forms, be it pills, drops or solution, do not exist.
Instructions for use and dosage
Symbicort Turbuhaler is not intended for the initial treatment of bronchial asthma of intermittent and easy persistent flow.
Selection of the dose of the drugs that make up the Symbicort Turbuhaler is carried out individually and depending on the severity of the disease. This need to be taken into account not only at the beginning of treatment with combined preparations, but also when the dose of the drug is changed.
In the event that individual patients require a different combination of doses of active substances than in the preparation Symbicort Turbuhaler, separate beta2-adrenomimetics and / or GCS in separate inhalers should be prescribed.
Bronchial asthma
Symbicort Turbuhaler 80 / 4.5 μg / dose and 160 / 4.5 μg / dose
Patients should be under the constant supervision of a physician for adequate selection of a dose of Symbicort Turbuhaler. The dose should be reduced to the lowest, against which the optimal control of symptoms of bronchial asthma remains. When full control over the symptoms of bronchial asthma is achieved against the background of the minimum recommended dose of the drug, the next step is to try the appointment of monotherapy with inhaled glucocorticosteroids.
There are two approaches to the appointment of Symbicort Turbuhaler therapy:
- as maintenance therapy Symbicort Turbuhaler is prescribed for permanent maintenance therapy in combination with a separate beta2-adrenergic stimulant of short action for relief of attacks;
- as maintenance therapy and for relief of seizures Symbicort Turbuhaler is prescribed for both constant maintenance therapy and on demand when symptoms appear.
As maintenance therapy
The patient should always have a separate inhaler with beta2-adrenergic stimulant of short action for relief of attacks.
Adults (18 years and over) are prescribed Symbicort Turbuhaler 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose for 1-2 inhalations 2 times a day. If necessary, it is possible to increase the dose to 4 inhalations 2 times a day.
Adolescents (12-17 years old) are prescribed Symbicort Turbuhaler 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose for 1-2 inhalations 2 times a day.
Children over the age of 6 years are prescribed Symbicort Turbuhaler 80 / 4.5 mkg / dose for 1-2 inhalations 2 times a day.
After achieving optimal control of the symptoms of bronchial asthma against the background of taking the drug 2 times a day, it is recommended to titrate the dose to the lowest effective, up to a dose once a day, when the doctor thinks the patient needs maintenance therapy in combination with long-acting bronchodilators.
Increased frequency of beta2-adrenergic stimulants of short action is an indicator of worsening of general control over the disease and requires revision of antiasthmatic therapy.
As maintenance therapy and for the relief of attacks
The patient must always have Symbicort Turbuhaler for relief of seizures.
In this case, the drug is especially indicated for patients with insufficient control of bronchial asthma and the need for frequent use of drugs to stop seizures; with indications in an anamnesis of exacerbations of bronchial asthma requiring medical intervention.
It is necessary to carefully monitor the occurrence of dose-dependent side effects in patients who use a large number of inhalations to stop seizures.
Adults (18 years and over) are prescribed Symbicort Turbuhaler 80 / 4.5 μg / dose and 160 / 4.5 μg / dose; the recommended dose is 2 inhalations per day: 1 inhalation in the morning and in the evening, or 2 inhalations once a day only in the morning or only in the evening. Some patients may receive a maintenance dose of the drug Symbicort Turbuhaler 160 / 4.5 mcg / dose 2 inhalations 2 times a day. If symptoms occur, the appointment of 1 additional inhalation is necessary. With a further increase in symptoms within a few minutes, another 1 additional inhalation is prescribed, but no more than 6 inhalations for stopping 1 attack.
Usually, no more than 8 inhalations per day are required, but you can increase the number of inhalations to 12 per day for a short time. In patients who use more than 8 inhalations per day, a review of therapy is recommended.
Symbicort Turbuhaler 80 / 4.5 mcg / dose and 160 / 4.5 mcg / dose as maintenance therapy and for relief of attacks is not recommended for children and adolescents under the age of 18 years.
Symbicort Turbuhaler 320/9 mcg / dose
Adults (18 years and older) drug prescribed for 1 inhalation 2 times a day. If necessary, it is possible to increase the dose to 2 inhalations 2 times a day. After achieving optimal control of the symptoms of bronchial asthma against the background of taking the drug 2 times a day, it is recommended to titrate the dose to the lowest effective, up to a dose once a day.
Adolescents aged 12-17 years are prescribed 1 inhalation 2 times a day.
Symbicort Turbuhaler 320/9 mcg / dose is not recommended for children under 12 years due to lack of clinical data.
Patients should visit the doctor regularly to monitor the optimal dose of the drug. The dose should be reduced to the lowest, against which the optimal control of symptoms of bronchial asthma remains. After achieving optimal control of the symptoms of bronchial asthma against the background of taking the drug 2 times a day, it is recommended to titrate the dose to the lowest effective, up to a dose once a day, when the doctor thinks the patient needs maintenance therapy in combination with long-acting bronchodilators.
COPD
Adults appoint Symbicort Turbuhaler 160 / 4.5 mcg / dose of 2 inhalations 2 times a day or Symbicort Turbuhaler 320/9 mcg / dose of 1 inhalation 2 times a day.
There is no need for a special dose selection for elderly patients.
There is no data on the use of Symbicort Turbuhaler in patients with renal or hepatic insufficiency. Because budesonide and formoterol are excreted mainly with the participation of hepatic metabolism, then in patients with severe cirrhosis of the liver, a slowing down of the drug release rate can be expected.
Rules of use turbuhaler
The mechanism of action of the turbuhaler is such that when the patient inhales through the mouthpiece, the air flows entrain the drug substance in the respiratory tract.
It is necessary to instruct the patient:
- carefully study the "Instruction for use" turbuhaler;
- inhale forcefully and deeply through the mouthpiece to ensure that the optimal dose of the drug reaches the lungs;
- never exhale through the mouthpiece;
- in order to minimize the possibility of developing a fungal lesion of the oropharynx, rinse the mouth with water after each inhalation.It is also necessary to rinse the mouth with water after inhalations for relief of symptoms and in case of candidiasis of the mucous membrane of the oral cavity and pharynx.
The patient may not feel a taste or feel the drug after using the turbuhaler, which is due to a small amount of the delivered substance.
Instructions for use turbuhaler
Turbuhaler - multi-dose inhaler, which allows you to dose and inhale the drug in very small doses. When inhaled, the powder from the turbuhaler is delivered to the lungs, so it is important that the patient breathes deeply and deeply through the mouthpiece.
Before the first use turbuhaler must be prepared for work:
- Unscrew and remove the cap.
- Hold the inhaler vertically with the red dispenser down. Do not hold the inhaler for the mouthpiece while turning the dispenser. Turn the dispenser all the way in one direction, and then as far as it will go - in the opposite direction. Carry out the described procedure twice.
Now the inhaler is ready for use, it is not necessary to repeat this procedure of preparing the turbulence engine for operation before each use.
To receive a single dose, the patient must perform the following procedure:
- Unscrew and remove the cap.
- Hold the inhaler vertically with the red dispenser down. Do not hold the inhaler for the mouthpiece while turning the dispenser. In order to measure the dose, turn the dispenser all the way in one direction, and then also up to the stop - in the opposite direction. During this procedure, you will hear a click.
- Exhale. Do not exhale through the mouthpiece.
- Gently place the mouthpiece between your teeth, squeeze your lips and inhale deeply and deeply through your mouth. The mouthpiece should not be chewed or compressed with teeth.
- Before exhaling, remove the inhaler from the mouth.
- If more than one dose is required, repeat steps 2-5.
- Close the inhaler cap, check that the inhaler cap has been carefully screwed.
- Rinse mouth with water without swallowing.
You can not remove the mouthpiece, tk. it is fixed to the inhaler and is not removed. The mouthpiece of the turbulentator rotates, but one should not rotate it unnecessarily.
Since the amount of inhaled powder is very small, one can not feel the taste of the powder after inhalation.
However, absolutely precise compliance with the instructions ensures inhalation (inhalation) of the required dose of the drug.
If the procedure for loading the inhaler more than once was repeated mistakenly before taking the drug, then inhaling the patients will still receive one dose of the drug. The dose indicator will show the total number of measured doses.
The sound that is heard when the inhaler shakes is produced by a dehumidifying agent, not a medicinal substance.
Need to replace the inhaler
The dose indicator shows the approximate number of doses remaining in the inhaler, the count of doses for filling the turbuhaler starts from the 60th or 120th dose (depending on the total number of doses purchased turbuhalera). The indicator shows an interval of 10 doses, so it does not show every metered (loaded) dose.
The turbuhaler delivers the necessary dose of the drug, even if no changes are visible in the dose indicator window.
The appearance of a red background in the dose indicator window means that there are 10 doses of the drug left in the turbuhaler. When the figure 0 appears on a red background in the middle of the dose window, the inhaler should be discarded.
It should be noted that even when the indicator window shows the number 0, the dispenser continues to rotate.However, the dose indicator stops fixing the number of doses (ceases to move) and the figure remains in the dose window of the inhaler.
Cleaning
Regularly (once a week), the mouthpiece should be cleaned from the outside with a dry cloth. Do not use water or other liquids to clean the mouthpiece.
Recycling
Care should be taken when handling the inhaler used and remember that some amount of the drug may remain inside the inhaler.
Side effect
- headache;
- psychomotor agitation;
- anxiety;
- nausea;
- dizziness;
- sleep disorders;
- depression;
- behavioral disorders (mainly in children);
- violation of taste;
- a feeling of palpitations;
- tachycardia;
- atrial fibrillation;
- supraventricular tachycardia;
- extrasystole;
- angina pectoris;
- fluctuations of blood pressure;
- tremor;
- Candidiasis of the oral and pharyngeal mucosa;
- slight irritation in the throat;
- cough;
- hoarseness;
- bronchospasm
- bruising;
- itching;
- dermatitis;
- hives;
- angioedema;
- anaphylactic reactions;
- hypokalemia;
- symptoms of systemic action of GCS (including adrenal hypofunction).
The systemic effect of inhaled glucocorticosteroids can be observed when taking the drug in high doses for a long time.
Contraindications
- Children under 6 years of age (for all medicinal forms);
- children under 12 years of age (for a dosage form containing budesonide 320 μg + formoterol 9 μg);
- hypersensitivity to budesonide, formoterol or inhaled lactose.
Application in pregnancy and lactation
There are no clinical data on the use of Symbicort Turbuhaler or combined use of budesonide and formoterol in pregnancy.
In pregnancy, Symbicort should be given only in cases where the expected benefit of therapy for the mother exceeds the potential risk to the fetus. Budesonide should be used in the lowest effective dose necessary to maintain adequate control of the symptoms of bronchial asthma.
It is not known whether budesonide and formoterol are excreted in human breast milk. Symbicort Turbuhaler may be prescribed to lactating women if the expected benefit of therapy for the mother exceeds the potential risk for the child.
Use in children
Contraindicated in children under 6 years (for all medicinal forms); in children under 12 years of age (for a dosage form containing budesonide 320 μg + formoterol 9 μg).
special instructions
It is recommended to gradually reduce the dose of the drug before cessation of treatment and it is not recommended to stop the therapy abruptly.
Symbicort Turbuhaler 80 / 4.5 μg / dose and 320/9 μg / dose is not intended for the treatment of patients with severe bronchial asthma.
Symbicort Turbuhaler is not intended for initial selection of therapy at the first stages of treatment of bronchial asthma.
If the effectiveness of therapy is insufficient or if the maximum recommended dose of Symbicort is exceeded, it is necessary to revise the treatment tactics. An unexpected and progressive deterioration in the management of symptoms of bronchial asthma or COPD is potentially life threatening and requires urgent medical intervention. In this situation, the possibility of increasing the dose of GCS should be considered; appointment of a course of oral GCS or treatment with antibiotics in case of infection.
Patients are advised to constantly have emergency medications,or Symbicort Turbuhaler (for patients with bronchial asthma using Symbicort Turbuhaler for maintenance therapy and for relief of seizures), short-acting beta2-adrenomimetics (for all patients using Symbicort Turbuhaler only for maintenance therapy).
It is necessary to draw the attention of the patient to the necessity of regularly taking a maintenance dose of Symbicort in accordance with the selected therapy, even in the absence of symptoms of the disease. Inhalation Symbicort Turbuhaler for relief of attacks should be performed only when symptoms occur, but the use of the drug is not indicated for regular preventive use, i.e. before exercise. In such cases, the use of a single short-acting bronchodilator is indicated.
If the symptoms of bronchial asthma are amenable to control, you can gradually reduce the dose of Symbicort Turbuhaler, while it is important to constantly monitor the condition of patients. Symbicort Turbuhaler should be administered at the lowest effective dose.
Treatment with Symbicort should not begin during an exacerbation or a significant deterioration in the course of bronchial asthma.
During the treatment with Symbicort Turbuhalerom can mark exacerbations and development of serious unwanted reactions associated with bronchial asthma. Patients should continue treatment, but seek medical attention if there is no control over the symptoms of bronchial asthma or in case of worsening after the start of therapy.
As with any other inhalation therapy, paradoxical bronchospasm may occur with an immediate increase in wheezing after taking a dose of the drug. In this connection, it is necessary to stop the therapy with Symbicort Turbuhaler, to reconsider the tactics of treatment and, if necessary, to prescribe alternative therapy.
Systemic action may occur with the administration of any inhaled glucocorticosteroids, especially when taking high doses of drugs for a long period of time. The manifestation of systemic action is less likely in inhalation therapy than with oral GCS. Possible systemic effects include suppression of adrenal function, growth retardation in children and adolescents, decreased bone mineral density, cataracts and glaucoma.
It is recommended to regularly monitor the growth of children who receive long-term inhaled glucocorticosteroids. In case of established growth retardation, therapy should be reviewed to reduce the dose of inhaled glucocorticosteroids. It is necessary to carefully evaluate the ratio of the benefits of GCS therapy to the possible risk of growth retardation. When choosing a therapy, consultation with a pediatric pulmonologist is recommended.
Based on limited data on long-term GCS, it can be assumed that most children and adolescents receiving inhaled budesonide therapy will eventually achieve normal adult growth rates. At the same time, a slight (about 1 cm) short-term growth retardation was reported, mainly in the first year of treatment.
Because of the potential effect of inhaled glucocorticosteroids on the bone mineral density, special attention should be paid to patients taking the drug at high doses for a long time with the presence of risk factors for osteoporosis. Studies of prolonged use of inhaled budesonide in children at an average daily dose of 400 μg (metered dose) or in adults at an average daily dose of 800 μg (metered dose) did not show a significant effect on bone mineral density.There is no data on the effect of the drug in high doses on bone mineral density.
If there is reason to believe that against the background of previous systemic therapy of GCS, the adrenal gland function was disrupted, precautions should be taken when transferring patients to Symbicort by Turbuchaler.
The advantages of inhaled budesonide therapy, as a rule, minimize the need for oral glucocorticosteroids, but in patients who stop oral GCS therapy, adrenal insufficiency may persist for a long time. Patients who in the past needed urgent high-dose GCS, received long-term treatment with high-dose inhaled glucocorticosteroids, may also be at this risk group. It is necessary to provide additional appointment of SCS during the period of stress or surgical intervention. It is recommended to instruct the patient about the need to rinse the mouth with water after inhalation in order to prevent the development of candidiasis of the oral mucosa. It is also necessary to rinse the mouth with water after the inhalation for relief of symptoms in the case of candidiasis of the mucous membrane of the oral cavity and pharynx.
Formoterol may cause prolongation of the QT interval, so the drug should be administered with caution to patients with an increased QT interval.
The need to apply and dose inhaled corticosteroids in patients with active or inactive forms of pulmonary tuberculosis, fungal, viral or bacterial infections of the respiratory system should be reviewed.
Special precautions should be taken in patients with unstable bronchial asthma who use short-acting bronchodilators to relieve attacks with exacerbation of severe bronchial asthma. the risk of hypokalemia increases with hypoxia and other conditions, when the likelihood of developing symptoms of hypokalemic action increases. In such cases it is recommended to monitor the potassium content in the serum.
Receiving patients with acute bronchial obstruction of formoterol at a dose of 90 mcg for 3 h is safe.
During the treatment period, the concentration of glucose in the blood should be monitored in patients with diabetes mellitus.
Symbicort Turbuhaler contains lactose (less than 1 mg / dose). Usually, this amount does not cause undesirable reactions in patients with lactose intolerance.
Impact on the ability to drive vehicles and manage mechanisms
Symbicort Turbuhaler does not affect the ability to drive vehicles and control mechanisms. It can influence the ability to drive vehicles and manage mechanisms while developing side effects.
Drug Interactions
With the simultaneous intake of Ketoconazole at a dose of 200 mg once a day and budesonide at a dose of 3 mg, the concentration of budesonide in plasma increases by an average of 6 times. When taking ketoconazole 12 hours after the administration of budesonide, the concentration of the latter in the plasma rises on average by 3 times. Information on this interaction with budesonide with inhalation administration is not available, but a marked increase in the concentration of the drug in the blood plasma should be expected. Since there is currently no data for recommendations on the selection of doses, the indicated combination of drugs should be avoided. If this is not possible, the intervals between ketoconazole and budesonide should be maximized. You should also consider the possibility of reducing the dose of budesonide. Other potent inhibitors of CYP3A4 are also likely to significantly increase the content of budesonide in plasma.It is not recommended to use Symbicort Turbuhaler as maintenance therapy and to relieve seizures for patients receiving potent inhibitors of CYP3A4.
The blockers of beta-adrenoreceptors can weaken or inhibit the action of formoterol. Symbicort Turbuhaler should not be prescribed simultaneously with beta-blockers (including eye drops), except in cases of extreme necessity.
With the simultaneous application of Symbicort Turbuhaler and quinidine, disopyramide, procainamide, phenothiazines, antihistamines (terfenadine), MAO inhibitors and tricyclic antidepressants, an extension of the QTc interval and an increased risk of ventricular arrhythmias may occur.
In addition, levodopa, levothyroxine, oxytocin and ethanol (alcohol) can reduce the tolerance of the heart muscle to beta2-adrenomimetics.
With the simultaneous administration of MAO inhibitors, as well as drugs with similar properties (furazolidone, procarbazine), an increase in blood pressure is possible.
There is an increased risk of arrhythmia in patients with general anesthesia with halogenated hydrocarbon preparations using Symbicort Turbuhaler.
With the simultaneous administration of Symbicort Turbuhaler and other beta-adrenoreceptor agonists, the side effect of formoterol may be increased.
The hypokalemic effect of beta2-adrenomimetics can be enhanced by simultaneous administration of xanthine derivatives, mineral derivatives of GCS and diuretics. Hypokalemia increases the predisposition to the development of arrhythmias in patients taking cardiac glycosides.
No interaction of budesonide with other medications that have been used to treat bronchial asthma has been observed.
Analogues of the drug Symbicort
Structural analogs for the active substance:
- Symbicort Turbuhaler.
Analogues on the curative effect (agents for the treatment of asthma):
- Asthmopent;
- Atrovent;
- Afonilum;
- Beklazone;
- Beclomet Ishihiler;
- Benacorte;
- Berlikort;
- Berodual;
- Berotek;
- Brikanil;
- Bronhosan;
- Budesonide;
- Ventolin;
- Hydrocortisone;
- Dexamethasone;
- Diprospan;
- Intal;
- Ithral;
- Clenbuterol;
- Cortisone;
- Cromogen;
- Cromoglyn;
- Xidifon;
- Metizred;
- Montelar;
- Oxys Turbuhaler;
- Pentamine;
- Platyphylline;
- Plibékot;
- Polyoxidonium;
- Polcortolone;
- Prednisolone;
- Pulmicort;
- Pulmicort Turbuhaler;
- Retafil;
- Salamol;
- Salvobent;
- Salbutamol;
- Salgim;
- Salmecort;
- Salmeter;
- Serevent;
- Seretid;
- Seredid Multidisk;
- Singulex;
- Spofillin retard;
- Theotard;
- Theophylline;
- Triamsinolone;
- Fliksotid;
- Celeston;
- Erespal;
- Eufillin;
- Eufilong.