Symbion 80 mcg + 4.5 mcg/PUFF Inhalation Aerosol

Symbion 80 mcg + 4.5 mcg/PUFF inhalation aerosol is manufactured by Beximco Pharmaceuticals Ltd.. It is a combination inhaler containing Budesonide + Formoterol Fumarate — budesonide, an inhaled corticosteroid, and formoterol, a long-acting bronchodilator. It is used as a controller (preventer) inhaler, taken regularly every day to keep asthma and COPD under control rather than to treat an attack that has already started.

Budesonide works inside the airway walls to reduce the inflammation and swelling that make breathing difficult. Formoterol relaxes the muscles around the airways, starts working within minutes and keeps the airways open for about 12 hours. Used regularly, Symbion reduces wheezing, breathlessness, chest tightness and night waking, and lowers the risk of asthma attacks and COPD flare-ups.

Symbion is prescribed for the regular, long-term treatment of:

• Asthma — when an inhaled corticosteroid alone does not give adequate control, or when both an inhaled steroid and a long-acting bronchodilator are appropriate
• COPD (chronic obstructive pulmonary disease) — to ease breathing and reduce repeated flare-ups in suitable patients

In certain asthma plans, doctors prescribe a budesonide–formoterol inhaler as both daily maintenance and as-needed relief (a MART/SMART regimen), because formoterol acts quickly — but follow this pattern only if your own doctor has specifically prescribed it. Otherwise treat Symbion purely as a daily controller and keep a separate reliever.

Use Symbion exactly as your doctor prescribes — commonly one or two inhalations twice daily (morning and evening), every day, even when you feel well. Children should use it only at the dose and age the doctor approves.

• Follow your written asthma action plan; do not take extra doses beyond what the doctor has allowed
• Use the correct technique for your device (dry-powder inhalers need a quick, deep, forceful breath in) — have your technique checked at follow-up visits
• Rinse your mouth with water and spit it out after every use to prevent oral thrush and hoarseness
• Keep a fast-acting reliever available as your doctor directs, and never stop Symbion suddenly without medical advice

Possible side effects of Symbion include:

• Oral thrush (white patches in the mouth) and hoarseness — far less likely if you rinse your mouth after each dose
• Throat irritation, cough
• Headache
• Trembling of the hands, palpitations or a fast heartbeat — usually mild and settling with continued use
• Muscle cramps, restlessness or sleep disturbance
• In COPD — a slightly increased chance of pneumonia; report fever, increased phlegm or worsening breathlessness

Rarely, breathing may worsen immediately after a dose (paradoxical bronchospasm) — use your reliever and seek urgent care. Long-term high doses can affect bones, eyes, blood sugar, adrenal function and growth in children, so regular review is important.

• Use it every day, even when you feel well — the steroid only works with regular use, and stopping suddenly can bring symptoms back
• Needing your reliever more often than usual is a warning sign that your asthma or COPD is worsening — see your doctor promptly instead of simply taking more puffs
• Rinse your mouth after every dose to prevent thrush and hoarseness
• Tell your doctor if you have heart disease, an irregular or fast heartbeat, high blood pressure, diabetes, thyroid disease, low blood potassium, or current or past tuberculosis
• Do not use another LABA-containing inhaler at the same time unless your doctor specifically directs it
• Attend regular reviews so the dose can be kept at the lowest that controls your symptoms, and have your inhaler technique rechecked

Tell your doctor about every medicine you take before starting Symbion. Notable interactions include:

• Strong CYP3A4 inhibitors — ketoconazole, itraconazole, ritonavir and some other HIV medicines, clarithromycin: these raise budesonide and formoterol levels and increase the risk of steroid and heart-related effects
• Beta-blockers — including propranolol and timolol eye drops — can cancel the effect of formoterol and narrow the airways; usually avoided in asthma
• Diuretics, theophylline, oral steroids — may add to potassium lowering, causing weakness, cramps or palpitations
• QT-prolonging medicines — certain antidepressants, antipsychotics and antiarrhythmics need extra caution
• Other LABA inhalers — must not be duplicated

Do not use Symbion if you:

• Are allergic to budesonide, formoterol or any other ingredient of the device
• Have a severe allergy to milk proteins, in the case of dry-powder devices that contain lactose

Symbion is not a primary treatment for a sudden, severe asthma attack (status asthmaticus) — emergency reliever treatment is required. It should be used with close medical supervision in severe heart rhythm disorders, uncontrolled heart disease, severe hypertension, untreated low potassium, thyrotoxicosis and active tuberculosis. Your doctor will decide whether it is suitable for you.

Pregnancy: Uncontrolled asthma is more dangerous to mother and baby than inhaled asthma medicines, so doctors usually continue effective inhaled treatment during pregnancy. Budesonide is among the best-studied inhaled steroids in pregnancy. Use Symbion only under your doctor's supervision and never stop it suddenly on your own while pregnant.

Breastfeeding: Only very small amounts of inhaled budesonide and formoterol reach breast milk, and breastfeeding is usually considered possible during treatment. Confirm with your doctor, who will keep you on the lowest effective dose and monitor the baby as needed.

Store Symbion below 30°C in a dry place, away from heat and direct sunlight. Keep the cover or cap closed when not in use.

• Protect dry-powder devices from moisture — never wash the mouthpiece with water; wipe it with a dry cloth
• Do not breathe out into the device
• Pressurised canisters must not be pierced or burned, even when empty
• Watch the dose counter and replace the inhaler when doses run out or by the discard date on the label
• Keep out of the reach and sight of children