SYMBICORT TURBUHALER 160 micrograms/4.5 micrograms INHALATION POWDER

Introduction

Package Leaflet: Information for the User

Symbicort Turbuhaler 160 micrograms/4.5 micrograms/inhalation powder for inhalation

Budesonide/formoterol fumarate dihydrate

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

• Keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack

1. What Symbicort Turbuhaler is and what it is used for
2. What you need to know before you use Symbicort Turbuhaler
3. How to use Symbicort Turbuhaler
4. Possible side effects
5. Storing Symbicort Turbuhaler
6. Contents of the pack and other information

1. What Symbicort Turbuhaler is and what it is used for

Symbicort Turbuhaler is an inhaler used for the treatment of asthma in adults and adolescents between 12 and 17 years of age. It is also used for the symptomatic treatment of Chronic Obstructive Pulmonary Disease (COPD) in adults over 18 years of age. It contains two different medicines: budesonide and formoterol fumarate dihydrate.

• Budesonide belongs to a group of medicines called “corticosteroids”, and works by reducing and preventing inflammation in your lungs.
• Formoterol fumarate dihydrate belongs to a group of medicines called “long-acting beta2 adrenergic agonists” or “bronchodilators”, and works by relaxing the muscles in the airways, making it easier to breathe.

Asthma

Symbicort Turbuhaler may be prescribed for asthma in two different ways.

• Some patients are prescribed two inhalers: Symbicort Turbuhaler and another inhaler for “relief of symptoms”.
• They use Symbicort Turbuhaler every day to help prevent asthma symptoms from occurring.
• They use their “reliever inhaler” when they have asthma symptoms, to help them breathe more easily.

• Some patients are prescribed Symbicort Turbuhaler as their only inhaler for asthma.
• They use Symbicort Turbuhaler every day to help prevent asthma symptoms from occurring.
• They also use Symbicort Turbuhaler when they need extra doses for relief of asthma symptoms, to help them breathe more easily, and, if agreed with their doctor, to prevent asthma symptoms (for example, before exercise or exposure to other allergens). They do not need a separate inhaler for this purpose.

Chronic Obstructive Pulmonary Disease (COPD)

Symbicort Turbuhaler can also be used to treat the symptoms of COPD in adults. COPD is a long-term disease of the airways in the lungs, usually caused by smoking.

2. What you need to know before you use Symbicort Turbuhaler

Do not use Symbicort Turbuhaler:

• if you are allergic to budesonide, formoterol or any of the other ingredients of this medicine (listed in section 6), which includes lactose (containing small amounts of milk proteins).

Warnings and precautions

Talk to your doctor or pharmacist before using Symbicort Turbuhaler if:

• You have diabetes.
• You have a lung infection.
• You have high blood pressure or have ever had any heart problems (including irregular heartbeats, fast pulse, narrowing of the arteries or heart failure).
• You have problems with your thyroid or adrenal glands.
• You have low levels of potassium in your blood.
• You have severe liver problems.

Contact your doctor if you have blurred vision or other visual disturbances.

Use in athletes

This medicine contains formoterol, which may produce a positive result in doping tests.

Other medicines and Symbicort Turbuhaler

Tell your doctor or pharmacist if you are using, have recently used or might use any other medicines.

In particular, tell your doctor or pharmacist if you are using any of the following medicines:

• Beta-blocker medicines (such as atenolol and propranolol for high blood pressure), including eye drops (such as timolol for glaucoma).

• Medicines to treat a fast or irregular heartbeat (such as quinidine).
• Medicines like digoxin, which are commonly used to treat heart failure.
• Diuretics (such as furosemide), used to treat high blood pressure.
• Steroid medicines taken by mouth (such as prednisolone).
• Xanthine medicines (such as theophylline or aminophylline), commonly used for asthma.
• Other bronchodilators (such as salbutamol).
• Tricyclic antidepressants (such as amitriptyline) and the antidepressant nefazodone.
• Phenothiazine medicines (such as chlorpromazine and prochlorperazine).
• Medicines called “HIV protease inhibitors” (such as ritonavir) for the treatment of HIV.
• Medicines for treating infections (such as ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin and telithromycin).
• Medicines for Parkinson's disease (such as levodopa).
• Medicines for thyroid problems (such as levothyroxine).

If you are in any of these situations, or if you are not sure, ask your doctor or pharmacist before using Symbicort Turbuhaler.

Also, tell your doctor or pharmacist if you are going to have a general anesthetic for a surgical operation or for dental treatment.

Pregnancy, breastfeeding and fertility

• Tell your doctor before using this medicine if you are pregnant, or planning to become pregnant; do not use Symbicort Turbuhaler unless your doctor has told you to.
• If you become pregnant while using Symbicort Turbuhaler, do not stop using it but consult your doctor immediately.
• If you are breastfeeding, consult your doctor before using Symbicort Turbuhaler.

Driving and using machines

Symbicort Turbuhaler has no or negligible influence on the ability to drive and use machines.

Symbicort Turbuhaler contains lactose

Symbicort Turbuhaler contains lactose, which is a type of sugar. If your doctor has told you that you have an intolerance to some sugars, consult your doctor before using this medicine. The amount of lactose in this medicine is normally not enough to cause problems in people who are intolerant to lactose.

The excipient lactose contains small amounts of milk proteins, which may cause allergic reactions in patients allergic to milk protein.

3. How to use Symbicort Turbuhaler

• Follow the administration instructions for this medication exactly as indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.
• It is essential to use Symbicort Turbuhaler daily, even if you do not have symptoms of asthma or COPD at that time.
• If you are using Symbicort Turbuhaler for asthma, your doctor will want to check your symptoms regularly.

If you have been taking steroid tablets for asthma or COPD, your doctor may reduce the number of tablets you take once you start treatment with Symbicort Turbuhaler. If you have been taking oral steroid tablets for a long time, your doctor may want to have a blood test done from time to time. You may feel unwell when the number of oral steroid tablets is reduced, even if your lung symptoms are improving. In that case, some symptoms such as nasal congestion or runny nose, weakness or muscle and joint pain, and skin rash (hives) may temporarily reappear. If any of these symptoms concern you, or if you experience any other symptoms such as headache, fatigue, nausea, or vomiting, contact your doctor immediately. If allergic or arthritic symptoms develop, you may need to take another medication. You should consult your doctor if you are concerned about whether you should continue using Symbicort Turbuhaler.

Your doctor may consider adding steroid tablets to your regular treatment during periods of stress (e.g., when you have a chest infection or before an operation).

Important information about asthma or COPD symptoms

If while using Symbicort Turbuhaler you experience difficulty breathing or wheezing, you should continue using it and contact your doctor as soon as possible, as you may need additional treatment.

Contact your doctor immediately if:

• Your breathing is getting worse or you often wake up at night with asthma symptoms.
• You start to feel chest tightness in the morning, or chest tightness lasts longer than usual.
• These signs may indicate that your asthma or COPD is not adequately controlled, and you may need immediate different or additional treatment.

Asthma

Symbicort Turbuhaler may be prescribed for asthma in two different ways, so the amount to use and when to use it depends on how your doctor has indicated:

• If your doctor has prescribed Symbicort Turbuhaler and another reliever inhaler separately, read the section "a) Using Symbicort Turbuhaler and another inhaler separately for symptom relief".
• If your doctor has prescribed Symbicort Turbuhaler as the only inhaler, read the section "b) Using Symbicort Turbuhaler as the only inhaler for asthma".

• Using Symbicort Turbuhaler and another inhaler separately for symptom relief

Use Symbicort Turbuhaler daily, as it helps prevent the onset of asthma symptoms.

Adults (from 18 years old)

• The usual dose is 1-2 inhalations, twice a day.
• Your doctor may prescribe up to a maximum of 4 inhalations, twice a day.
• If your symptoms are well-controlled, your doctor may ask you to use the medication once a day.

Adolescents (from 12 to 17 years old)

• The usual dose is 1-2 inhalations, twice a day.
• If your symptoms are well-controlled, your doctor may ask you to use the medication once a day.

There is a lower concentration of Symbicort Turbuhaler for children aged 6-11 years.

Symbicort Turbuhaler is not recommended for children under 6 years old.

Your doctor (or nurse) will help you manage your asthma. They will adjust the dose of this medication to the lowest dose that controls your asthma. However, do not adjust or stop the dose without talking to your doctor or nurse first.

Use your other "reliever inhaler" when asthma symptoms appear.Always keep this "reliever inhaler" with you to use when needed. Do not use Symbicort Turbuhaler to treat asthma symptoms, but use your reliever inhaler.

• Using Symbicort Turbuhaler as the only inhaler for asthma

Use Symbicort Turbuhaler in this way only if your doctor has indicated it and if you are over 12 years old.

Use Symbicort Turbuhaler daily, as it helps prevent the onset of asthma symptoms. You can use:

• 1 inhalation in the morning and1 inhalation in the evening

or

• 2 inhalations in the morning

or

• 2 inhalations in the evening.

Your doctor may increase the dose to 2 inhalations, twice a day.

Also, use Symbicort Turbuhaler as a "reliever inhaler"to treat asthma symptoms when they appear and to prevent the onset of asthma symptoms (e.g., when exercising or exposed to other allergens).

• If you have asthma symptoms, take 1 inhalation and wait a few minutes.
• If you do not feel better, take another inhalation.
• Do not take more than 6 inhalations at a time.

Always keep your Symbicort Turbuhaler inhaler with you to use when needed.

Normally, a total dose of more than 8 inhalations per day is not required. However, your doctor may allow you to use up to 12 inhalations per day for a limited period.

If you usually need to use 8 or more inhalations per day, go to your doctor or nurse, as you may need to change your treatment.

Never take more than 12 inhalations in total in 24 hours.

If you are exercising and notice asthma symptoms, use Symbicort Turbuhaler as described above. It is essential to talk to your doctor about using Symbicort Turbuhaler to prevent asthma symptoms; both the frequency of exercise and exposure to allergens could influence the treatment prescribed.

Chronic Obstructive Pulmonary Disease (COPD)

• Use only in adults (over 18 years old).
• The usual dose is 2 inhalations, twice a day.

Your doctor may also prescribe other bronchodilator medications, such as anticholinergics (e.g., ipratropium bromide or tiotropium bromide), for your COPD.

Preparing your new Symbicort Turbuhaler inhaler

Before using your newSymbicort Turbuhaler inhaler for the first time, you must prepare it as follows:

• Unscrew and lift the cap that covers the Turbuhaler. You will hear a small "click" when you unscrew the cap.
• Hold your Symbicort Turbuhaler inhaler upright with the red lock at the bottom.
• Turn the red lock all the way in one direction and then turn it all the way in the other direction (it does not matter which direction first). In one of the two directions, you should hear a characteristic "click". It does not matter if the "click" is heard on the first or second turn.
• Turn the red lock in both directions again.
• At this point, your Symbicort Turbuhaler inhaler is loaded and ready to use.

How to take an inhalation

Each time you need to take an inhalation, follow these instructions:

1. Unscrew and lift the cap that covers the Turbuhaler. You will hear a small "click" when you unscrew the cap.
2. Hold your Symbicort Turbuhaler inhaler upright with the red lock at the bottom.

1. Do not hold the mouthpiece when loading your Symbicort Turbuhaler inhaler. To load your Symbicort Turbuhaler inhaler with a dose, turn the red lock all the way in one direction.

Then turn it all the way in the other direction (it does not matter which direction first). In one of the two directions, you should hear a characteristic "click". It does not matter if the "click" is heard on the first or second turn. At this point, your Symbicort Turbuhaler inhaler is ready to use. Load your Symbicort Turbuhaler inhaler only when you are about to use it.

1. Keeping your Symbicort Turbuhaler inhaler away, slowly breathe out through your mouth (without discomfort). Do not blow through your Symbicort Turbuhaler inhaler.
2. Place the mouthpiece gently between your teeth, close your lips, and breathe in forcefully and deeply through your mouth. Do not bite or press the mouthpiece hard.

1. Remove your Symbicort Turbuhaler inhaler from your mouth and breathe out gently. The amount of medication inhaled is very small, which means you may not notice any taste after inhalation. However, if you have followed the instructions, you can be sure that you have inhaled the dose and that the medication has reached your lungs.
2. If you need to take another inhalation, repeat steps 2 to 6.
3. Put the cap back firmly after use.

1. Rinse your mouth with water after the morning and/or evening doses. Do not swallow.

Do not attempt to remove the mouthpiece or turn it unnecessarily, as it is fixed to your Symbicort Turbuhaler inhaler and should not be removed. Do not use your Symbicort Turbuhaler inhaler if it is damaged or if the mouthpiece has come off your Symbicort Turbuhaler inhaler.

As with all inhalers, caregivers should ensure that children who have been prescribed Symbicort Turbuhaler perform the inhalation technique correctly, as described above.

Cleaning your Symbicort Turbuhaler inhaler

Clean the outside of the mouthpiece with a dry cloth once a week, without using water or liquids.

When to start using a new inhaler

• The dose indicator tells you about the number of doses (inhalations) left in your Symbicort Turbuhaler inhaler, starting from 30, 60, or 120 doses when it is full.

• The dose indicator is marked in intervals of 10 (for 60 and 120 dose inhalers), and in intervals of 15 doses (for the 30 dose inhaler). Therefore, the dose indicator does not show all doses.
• When the red background first appears on the edge of the indicator window, there are approximately 20 doses left. When there are 10 doses left, the background of the indicator window is red, and when the 0 has reached the middle of the window, you should start using a new Symbicort Turbuhaler inhaler.

Note:

• Although your Symbicort Turbuhaler inhaler is empty, the red lock will continue to turn, and you will still hear the characteristic "click".
• The sound you hear when you shake your Symbicort Turbuhaler inhaler is not produced by the medication but by a desiccant, so it will not indicate how much medication is left in your Symbicort Turbuhaler inhaler.
• If you load your Symbicort Turbuhaler inhaler more than once by mistake before inhaling your dose, you will still inhale a single dose, although the indicator will count all loaded doses.

If you use more Symbicort Turbuhaler than you should

It is essential to use the dose indicated in the prospectus or prescribed by your doctor. Do not increase your dose without consulting your doctor.

The most common symptoms and signs that may occur after an overdose are tremors, headache, and rapid heartbeat.

In case of overdose or accidental ingestion, consult the Toxicology Information Service. Phone: 91 5620420, indicating the medication and the amount ingested.

If you forgot to use Symbicort Turbuhaler

• If you forget any of the Symbicort Turbuhaler doses, follow the recommended treatment as soon as you remember. However, if it is almost time for your next dose, do not worry about the missed dose.
• Do notuse a double dose to make up for missed doses.

If you have any other questions about using this medication, ask your doctor or pharmacist.

4. Possible side effects

Like all medications, this medication can cause side effects, although not everyone gets them.

If you experience any of the following situations, stop using Symbicort Turbuhaler and consult your doctor immediately:

• Your face swells, particularly around the mouth (tongue and/or throat and/or difficulty swallowing) or hives along with difficulty breathing (angioedema) and/or a sudden feeling of fainting, which indicates that you may be suffering an allergic reaction. This occurs rarely, affecting less than 1 in 1,000 patients.
• You have acute wheezing or difficulty breathing immediately after using your inhaler. If you experience any of these symptoms, stop using Symbicort Turbuhaler immediately and use your "reliever inhaler". Contact your doctor immediately, as you may need to change your treatment.This occurs very rarely, affecting less than 1 in 10,000 patients.

Other possible side effects:

Common (may affect up to 1 in 10 patients)

• Palpitations (noticing heartbeats), tremors. When these effects appear, they are usually mild and disappear when continuing to use Symbicort Turbuhaler.
• Thrush (fungal infection) in the mouth; this effect is less likely if you rinse your mouth with water after using Symbicort Turbuhaler.
• Mild throat irritation, cough, hoarseness.
• Headache.
• Pneumonia (lung infection) in patients with COPD.

Tell your doctor if you experience any of the following symptoms while inhaling Symbicort Turbuhaler; they could be symptoms of a lung infection:

• Fever or chills.
• Increased mucus production, change in mucus color.
• Increased cough or increased difficulty breathing.

Uncommon(may affect up to 1 in 100 patients)

• Agitation, restlessness, nervousness.
• Difficulty sleeping.
• Dizziness.
• Nausea (discomfort).
• Fast heartbeat.
• Bruises on the skin.
• Muscle cramps.
• Blurred vision.

Rare (may affect up to 1 in 1,000 patients)

• Rash, itching.
• Bronchospasm (contraction of the airway muscles, causing wheezing). If this happens suddenly just after using Symbicort Turbuhaler, stop using it and consult your doctor immediately.
• Low potassium levels in the blood.
• Irregular heartbeat.

Very rare (may affect up to 1 in 10,000 patients)

• Depression.
• Changes in behavior, especially in children.
• Chest pain or tightness (angina pectoris).
• Increased blood sugar (glucose) levels.
• Taste disturbances, such as unpleasant mouth taste.
• Changes in blood pressure.

Inhaled corticosteroids may affect the normal production of steroid hormones in the body, especially if high doses are used for a long time. These effects include:

• changes in bone mineral density (bone loss)
• cataracts (loss of transparency of the lens in the eye)
• glaucoma (increased eye pressure)
• growth retardation in children and adolescents
• effects on the adrenal glands (small glands located next to the kidneys).

These effects are much less likely with inhaled corticosteroids than with steroid tablets.

Reporting side effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect not listed in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for human use medications: www.notificaRAM.es. By reporting side effects, you can contribute to providing more information on the safety of this medication.

5. Storage of Symbicort Turbuhaler

• Keep this medication out of sight and reach of children.
• Do not use this medication after the expiration date that appears on the packaging or on the label of your inhaler after EXP. The expiration date is the last day of the month indicated.
• This medication does not require special storage conditions.
• Medications should not be thrown down the drain or into the trash. Deposit the packaging and medications you no longer need at the SIGRE point in the pharmacy. Ask your pharmacist how to dispose of the packaging and medications you no longer need. This way, you will help protect the environment.

6. Container contents and additional information

Composition of Symbicort Turbuhaler

The active ingredients are budesonide and formoterol fumarate dihydrate. Each inhaled dose contains 160 micrograms of budesonide and 4.5 micrograms of formoterol fumarate dihydrate.

The excipient is lactose monohydrate (which contains milk proteins).

Appearance of the product and container contents

Symbicort Turbuhaler is an inhaler that contains your medication. The inhalation powder is white. Each inhaler contains 30, 60, or 120 doses and consists of a white body and a red turning grip. The turning grip contains a Braille code with the number 6 as an identification digit, to differentiate it from other AstraZeneca inhaled medications.

Symbicort Turbuhaler is available in packs of 1 inhaler containing 30 doses or in packs of 1, 2, 3, 10, or 18 inhalers containing 60 or 120 doses.

Only some pack sizes may be marketed.

Marketing authorization holder and manufacturer

The holder is:

AstraZeneca Farmacéutica Spain, S.A.

C/ Puerto de Somport 21-23

28050 Madrid

Spain

The manufacturer is:

AstraZeneca AB

S-151 36 Södertälje

Sweden

This medication is authorized in the Member States of the European Economic Area under the following names:

Germany: Symbicort Turbohaler 160 μg/4.5 μg/inhalation; Austria: Symbicort Turbohaler 160 μg/4.5 μg/inhalation; Belgium: Symbicort Turbohaler 160 μg/4.5 μg/inhalation; Bulgaria: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Cyprus: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Croatia: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Denmark: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Slovakia: Symbicort Turbuhaler 200 μg/6 μg/inhalation; Slovenia: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Spain: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation powder for inhalation; Estonia: Symbicort Turbuhaler 160 μg/4.5 μg; Finland: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; France: Symbicort Turbuhaler 200 μg/6 μg/inhalation; Greece: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Netherlands: Symbicort Turbuhaler 200 μg/6 μg/inhalation; Hungary: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Ireland: Symbicort Turbohaler 200 μg/6 μg/inhalation; Iceland: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Italy: Symbicort 160 μg/4.5 μg/inhalation; Latvia: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Lithuania: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Luxembourg: Symbicort Turbohaler 160 μg/4.5 μg/inhalation; Malta: Symbicort Turbohaler 200 μg/6 μg/inhalation; Norway: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Poland: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Portugal: Symbicort Turbohaler 160 μg/4.5 μg/inhalation; United Kingdom: Symbicort Turbohaler 200 μg/6 μg/inhalation; Czech Republic: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Romania: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation; Sweden: Symbicort Turbuhaler 160 μg/4.5 μg/inhalation

Date of the last revision of this prospectus: February 2021

Detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/