Leaflet: information for the user

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

Budesonide/formoterol fumarate dihydrate

Read this leaflet carefully before you start using this medicine, as it contains important information for you.

- Keep this leaflet, as you may need to read it again.

- If you have any questions, consult your doctor or pharmacist.

- This medicine has been prescribed for you only, and you must not give it to others even if they have the same symptoms as you, as it may harm them.

-If you experience any side effects,consult your doctor or pharmacist,evenifthey are not listed in this leaflet. See section 4.

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

2.What you need to knowbefore starting to use Symbicort Turbuhaler

3.How to use Symbicort Turbuhaler

4.Possible side effects

5.Storage of Symbicort Turbuhaler

6. Contents of the pack and additional information

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 medications: budesonide and formoterol fumarate dihydrate.

• Budesonide belongs to a group of medications called “corticosteroids”, and it acts by reducing and preventing inflammation in your lungs.
• Formoterol fumarate dihydrate belongs to a group of medications called “long-acting beta2adrenergic agonists” or “bronchodilators”, and it acts by relaxing the muscles of the airways, making it easier for you to breathe.

Asthma

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

a) For some patients, two separate inhalers are prescribed:Symbicort Turbuhaler and another inhaler for “symptom relief”.

• They use Symbicort Turbuhaler daily, which helps prevent the occurrence of asthma symptoms.
• They use their “relief inhaler” when they experience asthma symptoms, to facilitate breathing.

b) For some patients, Symbicort Turbuhaler is prescribed as a single inhaler for asthma.

• They use Symbicort Turbuhaler daily, which helps prevent the occurrence of asthma symptoms.
• They also use Symbicort Turbuhaler when additional doses are needed for symptom relief, to facilitate breathing, and, if agreed with the doctor, alsoto prevent the occurrence of asthma symptoms (for example, when exercising or exposed to other allergens).They do not need another separate inhaler for this purpose.

Chronic Obstructive Pulmonary Disease (COPD)

Symbicort Turbuhaler may also be used for the treatment of COPD symptoms in adults. COPD is a chronic disease of the pulmonary airways, usually caused by smoking.

Do not use Symbicort Turbuhaler:

• if you are allergic to budesonide, formoterol or to any of the other ingredients of this medicine (including lactose, which contains small amounts of milk proteins).

Warnings and precautions

Consult your doctor or pharmacist before starting to use Symbicort Turbuhaler if:

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

Get in touch with your doctor if you experience blurred vision or other visual disturbances.

Use in athletes

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

Other medicines and Symbicort Turbuhaler

Inform your doctor or pharmacist if you are using, have used recently or might have to use any other medicine.

Particularly, inform your doctor or pharmacist if you are using any of the following medicines:

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

• Medicines to treat rapid or irregular heartbeats (for example quinidina).
• Medicines like digoxin, used commonly to treat heart failure.
• Diuretics (such as furosemide), used to treat high blood pressure.
• Oral steroids (such as prednisolone).
• Xanthine medicines (such as theophylline or aminophylline), used commonly 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 to treat infections (such as ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin and telithromycin).
• Medicines to treat Parkinson's disease (such as levo-dopa).
• Medicines to treat thyroid problems (such as levo-thyroxine).

If you find yourself in any of these situations, or if you are unsure, ask your doctor or pharmacist before using Symbicort Turbuhaler.

Also inform your doctor or pharmacist if you are to undergo general anaesthesia for a surgical operation or dental treatment.

Pregnancy, breastfeeding and fertility

• Inform your doctor before using this medicine if you are pregnant, or plan to become pregnant; do not use Symbicort Turbuhaler unless your doctor tells you to.
• If you become pregnant during treatment with Symbicort Turbuhaler, do not stop using it and consult your doctor immediately.
• If you are breastfeeding, talk to your doctor before using Symbicort Turbuhaler.

Driving and operating machines

The influence of Symbicort Turbuhaler on the ability to drive and operate machinery is negligible or insignificant.

Symbicort Turbuhaler contains lactose

Symbicort Turbuhaler contains lactose, which is a type of sugar. If your doctor has told you that you have a lactose intolerance, consult with him before using this medicine. The amount of lactose in this medicine usually does not cause problems in people with lactose intolerance.

The lactose excipient contains small amounts of milk proteins that may cause allergic reactions in patients with cow's milk protein allergy.

• Follow exactly the administration instructions of this medication as indicated by your doctor or pharmacist. If in 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 the time.
• If you are using Symbicort Turbuhaler for asthma, your doctor will want to check regularly how your symptoms are progressing.

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 do a blood test from time to time. You may feel unwell in general when the number of oral steroid tablets is reduced, even if your lung symptoms are improving.In this case, some symptoms may temporarily reappear such ascongestion orrunny nose, weakness ormuscle and joint painand skin rash (urticaria).If any of these symptoms concern you, or if you experience any others such as headache, fatigue, nausea, or vomiting, contact your doctor immediately.If you develop allergic or arthritic symptoms, 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 (for example, when you have a chest infection or before surgery).

Important information about asthma or COPD symptoms

If while using Symbicort Turbuhaler you feel difficulty breathing or emit "puffs" with breathing, 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 feeling 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 instructed you:

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

a) Using Symbicort Turbuhaler and another reliever inhaler separately for symptom relief

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

Adults (18 years and older)

• 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 (12-17 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 first talking to your doctor or nurse.

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

b) Using Symbicort Turbuhaler as a single inhaler for asthma

Use Symbicort Turbuhaler in this way only if your doctor has instructed you to and if you are 12 years old or older.

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

• 1 inhalation in the morningand1 inhalation at night

or

• 2 inhalations in the morning

or

• 2 inhalations at night.

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

Also use Symbicort Turbuhaler as a "reliever" to treat asthma symptoms when they appear and to prevent asthma symptoms from appearing (for example, during exercise or exposure 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 so you can use it when you need it.

Normally, you will not need a total dose of more than 8 inhalations per day. 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, see your doctor or nurse, as they may need to change your treatment.

Do not 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 your exercise and the frequency of your exposure to allergens may influence the treatment prescribed.

Chronic Obstructive Pulmonary Disease (COPD)

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

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

Preparing your new Symbicort Turbuhaler inhaler

Before using yournewSymbicort Turbuhaler inhalerfor the first time, you must prepare it as follows:

• Remove and lift the cap that covers the Turbuhaler. You will hear a small "click" when the cap is removed.
• Hold your Symbicort Turbuhaler inhaler in a vertical position with the red ring at the bottom.
• Turn the red ring until it clicks in one direction and then back again in the other direction (it does not matter which direction first). You will hear a characteristic "click" in one of the two directions. It does not matter if the "click" is heard in the first or second turn.
• Turn the red ring in both directions.
• Atthis point, your Symbicort Turbuhaler inhaler is already loaded and ready to use.

How to take an inhalation

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

1.Remove and lift the cap that covers the Turbuhaler. You will hear a small "click" when the cap is removed.

2.Hold your Symbicort Turbuhaler inhaler in a vertical positionwith the red ring at the bottom.

3. Do not hold the mouthpiece when loading your Symbicort Turbuhaler inhaler. To load your Symbicort Turbuhaler inhaler with a dose, gire the red ring until it clicks in one direction.

Later turn it back again until it clicks in the other direction (it does not matter which direction first). You will hear a characteristic "click" in one of the two directions. It does not matter if the "click" is heard in 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 going to use it.

4. Keeping your Symbicort Turbuhaler inhaler away, slowly exhale the air from your mouth (without it being uncomfortable). Do not blowa through your Symbicort Turbuhaler inhaler.

5. Place the mouthpiece gently between your teeth, close your lips, and inhaleenergetically and deeplythrough your mouth. Do not bite or press the mouthpiece hard.

6.Remove your Symbicort Turbuhaler inhaler from your mouth and exhale slowly.The amount of medication inhaled is very small, which means you may not notice any taste after inhalation.However, if you have followed the use instructions, you can be sure that you have inhaled the dose and that the medication has reached your lungs.

7. If you need to take another inhalation, repeat steps 2 to 6.

8. Put the cap firmly back on after use.

9.After your daily morning and/or evening doses, rinse your mouth with water. Do not swallow.

Do not try 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 loose from your Symbicort Turbuhaler inhaler.

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

Cleaning your Symbicort Turbuhaler inhaler

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

When to start using a new inhaler

• The dose indicator informs you about the number of doses (inhalations) remaining 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 in 10 doses (for the 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 of the indicator window first appears, there are approximately 20 doses left. When there are the last 10 doses left, the background of the indicator window is red, and when the 0 has reached the middle of the indicator window, you should start using a new Symbicort Turbuhaler inhaler.

Nota:

• Although your Symbicort Turbuhaler inhaler is empty, the ring will continue to turn and you will continue to hear the characteristic "click".
• The sound you hear when shaking your Symbicort Turbuhaler inhaler is not produced by the medication but by a drying agent, 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 the doses loaded.

If you use more Symbicort Turbuhaler than you should

It is essential to use the dose indicated in the leaflet or the dose 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, contact the Toxicology Information Service. Phone: 91 5620420, indicating the medication and the amount ingested.

If you forgot to use Symbicort Turbuhaler

• If you forget a dose of Symbicort Turbuhaler, 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 nottake a double dose to compensate for the missed doses.

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

Like all medicines, this medicine may cause side effects, although not everyone will experience them.

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

• Your face becomes swollen, particularly around the mouth (tongue and/or throat and/or difficulty swallowing) or hives accompanied by difficulty breathing (angioedema) and/or sudden feeling of faintness, indicating that you may be experiencing an allergic reaction. This occurs rarely, affecting fewer than 1 in 1,000 patients.
• You experience acute wheezing or difficulty breathing immediately after using your inhaler.If either of these symptoms occurs, stop using Symbicort Turbuhaler immediately and use your "relief inhaler." Contact your doctor immediately as you may need to change your treatment.This occurs very rarely, affecting fewer than 1 in 10,000 patients.

Other possible side effects:

Frequent (may affect up to 1 in 10 patients)

• Palpitations (note the heartbeats), tremors. When these effects occur, they are usually mild and disappear as you continue using your Symbicort Turbuhaler.
• Oral thrush (fungal infection) in the mouth; this effect is less likely if you rinse your mouth with water after using your Symbicort Turbuhaler.
• Mild throat irritation, cough, hoarseness.
• Headache.
• Pneumonia(lung infection) in patients with COPD.

Inform your doctor if you experience any of the following symptoms while inhaling Symbicort Turbuhaler, which may be symptoms of a lung infection:

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

Rare(may affect up to 1 in 100 patients)

• Agitation, restlessness, nervousness.
• Difficulty sleeping.
• Dizziness.
• Nausea (discomfort).
• Accelerated heart rate.
• Skin hematomas.
• Muscle cramps.
• Blurred vision.

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

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

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

• Depression.
• Changes in behavior, especially in children.
• Chest pain or discomfort (angina pectoris).
• Increased blood sugar levels.
• Alterations in taste, such as unpleasant mouth taste.
• Variationsin blood pressure.

Inhaled corticosteroids can 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 thinning)
• Cataracts (loss of transparency of the lens in the eye)
• Glaucoma (increased eye pressure)
• Delayed growth in children and adolescents
• Effectson the adrenal glands (small glands located near the kidneys).

These effects are much less likely with inhaled corticosteroids than with oral corticosteroids.

Reporting side effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this leaflet. You can also report them directly through theSpanish System for Pharmacovigilance of Medicines for Human Use:www.notificaRAM.es. By reporting side effects, you can contribute to providing more information on the safety of this medicine.

• Keep this medication out of the 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 conditions for conservation.
• Medications should not be thrown down the drain or in the trash. Dispose of the packaging and medications you no longer need at the SIGRE collection point at the pharmacy. Ask your pharmacist how to dispose of the packaging and medications you no longer need. By doing so, you will help protect the environment.

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 contents of the package

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

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

Only some package sizes may be marketed.

Marketing authorization holder and manufacturer responsible

The marketing authorization holder is:

AstraZeneca Farmacéutica Spain, S.A.

C/ Puerto de Somport 21-23

28050 Madrid

Spain

The manufacturer responsible is:

AstraZeneca AB

S-151 36 Södertälje

Sweden

This medicine is authorized in the member states of the European Economic Area with 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

Last review date of this leaflet: February 2021

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