Symbicort Caution For Usage

Incompatibilities: Not applicable.
INSTRUCTIONS FOR USE/HANDLING: Turbuhaler: Read all the following instructions carefully before using the inhaler.
The doctor, nurse or pharmacist should instruct the patient in the correct use of the inhaler.
Turbuhaler is a multidose inhaler from which very small amounts of powder are administered. When the patient breathes in through Turbuhaler, the powder is delivered in the lungs. It is therefore important to inhale forcefully and deeply through the mouthpiece.
How to prepare a new inhaler for use: Before using Turbuhaler for the first time the patient needs to prepare the inhaler for use: 1. Unscrew and lift off the cover. A rattling sound is heard when cover is unscrewed.
2. Hold the inhaler upright with the red grip downwards. Do not hold the mouthpiece when turning the grip. Turn the grip as far as it will go in one direction and then back again as far as it will go. It does not matter which way to turn first. During this procedure, there is a click sound. Perform the procedure twice.
The inhaler is now ready for use and the procedure should not be repeated. To take a dose, continue according to the instructions as follows.
How to use Symbicort Turbuhaler: To administer one dose, simply follow the instructions as follows.
1. Unscrew and lift off the cover. A rattling sound is heard when the cover is unscrewed.
2. Hold the inhaler upright with the red grip downwards. Do not hold the mouthpiece when turning the grip. To load the inhaler with a dose, turn the grip as far as it will go in one direction and then back again as far as it will go. It does not matter which way is turn first. During this procedure, the patient will hear a click.
3. Breathe out. Do not breathe out through the mouthpiece.
4. Place the mouthpiece gently between the teeth, close the lips and inhale forcefully and deeply through the mouth. Do not chew or bite on the mouthpiece.
5. Remove the inhaler from the mouth, before breathing out.
6. If more than one dose has been prescribed, repeat steps 2-5.
7. Replace the cover by screwing it back on tightly.
8. Rinse the mouth out with water. Do not swallow.
NOTE: Do not try to remove the mouthpiece since it is fixed to the inhaler. The mouthpiece can be rotated but do not twist it unnecessarily.
As the amount of the powder dispensed is very small, the patient may not be able to taste it after inhalation. However, the patient can still be confident that he/she had inhaled the dose if the instructions were followed.
If the patient by mistake performs the loading procedure more than once before taking the dose, the patient will still only receive one dose. The dose indicator will, however, register all the loaded doses.
The sound heard upon shaking the inhaler is not produced by the medication but by a drying agent.
When to replace the inhaler: The dose indicator tells approximately how many doses are left in the inhaler, starting with either 60 or 120 when full.
The indicator is marked in intervals of 10 doses. Therefore, it does not show the loading of each individual dose.
Be assured that the turbuhaler delivers the dose even if a movement in the dose indicator is not noticed.
For the last 10 doses, the background of the indicator is red. When the zero reaches the middle of the window, it is time to discard the inhaler.
Note that even when the dose indicator registers zero, it is still possible to turn the grip. However, the indicator stops moving and the zero remains in the window.
Cleaning: Wipe the outside of the mouthpiece regularly (once a week) with a dry tissue. Do not use water or liquids when cleaning the mouthpiece.
Disposal: Always be sure to dispose of used Turbuhaler responsibly in the recommended way, since some of the medicine will remain inside it. Ask the pharmacist for advice.
Remember: This medicine has been prescribed personally for the patient and should not be passed on to others. It may harm them, even if the symptoms are same as the patient.
Rapihaler: THE INHALER: The inhaler will already be assembled when the patient first receives it. Do not take the inhaler apart. If the canister becomes loose, then place it back and continue to use it as instructed.
PREPARING THE INHALER: Take the inhaler out of the moisture-protective foil before the patient uses it for the first time and throw away the foil. If the inhaler is new, shake it gently and release 2 puffs if using the 80/2.25 or 160/4.5 micrograms/actuation inhaler to prepare it for use. If the inhaler has not been used for a week or more, or it has been dropped, shake it gently and release 2 puffs in the air to prepare it for use.
TAKING THE MEDICINE: 1. Shake the inhaler gently before each use.
2. Remove the mouthpiece cover.
3. Hold the inhaler upright in front of the mouth, using the thumb(s) at the base of the inhaler and the index finger(s) on the top. Then breathe out as far as the patient can and put the mouthpiece gently in the mouth, between the teeth, and close the lips around it.
4. Start to breathe in deeply, comfortably and slowly through the mouth, press firmly down on the inhaler to release a puff of medicine.
5. Continue to breathe in and hold the breath for approximately 10 seconds or as long as it is comfortable, take the inhaler from the mouth and the finger from the top of the inhaler.
6. Take another puff, as directed by the doctor, shake the inhaler gently then repeat steps 3 to 5.
7. Put the mouthpiece cover back to keep dust and other debris from getting into the medicine.
8. Rinse the mouth with water to remove any excess medicine. Do not swallow.
IMPORTANT INFORMATION: CLEANING INSTRUCTIONS: The inhaler mouthpiece will need to be cleaned regularly, at least once a week. And to do this the patient will need to: 1. Remove the mouthpiece cover.
2. Wipe the inside and outside of the mouthpiece opening with a clean, dry cloth.
3. Replace the mouthpiece cover.
4. Do not put the inhaler in water.
5. Do not try to take the inhaler apart.
READING THE COUNTER: The arrow on the counter on the top of the inhaler points to the number of puffs remaining in the inhaler. It starts with 120 puffs when it is full.
The counter will count down toward zero ("0") each time the patient releases a puff of medicine (either when preparing the inhaler for use or when taking the medicine).
When the arrow on the counter enters the yellow area, this means that there are about 20 puffs left.
It is very important that the patient should note the number of puffs remaining in the SYMBICORT inhaler by reading the counter. Discard SYMBICORT after the counter reaches zero ("0"), indicating that the patient has used the number of puffs on the product label and box. The inhaler may not feel empty and it may continue to operate, but the patient will not get the right amount of medicine if he/she keeps using it.
Instructions for use, handling and disposal: Rapihaler: See Dosage & Administration. The canister should not be broken, punctured or burnt, even when apparently empty.
The canister contains a pressurised liquid. Do not expose to temperatures above 50°C.
Instructions for the correct use of Symbicort Rapihaler with a spacer device: The use of Symbicort Rapihaler with a spacer device is recommended to enable patients with difficulty in co-ordinating inhalation with actuation, such as young children or the elderly, to derive greater therapeutic benefit.
It is important to instruct the patient to carefully read the instructions for use/handling as previously mentioned in this monograph.