What is Symbion?
Symbion^® Bexicap is a Dry Powder Inhaler with combination of Formoterol Fumarate Dihydrate BP and Budesonide BP. Formoterol is a very potent, long-acting, β2 adrenoceptor-agonist with a high intrinsic activity and a rapid onset of action. Budesonide is a potent glucocorticoid that binds with high affinity to the glucocorticoid receptor.  It is a unique inhaler with the only combination recommended by GINA to be used for both maintenance and reliever therapy of Asthma.

How Symbion Works in Our Body?
Symbion contains the bronchodilator formoterol and the glucocorticosteroid budesonide. Both exhibit their mechanism of action and act additively to prevent and relieve airway diseases, asthma and COPD.
Budesonide
When inhaled, budesonide exerts a dose-dependent anti-inflammatory action in the airways, resulting in reduced symptoms and fewer asthma exacerbations. The exact mechanism responsible for the anti-inflammatory effect of glucocorticosteroids is unknown.

Formoterol
Inhaled formoterol, a selective long-acting β2-agonist (LABA) bronchodilator, results in rapid and long-acting relaxation of bronchial smooth muscle in patients with reversible airways obstruction. The bronchodilating effect is dose dependent, with an onset of effect within 1–3 minutes. Studies performed in both stable and acute severe asthma confirm that formoterol works as fast as salbutamol or terbutaline and faster than salmeterol . The duration of effect is lasts at least 12 hours after a single dose.


What is the indications of Symbion?
Maintenance and Reliever Treatment of Asthma
Symbion® (Formoterol Fumarate Dihydrate and Budesonide) is indicated for the long-term, twice-daily, maintenance treatment of asthma in patients 12 years of age and older where the use of a combination (long-acting, selective β2-agonist and inhaled corticosteroid) has been found to be appropriate. It can also be used as reliever, in case of acute asthma attack. Maintenance Treatment of Chronic Obstructive Pulmonary Disease (COPD) Symbion®  (Formoterol Fumarate Dihydrate and Budesonide) is indicated for the twice daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema.

What is the dosage guideline for Symbion?
Asthma:Dosage is individual and should be adjusted according to disease severity. When control has been achieved, the dose should be titrated to the lowest effective dose For Symbion^® Bexicap, there are two treatment approaches:

• Maintenance Therapy: Symbion^® Bexicap is taken as regular maintenance treatment with a separate rapid acting bronchodilator as rescue. Patients should be advised to have their separate rapid acting bronchodilator available for rescue use at all times.
• Single Maintenance and Reliever Therapy : Symbion^® Bexicap is taken as regular maintenance and as needed in response to symptoms.(For Symbion 6/100 Bexicap and 6/200 only) Patients take a daily maintenance dose of Symbion^® Bexicap and in combination take Symbion® Bexicap as needed in response to symptoms. Patients should be advised to always have Symbion^® Bexicap available for use. Adults (18 years and older): The recommended maintenance dosage is 2 inhalations per day as maintenance therapy (either one inhalation twice daily, or two inhalations in either the morning or the evening), although some patients may require two inhalations twice daily. Patients should take 1 additional inhalation as needed in response to symptoms. If symptoms persist after a few minutes, an additional inhalation should be taken. Not more than 6 inhalations should be taken on any single occasion. A total daily dose of more than 8 inhalations is not normally needed; however, a total daily dose of up of 12 inhalations could be used for a limited period. Patients using more than 8 inhalations daily should be strongly recommended to seek medical advice.

COPD (Chronic Obstructive Pulmonary Disease)
Symbion® 6/200 Bexicap: 2 Bexicap capsule, twice daily

What are the precautions to follow?
It is recommended that the dose is tapered when the treatment is discontinued and should not be stopped abruptly. If patients find the treatment ineffective, or exceed the highest recommended dose of Symbion^® Bexicap, medical attention must be sought. Sudden and progressive deterioration in control of asthma is potentially life threatening and the patient should undergo urgent medical assessment. In this situation consideration should be given to the need for increased therapy with corticosteroids e.g. a course of oral corticosteroids, or antibiotic treatment if an infection is present. Patients should be advised to have their rescue inhaler available at all times. Patients should be reminded to take their Symbion^® Bexicap maintenance dose as prescribed, even when asymptomatic. The prophylactic use of Symbion^®, e.g. before exercise, has not been studied. Once asthma symptoms are controlled, consideration may be given to gradually reducing the dose of Symbion^®. Regular review of patients as treatment is stepped down is important. The lowest effective dose of Symbion^® Bexicap should be used.

Prescribe Information