Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

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Oxis Turbohaler 6, inhalation powder

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Formoterol fumarate dihydrate may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Formoterol fumarate dihydrate

Equivalent medicines (same active substance, strength and form)

Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

for Oxis Turbohaler is an inhaler. It contains a medicine called formoterol. This belongs to a group of medicines called 'long-acting beta-agonists' or 'bronchodilators'. It works by relaxing the muscles in your airways. This helps you to breathe more easily. It starts to work within 1 to 3 minutes and the effects last up to 12 hours. Your doctor has prescribed this medicine to treat asthma or chronic obstructive pulmonary disease (COPD). Asthma Oxis Turbohaler is used to treat asthma in adults, adolescents and children 6 years and older. For asthma, your doctor will prescribe two asthma inhalers: Oxis Turbohaler and a separate 'corticosteroid' inhaler. These should be used together.  Oxis Turbohaler is used to help prevent asthma symptoms from happening.  Some people also use Oxis Turbohaler when they need extra doses for relief of asthma symptoms, to make it easier to breathe again.  Oxis Turbohaler can also be used before exercise to prevent asthma symptoms caused by exercise. Chronic obstructive pulmonary disease (COPD) Oxis Turbohaler can also be used to treat the symptoms of COPD in adults. COPD is a longterm disease of the airways in the lungs, which is often caused by cigarette smoking.

What you need to know before you take it

e Oxis Turbohaler Do not use Oxis Turbohaler:  If you are allergic (hypersensitive) to formoterol, or any of the other ingredients of this medicine (listed in section 6).

Warnings and Precautions Talk to your doctor or pharmacist before using Oxis Turbohaler if  You are diabetic. You may need some additional blood sugar tests while you are using Oxis Turbohaler.  You have high blood pressure or you have ever had a heart problem.  You have problems with your thyroid gland.  You have low levels of potassium in your blood. Your doctor may take blood samples to check the levels of potassium in your blood.  You have severe liver problems such as liver cirrhosis. If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before using Oxis Turbohaler. Other medicines and Oxis Turbohaler Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines that you buy without a prescription and herbal medicines. This is because Oxis Turbohaler can affect the way some medicines work and some medicines can have an effect on Oxis Turbohaler. In particular, tell your doctor or pharmacist if you are taking any of the following medicines:  Beta-blocker medicines (such as atenolol or propranolol for high blood pressure), including eyedrops (such as timolol for glaucoma).  Medicines for a fast or uneven heart beat (such as quinidine).  Medicines like digoxin, often used to treat heart failure.  Diuretics, also known as 'water tablets' (such as furosemide). These are used to treat high blood pressure.  Steroid medicines that you take by mouth (such as prednisolone).  Xanthine medicines (such as theophylline or aminophylline). These are often used to treat asthma.  Erythromycin (used to treat infections).  Anti-histamines (such as terfenadine).  Other substances that dilate the airways (bronchodilators, such as salbutamol).  Ephedrine (used to treat asthma or as a decongestant).  Tricyclic anti-depressants (such as amitriptyline). If any of the above applies to you, or if you are not sure, talk to your doctor or pharmacist before using Oxis Turbohaler. Also tell your doctor or pharmacist if you are going to have a general anaesthetic for an operation or for dental work. The addition of anticholinergics (such as tiotropium or ipratropium bromide) to the treatment with Oxis Turbohaler, can help to open your airways even more. Pregnancy, breast-feeding and fertility  If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor for advice before taking this medicine – do not use Oxis Turbohaler unless your doctor tells you to.  If you get pregnant while using Oxis Turbohaler, do not stop using Oxis Turbohaler but talk to your doctor immediately.

Driving and using machines Oxis Turbohaler is not likely to affect you being able to drive or use any tools or machines. Oxis Turbohaler contains lactose Oxis Turbohaler contains lactose, which is a type of sugar. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product. The amount of lactose in this medicine does not normally cause problems in people who are lactose intolerant. The excipient lactose contains small amounts of milk proteins, which may cause allergic reactions.

3. How to use Oxis Turbohaler   

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Do not increase the dose of Oxis Turbohaler prescribed by your doctor without talking to your doctor first. If you are using Oxis Turbohaler regularly for asthma or COPD you should continue to use your medicine, even if you have no symptoms.

Important information about your asthma or COPD symptoms If you feel you are getting breathless or wheezy while using Oxis Turbohaler, you should continue to use Oxis Turbohaler but go to see 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.  You start getting chest tightness.  You are not getting relief from your current dose.  You need to take more than your usual dose for more than two days in a week.  You need to use your Turbohaler more often than usual before exercise. These signs could mean that your asthma or COPD is not being properly controlled and you may need different or additional treatment immediately. Asthma Oxis Turbohaler should not be used in children under 6 years of age. Adults (18 years and above)  The recommended dose is 1 or 2 inhalations, once or twice a day.  Your doctor may increase this to 4 inhalations, once or twice a day.  Some people also use Oxis Turbohaler as a 'reliever inhaler'. If you get asthma symptoms, the usual dose is 1 or 2 inhalations when they happen.  A total daily dose of more than 8 inhalations is not normally needed. This includes the inhalations that you take every day, when you get asthma symptoms and before

exercise. However, your doctor may allow you to take up to 12 inhalations a day. Do not use more than 12 inhalations in total in 24 hours. Do not take more than 6 inhalations at any one time.

Children and adolescents (6 to 17 years)  The recommended dose is 2 inhalations, once or twice a day.  Some children also use Oxis Turbohaler as a 'reliever inhaler'. If your child gets asthma symptoms, the usual dose is 1 or 2 inhalations when they happen.  A total daily dose of more than 4 inhalations is not normally needed. This includes the inhalations that your child takes every day, when they get asthma symptoms and before exercise. However, your doctor may allow your child to take up to 8 inhalations a day. Your child should not use more than 8 inhalations in total in 24 hours.  Your child should not have more than 2 inhalations at any one time. Your doctor (or asthma nurse) will help you to manage your asthma. Once your asthma is well controlled your doctor may consider it appropriate to gradually reduce the dose of Oxis Turbohaler. Asthma caused by exercise If you or your child have asthma symptoms caused by exercise, your doctor may advise you or your child to use Oxis Turbohaler before exercise as well. Oxis Turbohaler should not be used in children under 6 years of age. Adults (18 years and above)  The recommended dose is 2 inhalations before exercise.  A total daily dose of more than 8 inhalations is not normally needed. This includes the inhalations that you take every day, when you get asthma symptoms and before exercise. However, your doctor may allow you to take up to 12 inhalations a day. Do not use more than 12 inhalations in total in 24 hours.  Do not take more than 6 inhalations at any one time. Children and adolescents (6 to 17 years)  The recommended dose is 1 or 2 inhalations before exercise.  A total daily dose of more than 4 inhalations is not normally needed. This includes the inhalations that your child takes every day, when they get asthma symptoms and before exercise. However, your doctor may allow your child to take up to 8 inhalations a day. Your child should not use more than 8 inhalations in total in 24 hours.  Your child should not have more than 2 inhalations at any one time.

Chronic obstructive pulmonary disease (COPD)  Only to be used by adults (aged 18 years and above).  The recommended dose is 2 inhalations once or twice a day.  Your doctor may advise you to take extra doses for relief of your COPD symptoms.  You should not have more than 8 inhalations a day.  Do not take more than 4 inhalations at any one time.

Preparing your new Oxis Turbohaler Inhaler Before using your new Oxis Turbohaler for the first time, you need to prepare it for use as follows.      

Unscrew the white cover and lift it off. You may hear a rattling sound. Hold your Oxis Turbohaler upright with the turquoise grip at the bottom. Turn the turquoise grip as far as it will go in one direction. Then turn it as far as it will go in the other direction (it does not matter which way you turn it first). You should hear a click sound. Do this again, turning the turquoise grip in both directions. Your Oxis Turbohaler is now ready for use.

How to take it

an inhalation Every time you need to take an inhalation, follow the instructions below.

Mouthpiece Indicator Grip

1. Unscrew the white cover and lift it off. You may hear a rattling sound. 2. Hold your Turbohaler upright with the turquoise grip at the bottom. 3. Do not hold the mouthpiece when you load your Turbohaler. To load your Turbohaler with a dose, turn the turquoise grip as far as it will go in one direction. Then turn it as far as it will go in the other direction (it does not matter which way you turn it first). You should hear a click sound. Your Turbohaler is now loaded and ready to use. Only load your Turbohaler when you need to use it.

4. Hold your Turbohaler away from your mouth. Breathe out gently (as far as is comfortable). Do not breathe out through your Turbohaler. 5. Place the mouthpiece gently between your teeth. Close your lips. Breathe in as deeply and as hard as you can through your mouth. Do not chew or bite on the mouthpiece.

6. Remove your Turbohaler from your mouth. Then breathe out gently. The amount of medicine that is inhaled is very small. This means you may not be able to taste it after inhalation. If you have followed the instructions, you can be confident that you have inhaled the dose and the medicine is now in your lungs. 7. If you are to take a second inhalation, repeat steps 2 to 6. 8. Replace the cover tightly after use. Do not try to remove the mouthpiece since it is fixed to your Turbohaler and must not be taken off. The mouthpiece can be rotated but do not twist it unnecessarily. Do not use your Turbohaler if it has been damaged or if the mouthpiece has come apart from your Turbohaler. As with all inhalers, caregivers should ensure that children prescribed Oxis Turbohaler use correct inhalation technique, as described above. Cleaning your Turbohaler Wipe the outside of the mouthpiece once a week with a dry tissue. Do not use water or liquids. When to start using a new Turbohaler  The dose indicator tells you how many doses are left in the Turbohaler, starting with 60 doses when it is full.

The dose indicator is marked in intervals of 10 doses. Therefore, it does not show every dose. When you first see a red mark at the edge of the indicator window, there are approximately 20 doses left. For the last 10 doses, the background of the dose indicator is red. When the '0' on the red background has reached the middle of the window, you must start using a new Turbohaler.

Note:  The grip will still twist and 'click' even when your Turbohaler is empty.  The sound that you hear as you shake your Turbohaler is produced by a drying agent and not the medicine. Therefore, the sound does not tell you how much medicine is left in your Turbohaler.  If you load your Oxis Turbohaler more than once by mistake before taking your dose, you will still only receive one dose. However, the dose indicator will register all the loaded doses. If you use more Oxis Turbohaler than you should If you use more Oxis Turbohaler than you should, contact your doctor or pharmacist for advice immediately. The following effects may happen: trembling, headache or a rapid heartbeat. If you forget to use Oxis Turbohaler If you forget to take a dose, take it as soon as you remember. However, if it is nearly time for your next dose, skip the missed dose. Do not take a double dose to make up for a forgotten dose. If you stop using Oxis Turbohaler Do not stop using Oxis Turbohaler without talking to your doctor. If you have any further questions on using your Turbohaler, ask your doctor, nurse or pharmacist.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. If the following happens to you, stop using Oxis Turbohaler and talk to your doctor immediately:  Bronchospasm (tightening of the muscles in the airways which causes sudden wheezing) after inhaling your medicine. This happens very rarely, may affect up to 1 in 10,000 people. Other possible side effects: Common (may affect up to 1 in 10 people)  Trembling or shaking. If these effects occur, they are usually mild and usually disappear as you continue to use Oxis Turbohaler.  Headache.  Feeling dizzy.  Nausea (feeling sick).  Muscle cramps. Uncommon (may affect up to 1 in 100 people)  Palpitations (awareness of your heart beating). If this effect occurs, it is usually mild and usually disappear as you continue to use Oxis Turbohaler.

        

Disturbed sleep. Fast heart beat. Allergic reactions such as rash, itching and bronchospasm. Low level of potassium in your blood. An increase in the amount of sugar (glucose) in your blood. Taste changes, such as an unpleasant taste in the mouth. Changes in your blood pressure. Uneven heart beat. Chest pain or tightness in the chest (angina pectoris).

Rare (may affect up to 1 in 1,000 people)  Feeling restless or agitated. Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly (see details below). By reporting side effects you can help provide more information on the safety of this medicine. United Kingdom Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

How to store it

Oxis Turbohaler     

Keep this medicine out of the sight and reach of children. This medicinal product does not require any special storage conditions. When not in use, Oxis Turbohaler should be stored with the cover tightened. Do not use this medicine after the expiry date which is stated on the carton or on the side of your Turbohaler. The expiry date refers to the last day of that month. Always be sure to dispose of your used Turbohaler responsibly, since some of the medicine will remain inside it. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

Contents of the pack and other information

What Oxis Turbohaler 6 contains The active substance is formoterol fumarate dihydrate. Each dose contains 6 micrograms of formoterol fumarate dihydrate of which you can inhale 4.5 micrograms. The other ingredient is lactose monohydrate (which contains milk proteins). See section 2 Oxis Turbohaler contains lactose. What Oxis Turbohaler 6 looks like and contents of the pack Oxis Turbohaler 6 is an inhaler containing your medicine. The inhalation powder is white in colour. Each Turbohaler contains 60 doses and has a white body with a turquoise turning grip.

Oxis Turbohaler 6 is available in the following pack sizes: 60 doses (1 inhaler), 3×60 doses (3 inhalers), 10×60 doses (10 inhalers), 18×60 doses (18 inhalers) or 20×60 doses (20 Inhalers). Not all pack sizes may be marketed. Marketing Authorisation Holder and Manufacturer The Marketing Authorisation for Oxis Turbohaler 6 in the United Kingdom is held by AstraZeneca UK Limited, 1 Francis Crick Avenue, Cambridge, CB2 0AA, UK. Oxis Turbohaler 6 is manufactured by AstraZeneca AB, Forskargatan 18, SE-151 36 Södertälje, Sweden. This medicinal product is authorised in the Member States of the EEA under the following names: Austria Belgium Denmark Finland Germany Greece Ireland Italy Luxembourg The Netherlands Portugal Spain Sweden UK

Oxis Turbohaler 6 μg – Dosier – Pulverinhalator Oxis Turbohaler 4,5 μg/dose Oxis Turbuhaler Oxis Turbuhaler Oxis Turbohaler 6 Mikrogramm Pulver zur Inhalation Oxez Turbuhaler Oxis Turbohaler 6, inhalation powder Oxis Turbohaler 4.5 Oxis Turbohaler 4.5 μg/dose Oxis 6 Turbuhaler Oxis Turbohaler Oxis Turbuhaler 4.5 microgramos polvo para inhalación Oxis Turbuhaler Oxis Turbohaler 6, inhalation powder

To listen to or request a copy of this leaflet in Braille, large print or audio please call, free of charge: 0800 198 5000 Please be ready to give the following information: Product name Oxis Turbohaler 6 Reference number 17901/0154 This is a service provided by the Royal National Institute of Blind People. This leaflet was last revised in June 2023. © AstraZeneca 2023 Oxis and Turbohaler are trade marks of the AstraZeneca group of companies. RSP 23 0023

Frequently asked questions about Oxis Turbohaler 6, inhalation powder

How do I take Oxis Turbohaler 6, inhalation powder?

Oxis Turbohaler 6, inhalation powder comes as inhaler. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Oxis Turbohaler 6, inhalation powder?

The active substance in Oxis Turbohaler 6, inhalation powder is formoterol fumarate dihydrate.

Are there equivalent medicines to Oxis Turbohaler 6, inhalation powder?

Medicines with the same active substance, strength and form include: Oxis Turbohaler 12, inhalation powder. They are interchangeable only if your prescriber or pharmacist says so.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Oxis Turbohaler 6, inhalation powder, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Oxis Turbohaler 6, inhalation powder without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Formoterol fumarate dihydrate (37 medicines)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Oxis Turbohaler is indicated in adults, adolescents and children aged 6 years and older, as add on therapy to maintenance treatment with inhaled corticosteroids, for the relief of broncho-obstructive symptoms and prevention of exercise-induced symptoms, in patients with asthma when adequate treatment with corticosteroids is not sufficient.Oxis Turbohaler is also indicated in adults for the relief of broncho-obstructive symptoms in patients with chronic obstructive pulmonary disease (COPD).

4.2. Posology and method of administration

Posology

Use of doses above those normally required by the individual patient on more than 2 days per week, is a sign of suboptimal disease control and maintenance treatment should be reassessed. Asthma:

In asthma, Oxis Turbohaler can be used once or twice daily ('regular dosage') and as 'relief medication' to relieve acute broncho-obstructive symptoms. Adults aged > 18 years:

Relief medication: 1 or 2 inhalations for the relief of acute broncho-obstructive symptoms. Regular dosage: 1 or 2 inhalations once or twice daily. Some patients may need 4 inhalations once or twice daily. Prevention of exercise-induced bronchoconstriction: 2 inhalations before exercise. The daily dose for regular use should not exceed 8 inhalations, however occasionally up to a maximum of 12 inhalations may be allowed within a 24-hour period. No more than 6 inhalations should be taken on any single occasion. Children and adolescents 6 years and older:

Relief medication: 1 or 2 inhalations for the relief of acute broncho-obstructive symptoms.Regular dosage: 2 inhalations once or twice daily.Prevention of exercise-induced bronchoconstriction: 1 or 2 inhalations before exercise.The regular daily dose should not exceed 4 inhalations, however occasionally up to 8 inhalations may be allowed within a 24-hour period. No more than 2 inhalations should be taken on any single occasion.COPD: Adults aged > 18 years:

Regular dosage: 2 inhalations once or twice daily.The daily dose for regular use should not exceed 4 inhalations. If required, additional inhalations above those prescribed for regular therapy may be used for relief of symptoms, up to a maximum total daily dose of 8 inhalations (regular plus as required). More than 4 inhalations should not be taken on any single occasion. Special populations:

Elderly

There are no special dosing requirements for elderly patients. Patients with hepatic or renal impairment:

There are no data available for use of Oxis Turbohaler in patients with hepatic or renal impairment (see also section 5.2). Paediatric population:

Oxis Turbohaler is not recommended for use in children below 6 years due to insufficient data on safety and efficacy.NB! A higher strength (12 micrograms/dose) is available as an alternative for patients requiring 2 or more inhalations. Method of administration

Instructions for correct use of Oxis Turbohaler

Oxis Turbohaler is inspiratory flow driven which means that, when the patient inhales through the mouthpiece, the substance will follow the inspired air into the airways.Note! It is important to instruct the patient to breathe in forcefully and deeply through the mouthpiece to ensure that an optimal dose is obtained.It is important to instruct the patient never to chew or bite on the mouthpiece and never to use the inhaler if it has been damaged or if the mouthpiece has become detached.The patient may not taste or feel any medication when using Oxis Turbohaler due to the small amount of drug dispensed.Detailed instructions for use are packed together with each inhaler.

4.3. Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

4.4. Special warnings and precautions for use

General

Oxis Turbohaler should not be used (and is not sufficient) as the first treatment for asthma.Asthmatic patients who require therapy with long acting β2-agonists, should also receive optimal maintenance anti-inflammatory therapy with corticosteroids. Patients must be advised to continue taking their anti-inflammatory therapy after the introduction of Oxis Turbohaler even when symptoms decrease. Should symptoms persist, or treatment with β2-agonists need to be increased, this indicates a worsening of the underlying condition and warrants a reassessment of the maintenance therapy. Although Oxis Turbohaler may be introduced as add-on therapy when inhaled corticosteroids do not provide adequate control of asthma symptoms, patients should not be initiated on Oxis Turbohaler during an acute severe asthma exacerbation, or if they have significantly worsening or acutely deteriorating asthma. Serious asthma-related adverse events and exacerbations may occur during treatment with Oxis Turbohaler. Patients should be asked to continue treatment but to seek medical advice if asthma symptoms remain uncontrolled or worsen after initiation on Oxis Turbohaler. Once asthma symptoms are controlled, consideration may be given to gradually reducing the dose of Oxis Turbohaler. Regular review of patients as treatment is stepped down is important. The lowest effective dose of Oxis Turbohaler should be used.The maximum daily dose should not be exceeded. The long-term safety of regular treatment at higher doses than 36 micrograms per day in adults with asthma, 18 micrograms per day in children with asthma and 18 micrograms per day in patients with COPD, has not been established.Frequent need of medication (i.e. prophylactic treatment e.g. corticosteroids and long-acting β2-agonists) for the prevention of exercise-induced bronchoconstriction several times every week, despite an adequate maintenance treatment, can be a sign of suboptimal asthma control, and warrants a reassessment of the asthma therapy and an evaluation of the compliance. Cardiovascular and endocrine disorders

Caution should be observed when treating patients with thyrotoxicosis, phaeochromocytoma, hypertrophic obstructive cardiomyopathy, idiopathic subvalvular aortic stenosis, severe hypertension, aneurysm or other severe cardiovascular disorders, such as ischaemic heart disease, tachyarrhythmias or severe heart failure. QTc prolongation

Formoterol may induce prolongation of the QTc-interval. Caution should be observed when treating patients with prolongation of the QTc-interval and in patients treated with drugs affecting the QTc-interval (see section 4.5). Diabetic patients

Due to the hyperglycaemic effects of β2-agonists, additional blood glucose monitoring is recommended initially in diabetic patients. Hypokalaemia

Potentially serious hypokalaemia may result from β2-agonist therapy. Particular caution is recommended in acute severe asthma as the associated risk may be augmented by hypoxia. The hypokalaemic effect may be potentiated by concomitant treatment with xanthine-derivatives, steroids and diuretics. The serum potassium levels should therefore be monitored. Bronchospasm

As with other inhalation therapy, the potential for paradoxical bronchospasm should be considered. If it occurs, the treatment should be discontinued immediately and alternative therapy started (see section 4.8). Lactose intolerance

Oxis Turbohaler contains lactose monohydrate 895.5 micrograms per delivered dose. This amount does not normally cause problems in lactose intolerant people. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine. Paediatric population

Children up to the age of 6 years should not be treated with Oxis Turbohaler, as no sufficient experience is available for this group.

4.5. Interaction with other medicinal products and other forms of interaction

No specific interaction studies have been carried out with Oxis Turbohaler.Concomitant treatment with other sympathomimetic substances such as other β2-agonists or ephedrine may potentiate the undesirable effects of Oxis Turbohaler and may require titration of the dose. Concomitant treatment with xanthine derivatives, steroids or diuretics such as thiazides and loop diuretics may potentiate a rare hypokalaemic adverse effect of β2-agonists. Hypokalaemia may increase the disposition towards arrhythmias in patients who are treated with digitalis glycosides. There is a theoretical risk that concomitant treatment with other drugs known to prolong the QTc-interval may give rise to a pharmacodynamic interaction with formoterol and increase the possible risk of ventricular arrhythmias. Examples of such drugs include certain antihistamines (e.g. terfenadine, astemizole, mizolastine), certain antiarrhythmics (e.g. quinidine, disopyramide, procainamide), erythromycin and tricyclic antidepressants.There is an elevated risk of arrhythmias in patients receiving concomitant anaesthesia with halogenated hydrocarbons.The bronchodilating effects of formoterol can be enhanced by anticholinergic drugs.Beta-adrenergic blockers can weaken or inhibit the effect of Oxis Turbohaler. Oxis Turbohaler should therefore not be given together with beta-adrenergic blockers (including eye drops) unless there are compelling reasons.

4.6. Fertility, pregnancy and lactation

Pregnancy

There are no adequate data from the use of formoterol in pregnant women. In animal studies formoterol has caused implantation losses as well as decreased early postnatal survival and birth weight. The effects appeared at considerably higher systemic exposures than those reached during clinical use of Oxis Turbohaler. Treatment with Oxis Turbohaler may be considered at all stages of pregnancy if needed to obtain asthma control and if the expected benefit to the mother is greater than any possible risk to the foetus. The potential risk for humans is unknown. Breast-feeding

It is not known whether formoterol passes into human breast milk. In rats, small amounts of formoterol have been detected in maternal milk. Administration of Oxis Turbohaler to women who are breastfeeding should only be considered if the expected benefit to the mother is greater than any possible risk to the child. Fertility

Animal reproduction studies with formoterol have shown a somewhat reduced fertility in male rats at considerably higher systemic exposures than those reached during clinical use. Thus, these animal experimental results do not seem to be relevant in humans.

4.7. Effects on ability to drive and use machines

Oxis Turbohaler has no or negligible influence on the ability to drive and use machines.

4.8. Undesirable effects

Summary of the safety profile

The most commonly reported adverse events of β2-agonist therapy, such as tremor and palpitations, tend to be mild and disappear within a few days of treatment. Tabulated list of adverse reactions

Adverse reactions, which have been associated with formoterol are given below, listed by system organ class and frequency. Frequency are defined as: very common (≥1/10), common (≥1/100 and <1/10), uncommon (≥1/1 000 and <1/100), rare (≥1/10 000 and <1/1000) and very rare <1/10 000). System Organ Class Frequency Adverse Reaction

Cardiac disorders Uncommon Palpitations

Uncommon Tachycardia

Uncommon Cardiac arrhythmias, e.g. atrial fibrillation, supraventricular tachycardia, extrasystoles.

Uncommon Angina pectoris

Very rare Prolongation of QTc interval

Gastrointestinal disorders Common Nausea

Immune system disorders Uncommon Hypersensitivity reactions, e.g. bronchospasm, exanthema, urticaria, pruritus

Metabolic and nutrition disorders Uncommon Hypokalemia

Uncommon Hyperglycaemia

Musculoskeletal, connective tissue and bone disorders Common Muscle cramps

Nervous system disorders Common Headache*, tremor, dizziness

Uncommon Taste disturbances

Psychiatric disorders Uncommon Sleep disturbances

Rare Agitation, restlessness

Vascular disorders Uncommon Variations in blood pressure

* Headache occurred in 6.5% of patients in OXIS and 6.2% on placebo. Description of selected adverse reactions

As with all inhalation therapy, paradoxical bronchospasm may occur in very rare cases (see section 4.4).Treatment with β2-agonists may result in an increase in blood levels of insulin, free fatty acids, glycerol and ketone bodies.The excipient lactose contains small amounts of milk proteins. These may cause allergic reactions. Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9. Overdose

There is limited clinical experience on the management of overdose. Symptoms

An overdose would likely lead to effects that are typical of β2-agonists: tremor, headache, palpitations. Symptoms reported from isolated cases are tachycardia, hyperglycaemia, hypokalaemia, prolonged QTc-interval, arrhythmia, nausea and vomiting. Supportive and symptomatic treatment is indicated. Management

Use of cardioselective beta-blockers may be considered, but only subject to extreme caution since the use of β-adrenergic blocker medication may provoke bronchospasm. Serum potassium should be monitored.

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