MedlinePlus Drug Information: Fluticasone and Salmeterol Oral Inhalation

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Other drug names:	A-Am An-Az B C-Ch Ci-Cz D-Dh Di-Dz E F G H I-J K-L M-Mh Mi-Mz N-Nh Ni-Nz O P-Pl Pm-Pz Q-R S-Sn So-Sz T-To Tp-Tz U-V W-Z 0-9

Fluticasone and Salmeterol Oral Inhalation

(floo tik' a sone and sal me' te role)

Brand name(s): Advair Diskus

Contents of this page:
Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow?	What should I do if I forget a dose? What side effects can this medication cause? What storage conditions are needed for this medicine? In case of emergency/overdose What other information should I know?

IMPORTANT WARNING:

A large clinical study found a small increase in deaths from asthma in patients who used salmeterol. Do not use fluticasone and salmeterol if you have asthma that is quickly getting worse. If you have any of the following signs of worsening asthma, call your doctor immediately: short-acting inhaler (e.g., albuterol) does not work as well as it used toneed to use more puffs than usual of short-acting inhaler or use it more oftenpeak-flow meter shows breathing is worseningneed to go to the emergency room for asthma treatment.

Why is this medication prescribed?

The combination of fluticasone and salmeterol is used to prevent wheezing, shortness of breath, and breathing difficulties caused by asthma. Fluticasone is in a class of medications called steroids. It works by reducing swelling in the airways. Salmeterol is in a class of medications called long-acting beta-agonists. It works by relaxing and opening air passages in the lungs, making it easier to breathe.

How should this medicine be used?

The combination of fluticasone and salmeterol comes as a powder to inhale by mouth using a special inhaler device. It usually is used twice a day, in the morning and evening, about 12 hours apart. To help you remember to use fluticasone and salmeterol, use it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use fluticasone and salmeterol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Do not use fluticasone and salmeterol during an asthma attack. Your doctor will prescribe a short-acting inhaler to use during attacks.

Fluticasone and salmeterol inhalation controls asthma but does not cure it. It may take a week or longer before you feel the full benefit of fluticasone and salmeterol. Tell your doctor if your symptoms do not improve after 2 weeks. Continue to use fluticasone and salmeterol even if you feel well. Do not stop using fluticasone and salmeterol without talking to your doctor. If you stop taking fluticasone and salmeterol, your symptoms may return.

Before you use fluticasone and salmeterol inhalation for the first time, read the written instructions that come with it. Ask your doctor, pharmacist, or respiratory therapist to show you how to use the inhaler. Practice using your inhaler while he or she watches.

To use the inhaler, follow these steps:

Hold the inhalation device in one hand, and put the thumb of your other hand on the thumbgrip. Push your thumb away from you as far as it will go until the mouthpiece appears and snaps into position.
Hold the inhalation device in a horizontal position with the mouthpiece toward you. Slide the lever away from you as far as it will go until it clicks.
Every time the lever is pushed back, a dose is ready to inhale. You will see the number in the dose counter go down. Do not waste doses by closing the device, playing with the lever, or advancing the lever more than once.
Hold the inhalation device level and away from your mouth, and breathe out as far as you comfortably can.
Put the mouthpiece to your lips. Breathe in quickly and deeply though the inhalation device, not through your nose.
Remove the inhalation device from your mouth, and hold your breath for 10 seconds or as long as you comfortably can. Breathe out slowly.
Put your thumb on the thumbgrip and slide it back toward you as far as it will go. The device will click shut.
Rinse your mouth with water, but do not swallow.

Never exhale into the inhalation device, take the device apart, or wash the mouthpiece or any part of the device. Keep the device dry. Do not use the device with a spacer.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using fluticasone and salmeterol,

tell your doctor and pharmacist if you are allergic to fluticasone (Flonase, Flovent), salmeterol (Serevent), any other medications, or milk protein.
do not use formoterol (Foradil) or salmeterol (Serevent) while using fluticasone and salmeterol.
tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral); beta-blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); danazol (Danocrine); delavirdine (Rescriptor); diltiazem (Cardizem, Dilacor, Tiazac); diuretics ('water pills'); erythromycin (E.E.S., E-Mycin, Erythrocin); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); HIV protease inhibitors such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir); isoniazid (INH, Nydrazid); metronidazole (Flagyl); nefazodone (Serzone); oral contraceptives (birth control pills); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Also tell your doctor and pharmacist if you are taking the following medications or have stopped taking them during the past 2 weeks: antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); and monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor if you have or have ever had high blood pressure, irregular heartbeat, seizures, hyperthyroidism (overactive thyroid), diabetes, tuberculosis, glaucoma, or liver or heart disease, and if you have a herpes eye infection or a fungal, viral, or bacterial infection (except an infection of the skin).
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using fluticasone and salmeterol, call your doctor.
if you are having surgery, including dental surgery, tell your doctor or dentist that you are using fluticasone and salmeterol.
if you have been using a short-acting beta-agonist inhaler such as albuterol (Proventil, Ventolin) on a regular basis (for example, four times a day), your doctor will probably tell you to stop using it regularly when you start using fluticasone and salmeterol. Keep your other inhaler to use during an asthma attack.
avoid exposure to chickenpox or measles. If you are exposed to these diseases or if you develop symptoms of these diseases, call your doctor immediately. You may need to get a vaccine to protect you from these infections.

What special dietary instructions should I follow?

Talk to your doctor about drinking grapefruit juice while taking this medicine.

What should I do if I forget a dose?

Inhale the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not inhale a double dose to make up for a missed one.

What side effects can this medication cause?

Fluticasone and salmeterol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

runny nose
sneezing
sore throat
hoarseness
sinus pain
cough
headache
upset stomach
vomiting
diarrhea
stomach pain
muscle and bone pain
throat irritation

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

shaking hands that you cannot control
hives
skin rash
swelling of the face, throat, tongue, lips, hands, feet, ankles, or lower legs
choking or difficulty swallowing
increased difficulty breathing
noisy, high-pitched breathing
pounding or fast heartbeat
chest pain
nervousness
blurred vision
white patches in the mouth
fever, chills, and other signs of infection

Fluticasone and salmeterol may cause children to grow more slowly. If your child is using fluticasone and salmeterol and does not seem to be growing properly, talk to your child's doctor.

Fluticasone and salmeterol may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away the inhalation device 1 month after you remove it from the foil overwrap or after every blister has been used (when the dose indicator reads 0), whichever comes first. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

seizures
chest pain
dizziness
fainting
blurred vision
fast, pounding, or irregular heartbeat
nervousness
headache
shaking hands that you cannot control
muscle cramps or weakness
dry mouth
upset stomach
dizziness
excessive tiredness
lack of energy
difficulty falling asleep or staying asleep
thirst
flushing
dry skin
frequent urination
loss of appetite
trouble breathing

What other information should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Last Revised - 01/01/2004

American Society of Health-System Pharmacists, Inc. Disclaimer