Fluticasone/SalmeterolFluticasone Propionate/Salmeterol

About Fluticasone/Salmeterol

Fluticasone propionate calms airway inflammation and salmeterol, a long-acting beta2-agonist, relaxes the airways. Advair Diskus is labeled for twice-daily treatment of asthma from age 4 (the 100/50 strength for ages 4 to 11) and, at 250/50 only, for maintenance treatment of airflow obstruction in COPD, including chronic bronchitis and emphysema, and for reducing exacerbations in people with COPD who have had them. Advair HFA (2 puffs twice a day) and AirDuo RespiClick (1 inhalation twice a day) are labeled only for asthma, from age 12. The strength is chosen by asthma severity, up to 500/50 twice a day for the Diskus, 230/21 for Advair HFA and 232/14 for AirDuo. None of them treats sudden symptoms, so a quick-relief inhaler is kept on hand.

There is no boxed warning; the one Advair carried was removed in December 2017. The label explains that a long-acting beta2-agonist used alone for asthma raises the risk of asthma-related death, while large trials of the combination with an inhaled steroid showed no significant rise in serious asthma events. It is not used for acute symptoms, with another long-acting beta2-agonist, or as the main treatment of status asthmaticus, and the powder inhalers (Advair Diskus, its generics and AirDuo) must not be used by anyone with a severe milk protein allergy. Other warnings cover thrush, pneumonia in COPD, more serious chickenpox or measles, adrenal insufficiency when switching from oral steroids, bone thinning, slower growth in children, glaucoma and cataracts, paradoxical bronchospasm, heart effects, low potassium and high blood sugar. Common side effects include respiratory infections, sore throat, hoarseness, thrush and headache, and pneumonia in COPD.

The devices are not interchangeable. Advair Diskus and its rated generics are dry-powder inhalers; Advair HFA is a spray that is shaken for 5 seconds and primed with 4 sprays before first use (2 sprays after more than 4 weeks unused or if dropped); AirDuo RespiClick is an inhalation-driven powder inhaler with its own strengths that needs no priming and is never washed. After every dose, the mouth is rinsed with water that is not swallowed. Children’s growth is monitored, and the label calls for bone density checks in COPD. AirDuo Digihaler is listed as discontinued.

Taking Fluticasone/Salmeterol

How to take it

Twice a day, about 12 hours apart: 1 inhalation from a Diskus-type or AirDuo inhaler, or 2 puffs of Advair HFA, shaken for 5 seconds before each spray. Rinse your mouth with water and spit it out after each dose. Never breathe out into a powder inhaler or wash it, do not use it with a spacer, and keep it in a dry place.

If you miss a dose

Skip the missed dose and continue your regular schedule. Do not inhale a double dose to make up for it.

Storage

At room temperature, away from sunlight, excess heat and moisture (not in the bathroom), out of reach of children. Throw away Advair Diskus or Wixela Inhub 1 month after opening its foil pouch, and AirDuo 30 days after opening its pouch, or sooner if the counter reads 0; throw away Advair HFA when its counter reads 000.

Interactions to know about

Strong CYP3A4 inhibitors such as ritonavir and ketoconazole are not recommended with it. Beta-blockers can block salmeterol’s effect, non-potassium-sparing diuretics can worsen low potassium, and monoamine oxidase inhibitors or tricyclic antidepressants can strengthen its effects on the heart and blood vessels.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Fluticasone/Salmeterol differs from pharmacy to pharmacy

Only the Diskus type has rated generics: Wixela Inhub and other fluticasone and salmeterol inhalation powders are AB-rated to Advair Diskus, so a pharmacist can substitute one for a Diskus prescription where state law allows. Advair HFA and AirDuo RespiClick have no rated generics, so a prescription naming either is filled with that device; its authorized generic is the same inhaler sold under the generic name.

The strengths are not equivalent across devices (250/50 in the Diskus is not the same dose as 230/21 in Advair HFA or 232/14 in AirDuo), so quotes are comparable only for the same device and strength, and only the prescriber can change the device.

Ways to pay less for Fluticasone/Salmeterol without insurance

• If Advair Diskus is prescribed, check that the prescription allows a rated generic such as Wixela Inhub.
• If you use Advair HFA or AirDuo RespiClick, ask the pharmacy whether its authorized generic can be dispensed for your prescription.
• Ask the prescriber whether a Diskus-type inhaler, the only form with rated generics, would suit you.
• For a brand device, ask the maker whether its savings or patient assistance program applies to someone paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Fluticasone/Salmeterol

1. 1.Is my inhaler the device and strength my prescriber wrote, or a rated generic of it?
2. 2.Does my inhaler need shaking or priming, and how do I read its counter?
3. 3.How should I rinse my mouth after each dose?
4. 4.Which inhaler should I use for sudden symptoms?

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