Fluticasone Salmeterol

Fluticasone Salmeterol Brand Names

Advair | Advair HFA | AIRDUO RESPICLICK

What is Fluticasone Salmeterol

Fluticasone salmeterol is a combination of an inhaled corticosteroid (ICS), fluticasone, and a long-acting beta-agonist (LABA), salmeterol.

The combination is used for maintenance therapy of asthma in adults and pediatric patients as young as 4 years of age, for selected products.

Fluticasone salmeterol is also indicated in adults for the maintenance treatment of chronic obstructive pulmonary disease (COPD) and to reduce exacerbations of COPD.

Fluticasone salmeterol is not indicated for acute bronchospasm or acute asthmatic attacks.

The use of LABAs alone to treat asthma without an inhaled corticosteroid (ICS) to treat lung inflammation is associated with an increased risk of asthma-related death; therefore, LABAs are contraindicated in patients with asthma without the use of an asthma controller medication (i.e., an ICS).

A LABA should not be the first drug used to treat asthma and should only be added to the asthma treatment regimen if other medications (including low- or medium-dose ICS monotherapy) do not control asthma.

Inhaled corticosteroids (ICS) such as fluticasone are a preferred pharmacologic treatment in the long-term management of persistent asthma of various severities according to the Expert Panel of the National Asthma Education and Prevention Program (NAEPP); NAEPP concluded that ICSs are the most potent and consistently effective class of medications for the long-term control of asthma in both adults and children.

A LABA is an acceptable adjunct to maintenance treatment with an ICS for persistent asthma that is inadequately controlled with a low-dose ICS (step 3 care). NAEPP gives equal consideration to increasing the ICS dose versus adding a LABA for insufficient control of asthma symptoms.

The preferred treatments in steps 4 to 6 care include the combined use of an LABA and ICS.

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, fluticasone; salmeterol may be used as initial therapy in group D (those with a high risk of exacerbation).

Combination of a LABA with an ICS has the greatest likelihood of reducing exacerbations in patients with blood eosinophil counts of 200 cells/microliter and higher. An ICS combined with a LABA is more effective than the individual components in improving lung function and health status and reducing exacerbations in patients with exacerbations and moderate to very severe COPD; however clinical trials failed to demonstrate a statistically significant effect on survival.

At follow-up, if the patient is still experiencing dyspnea, consider switching inhaler device and investigate for other causes of dyspnea.

If the patient has COPD exacerbations, consider triple therapy with a long-acting muscarinic antagonist (LAMA), a LABA, and ICS.

The combination of fluticasone salmeterol was FDA-approved in 2000.

Indications

  1. asthma
  2. chronic bronchitis
  3. chronic obstructive pulmonary disease (COPD)
  4. emphysema

For the maintenance treatment of asthma

Side Effects

  1. abdominal pain
  2. adrenocortical insufficiency
  3. agitation
  4. anaphylactoid reactions
  5. angioedema
  6. anxiety
  7. arrhythmia exacerbation
  8. arthralgia
  9. asthma-related death
  10. atrial fibrillation
  11. back pain
  12. blurred vision
  13. bronchospasm
  14. candidiasis
  15. cataracts
  16. Churg-Strauss syndrome
  17. conjunctivitis
  18. constipation
  19. contact dermatitis
  20. cough
  21. Cushing’s syndrome
  22. Cushingoid features
  23. dental pain
  24. depression
  25. diarrhea
  26. dizziness
  27. dysmenorrhea
  28. dyspepsia
  29. dysphonia
  30. dyspnea
  31. ecchymosis
  32. edema
  33. elevated hepatic enzymes
  34. eosinophilia
  35. epistaxis
  36. fever
  37. growth inhibition
  38. headache
  39. hemorrhoids
  40. hyperglycemia
  41. hypertension
  42. hypokalemia
  43. hypotension
  44. hypothalamic-pituitary-adrenal (HPA) suppression
  45. hypothyroidism
  46. ichthyosis
  47. increased intracranial pressure
  48. infection
  49. influenza
  50. insomnia
  51. irritability
  52. keratitis
  53. laryngitis
  54. malaise
  55. menstrual irregularity
  56. migraine
  57. muscle cramps
  58. musculoskeletal pain
  59. myalgia
  60. myocardial infarction
  61. nasal congestion
  62. nausea
  63. ocular hypertension
  64. oral ulceration
  65. osteoporosis
  66. pallor
  67. palpitations
  68. paresthesias
  69. pharyngitis
  70. photosensitivity
  71. pruritus
  72. QT prolongation
  73. rash
  74. restlessness
  75. rhinitis
  76. rhinorrhea
  77. sinus tachycardia
  78. sinusitis
  79. skin laceration
  80. ST-T wave changes
  81. supraventricular tachycardia (SVT)
  82. throat irritation
  83. tracheitis
  84. tremor
  85. urticaria
  86. vaginitis
  87. vasculitis
  88. ventricular tachycardia
  89. vomiting
  90. weight gain
  91. wheezing
  92. xerostomia

Monitoring Parameters

  • blood glucose
  • growth rate
  • pulmonary function tests (PFTs)
  • serum potassium
  • weight

Contraindications

  • acute bronchospasm
  • alcoholism
  • angioedema
  • asthma-related death
  • bradycardia
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cataracts
  • children
  • coronary artery disease
  • corticosteroid therapy
  • diabetes mellitus
  • females
  • geriatric
  • glaucoma
  • growth inhibition
  • heart failure
  • hepatic disease
  • hypertension
  • hyperthyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothalamic-pituitary-adrenal (HPA) suppression
  • immunosuppression
  • increased intracranial pressure
  • increased intraocular pressure
  • infants
  • labor
  • long QT syndrome
  • malnutrition
  • MAOI therapy
  • milk protein hypersensitivity
  • myocardial infarction
  • osteoporosis
  • paradoxical bronchospasm
  • pheochromocytoma
  • pregnancy
  • QT prolongation
  • respiratory insufficiency
  • seizure disorder
  • seizures
  • status asthmaticus
  • thyroid disease
  • thyrotoxicosis
  • tuberculosis

Interactions

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  • Triclabendazole
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Tuberculin Purified Protein Derivative, PPD
  • Tubocurarine
  • Tucatinib
  • Vancomycin
  • Vandetanib
  • Vardenafil
  • Vecuronium
  • Vemurafenib
  • Venlafaxine
  • Vigabatrin
  • Vincristine Liposomal
  • Voriconazole
  • Vorinostat
  • Warfarin
  • Zafirlukast
  • Ziprasidone
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