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

• Abarelix
• Abatacept
• Acebutolol
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