Advair

Generic Name: fluticasone and salmeterol (floo TIK a sone, sal ME te rol)
Brand Names: Advair Diskus, Advair HFA, AirDuo RespiClick

What is Advair inhalation?

Advair contains a combination of fluticasone and salmeterol. Fluticasone is a steroid that prevents the release of substances in the body that cause inflammation. Salmeterol is a bronchodilator. It works by relaxing muscles in the airways to improve breathing.

Advair is used to prevent asthma attacks attacks. It is also used to prevent flare-ups or worsening of chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis and/or emphysema.

In people with COPD, Advair is for long-term treatment. In people with asthma, this medicine is for short-term treatment until symptoms are well controlled with with other medicines.

Advair is for use in adults and children who are at least 4 years old. Advair HFA is for use in adults and children who are at least 12 years old.

Important information

You should not use Advair if you are allergic to fluticasone, salmeterol, or milk proteins.

Advair is not a rescue medicine. It will not work fast enough to treat an asthma or bronchospasm attack.

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Salmeterol may increase the risk of death in people with asthma, but the risk in people with COPD is not known. Use only the prescribed dose of Advair, and do not use it for longer than your doctor recommends. Follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits of using Advair.

Before taking this medicine

You should not use Advair if you are allergic to fluticasone or salmeterol (Serevent), or:

if you have a severe allergy to milk proteins; or

if you are having an asthma attack or severe COPD symptoms.

To make sure this medicine is safe for you, tell your doctor if you have:

a food or drug allergy;

heart disease or high blood pressure;

epilepsy or other seizure disorder;

any type of infection;

a weak immune system;

diabetes;

glaucoma;

tuberculosis;

osteoporosis;

a thyroid disorder; or

liver disease.

Long-term use of steroids may lead to bone loss (osteoporosis), especially if you smoke, if you do not exercise, if you do not get enough vitamin D or calcium in your diet, or if you have a family history of osteoporosis.

It is not known whether Advair is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using Advair.

It is not known whether this medicine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Fluticasone can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medication.

Advair is not approved for use by anyone younger than 4 years old.

How should I use Advair?

Use Advair exactly as it was prescribed for you. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended. Using too much of this medicine can cause life-threatening side effects.

Advair is not a rescue medicine. It will not work fast enough to treat an asthma attack. Use only a fast acting inhalation medicine for an asthma attack.

Seek medical attention if you think your medications are not working as well.

Advair Diskus is a powder form of fluticasone and salmeterol that comes with a special inhaler device pre-loaded with blister packs containing measured doses of the medicine. The device opens and loads a blister each time you use the inhaler. This device is not to be used with a spacer.

Advair HFA is an aerosol form of fluticasone and salmeterol that comes in a canister that is used with an actuator inhaler device. Use only the inhaler device provided with Advair HFA.

Shake the Advair HFA inhaler for at least 5 seconds before each spray.

To reduce the chance of developing a yeast infection in your mouth, rinse with water after using your inhaler. Do not swallow.

Keep track of the number of sprays you have used and throw away the Advair HFA canister after 120 sprays, even if it feels like there is still medicine in it.

Your doctor will need to check your lung function on a regular basis. Once your asthma is under control, your doctor may want you to stop using this medicine. Keep all follow-up appointments and do not stop using the medicine unless your doctor tells you to.

Your dose needs may change if you have surgery, are ill, are under stress, or have recently had an asthma attack. Do not change your medication dose or schedule without your doctor's advice.

If you also use an oral steroid medication, you should not stop using it suddenly. Follow your doctor's instructions about tapering your dose.

While using Advair, your vision and your bone mineral density may need to be checked often.

Seek medical attention if your breathing problems do not improve, or if your symptoms get worse quickly. If you use a peak flow meter at home, call your doctor if your numbers are lower than normal.

Store your medicine at room temperature away from moisture, light, and heat (especially high heat, such as open flame or in a car on a hot day).

Throw the inhaler device away 1 month after you took it out of the foil pouch, or if the dose indicator shows a zero (even if it feels like there is still medicine inside).

Once your asthma is under control, your doctor may want you to stop using this medicine. Keep all follow-up appointments and do not stop using the medicine unless your doctor tells you to.

Advair dosing information

Usual Adult Dose of Advair for Chronic Obstructive Pulmonary Disease - Maintenance:

Fluticasone 250 mcg-salmeterol 50 mcg (1 inhalation) orally twice a day, approximately 12 hours apart

Comments:

-If shortness of breath occurs in the period between doses, use an inhaled, short-acting beta2-agonist for immediate relief.

-Fluticasone 250 mcg-salmeterol 50 mcg is the only approved dosage for the treatment of COPD; higher doses are not recommended, as advantage of the higher strength has not been demonstrated.

Uses: Maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema; to reduce exacerbations of COPD in patients with a history of exacerbations

Usual Adult Dose of Advair for Asthma - Maintenance:

Inhalation Powder:

-1 inhalation of fluticasone 100 mcg-salmeterol 50 mcg, fluticasone 250 mcg-salmeterol 50 mcg, or fluticasone 500 mcg-salmeterol 50 mcg orally twice a day

-Maximum dose: Fluticasone 500 mcg-salmeterol 50 mcg orally twice a day

Inhalation Aerosol:

-2 inhalations of fluticasone 45 mcg-salmeterol 21 mcg, fluticasone 115 mcg-salmeterol 21 mcg, or fluticasone 230 mcg-salmeterol 21 mcg orally twice a day

-Maximum dose: Fluticasone 230 mcg-salmeterol 31 mcg orally twice a day

Comments:

-Inhalations should be administered approximately 12 hours apart.

-Initial dose should be based on the patient's asthma severity.

-If shortness of breath occurs in the period between doses, use an inhaled, short-acting beta2-agonist for immediate relief.

-Improvement in asthma control occurs within 30 minutes of beginning treatment; maximum benefit can take 1 week or longer.

-The inhalation dose can be increased if response does not improve after 2 weeks of therapy.

-If previously effective dose fails to improve asthma control, reevaluate treatment and consider additional therapies (e.g., adding additional inhaled or oral corticosteroid).

Uses: Treatment of asthma in patients not adequately controlled on a long term asthma control medication such as an inhaled corticosteroid, or whose disease severity clearly warrants initiation of treatment with both an inhaled corticosteroid and a LABA

Usual Pediatric Dose of Advair for Asthma - Maintenance:

Inhalation Powder:

Less than 4 years: Not recommended.

4 years to 11 years:

-Fluticasone 100 mcg-salmeterol 50 mcg (1 inhalation) orally twice a day

12 years or older:

-1 inhalation of fluticasone 100 mcg-salmeterol 50 mcg, fluticasone 250 mcg-salmeterol 50 mcg, or fluticasone 500 mcg-salmeterol 50 mcg orally twice a day

-Maximum dose: Fluticasone 500 mcg-salmeterol 50 mcg orally twice a day

Inhalation Aerosol:

Less than 12 years: Use is not approved.

12 years and older:

-2 inhalations of fluticasone 45 mcg-salmeterol 21 mcg, fluticasone 115 mcg-salmeterol 21 mcg, or fluticasone 230 mcg-salmeterol 21 mcg orally twice a day

Comments:

-Inhalations should be administered approximately 12 hours apart.

-Initial dose should be based on the patient's asthma severity.

-If shortness of breath occurs in the period between doses, use an inhaled, short-acting beta2-agonist for immediate relief.

-Improvement in asthma control occurs within 30 minutes of beginning treatment; maximum benefit can take 1 week or longer.

-The dose can be increased if response does not improve after 2 weeks of therapy.

-If previously effective dose fails to improve asthma control, reevaluate treatment and consider additional therapies (e.g., adding additional inhaled or oral corticosteroid).

Uses: Treatment of asthma in patients not adequately controlled on a long term asthma control medication such as an inhaled corticosteroid, or whose disease severity clearly warrants initiation of treatment with both an inhaled corticosteroid and a LABA

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include dizziness, vomiting, weakness, chest pain, tremors, feeling nervous, fast or pounding heartbeats, or seizure.

What should I avoid while using Advair?

Do not use a second inhaled bronchodilator unless your doctor tells you to. This includes formoterol (Foradil, Perforomist, Symbicort, Dulera), arformoterol (Brovana), indacaterol (Arcapta), olodaterol (Striverdi, Stiolto Respimat), salmeterol (Serevent), or vilanterol (Bree Ellipta, Anoro Ellipta).

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medicine.

Advair side effects

Get emergency medical help if you have signs of an allergic reaction to Advair: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

wheezing, choking, or other breathing problems after using this medicine;

chest pain, fast or uneven heart beats, restless feeling, tremors;

severe headache, pounding in your neck or ears, nosebleed;

fever, chills, swollen glands, mouth sores, skin sores, flu symptoms, cough with yellow or green mucus;

blurred vision, tunnel vision, eye pain, or seeing halos around lights;

high blood sugar - increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin;

low potassium - confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling; or

signs of a hormonal disorder - worsening tiredness or muscle weakness, feeling light-headed, anxiety, feeling irritable, nausea, vomiting, loss of appetite, diarrhea, weight loss, weight gain, slow wound healing.

Common Advair side effects may include:

headache, muscle pain, bone pain, back pain;

nausea, vomiting;

throat irritation, white patches in the mouth or throat;

cold symptoms such as stuffy nose, sneezing, sore throat; or

ongoing cough, hoarseness or deepened voice.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Advair?

Many drugs can interact with this medicine. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

an antidepressant, heart or blood pressure medicine, a diuretic or "water pill";

antifungal medicine such as ketoconazole; or

ritonavir (Norvir) or lopinavir/ritonavir (Kaletra).

This list is not complete and many other drugs can interact with fluticasone and salmeterol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.