Fluticasone-Salmeterol

What Is Fluticasone–Salmeterol?

Fluticasone–salmeterol is a combination inhalation medicine. It contains two active ingredients in one inhaler:

• Fluticasone propionate: an inhaled corticosteroid (ICS) that reduces swelling and irritation in the airways.
• Salmeterol: a long-acting beta2-agonist (LABA) that relaxes the muscles around the airways to help keep them open.

Drug class: Inhaled corticosteroid / long-acting beta2-agonist (ICS/LABA) combination.

Approved Uses

Depending on the country, the product, and the label, this medicine is approved for:

• Asthma: regular (maintenance) treatment to help control symptoms and prevent flare-ups in people whose asthma is not controlled with a long-term controller medicine alone, or whose doctor decides a combination is needed.
• COPD: long-term maintenance treatment of airflow blockage in COPD, including chronic bronchitis and emphysema, and to reduce flare-ups (exacerbations) in people with a history of them. Only certain products and strengths are approved for COPD.

It is not a rescue inhaler. It does not relieve sudden breathing problems.

Available Formulations and Strengths

Fluticasone–salmeterol comes in two main inhaler types. Strengths are written as fluticasone propionate / salmeterol in micrograms (mcg).

Formulation	Common Strengths	Notes
Dry powder inhaler (breath-activated)	100/50 mcg, 250/50 mcg, 500/50 mcg	Powder is inhaled through the mouth. Generic versions are available.
Metered-dose inhaler (HFA, aerosol spray)	45/21 mcg, 115/21 mcg, 230/21 mcg	Delivers a measured spray per puff. Usually used with a spacer if advised.

Approved ages and conditions differ by product and country. For example, the powder inhaler is used in children and adults with asthma and in adults with COPD at a specific strength, while the aerosol inhaler is generally used in older children, teenagers, and adults for asthma. A prescriber or pharmacist can confirm which product and strength apply to you.

What Is the Recommended Dosage of Fluticasone–Salmeterol?

The correct dose is set by a licensed healthcare professional. It depends on several factors:

• The condition being treated: asthma and COPD are dosed differently, and not every strength is approved for both.
• Age: children, teenagers, and adults may use different products and strengths.
• Severity of symptoms and how well the condition is controlled.
• Other health conditions, such as liver problems or heart disease.

Body weight is not usually used to set the dose for this inhaler.

Dosage Forms

• Inhalation powder (dry powder inhaler), used by mouth only.
• Inhalation aerosol (metered-dose inhaler), used by mouth only.

General Use Information

This medicine is generally taken twice a day, about 12 hours apart. Taking more than prescribed does not improve symptom control and can raise the risk of side effects, including serious heart-related effects. Always follow the instructions from your specialist and the directions on your pharmacy label.

After each use, rinse your mouth with water and spit it out. Do not swallow the rinse water. This helps lower the chance of mouth and throat infections.

How Fluticasone–Salmeterol Works

Each ingredient works in a different way:

• Fluticasone propionate is a steroid. It calms swelling and irritation inside the airways. Less swelling means the airways are less likely to react to triggers such as allergens, smoke, or cold air.
• Salmeterol is a bronchodilator. It relaxes the tight muscles around the airways, which helps them stay open for about 12 hours.

Together, they help manage symptoms such as wheezing, coughing, chest tightness, and shortness of breath. This medicine controls these conditions but does not cure asthma or COPD. It works best when used regularly as prescribed, even when you feel well. Because it is slow to act, it should not be used for sudden symptoms. Full benefit may take days to weeks.

Is a Prescription Required to Buy Fluticasone–Salmeterol Online?

Yes. Fluticasone–salmeterol is a prescription-only medicine.

Which Specialist Can Help?

• A pulmonologist (lung specialist) commonly manages COPD and more difficult asthma.
• An allergist/immunologist often treats allergic asthma.
• A primary care provider or pediatrician may also prescribe and monitor it.

Buying Safely

• Only buy from licensed pharmacies that require a valid prescription.
• Be cautious of websites that offer inhalers without a prescription or at unusually low prices. These products may be counterfeit, expired, stored incorrectly, or contain the wrong ingredients. Counterfeit inhalers have been reported in some markets.
• Check that the inhaler is sealed, labeled correctly, and shows an expiration date. Ask a pharmacist if something looks unusual.

Side Effects of Fluticasone–Salmeterol

Most people tolerate this medicine well, but side effects can happen. Not everyone will have them.

Common Side Effects

• Upper respiratory infections, such as colds
• Sore or irritated throat
• Hoarse voice
• Headache
• Cough
• Thrush (a yellow-white fungal infection) in the mouth or throat
• Bronchitis or sinus inflammation
• Nausea
• Muscle, bone, or joint pain
• Shakiness, nervousness, or a faster heartbeat (more likely with beta2-agonists)

Serious Side Effects

Serious side effects are uncommon. They include:

• Sudden worsening of breathing or wheezing right after a dose (paradoxical bronchospasm)
• Pneumonia, which has been reported more often in people with COPD who use inhaled steroids
• Allergic reactions: rash, hives, swelling of the face, lips, or tongue, or trouble breathing
• Fast, pounding, or irregular heartbeat, chest pain, or high blood pressure
• Low blood potassium or high blood sugar
• Eye problems, such as blurred vision, cataracts, or glaucoma
• Lower bone density with long-term use
• Suppressed adrenal function or signs of too much steroid effect, particularly after long-term use or when switching from steroid tablets
• Slowed growth in children (growth should be monitored)
• Increased risk of infections, or worsening of existing infections such as tuberculosis, herpes, or fungal infections

When to Get Medical Help Right Away

Call emergency services or seek urgent care if you have:

• Severe trouble breathing, or breathing that gets worse after using the inhaler
• Swelling of the face, lips, tongue, or throat
• Chest pain or a very fast or irregular heartbeat
• Fainting or severe dizziness

Contact your healthcare professional promptly if your symptoms are getting worse, you need your rescue inhaler more often than usual, or you notice white patches in your mouth.

Drug Interactions

Some medicines can change how fluticasone–salmeterol works or increase the chance of side effects. Always give your specialist and pharmacist a complete list of everything you take.

Prescription Medicine Categories

• Strong CYP3A4 inhibitors, which can raise salmeterol and fluticasone levels in the body and increase heart-related and steroid-related effects. Examples include certain antifungals (such as ketoconazole), certain antibiotics (such as clarithromycin), and some HIV medicines (such as ritonavir-containing products). Use with these medicines is generally not recommended.
• Other long-acting beta2-agonists (including other combination inhalers and oral beta-agonists), because taking more than one may increase heart and nervous system effects.
• Beta-blockers (including some eye drops), which can block the effect of salmeterol and may trigger breathing problems in some people.
• Diuretics (“water pills”) that lower potassium, which can add to potassium-lowering effects.
• Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants, which may increase the effects of salmeterol on the heart and blood vessels. This may also apply for two weeks after stopping these medicines.
• Medicines that can affect heart rhythm (QT prolongation).

Over-the-Counter (OTC) Medicines

• Decongestants and some cold and allergy products may increase heart rate or blood pressure.
• Other OTC inhalers or asthma products should only be used if your healthcare professional approves.

Supplements and Herbal Products

• Some herbal and dietary supplements, including stimulant-type products (for example, those with high caffeine, ephedra-like ingredients, or bitter orange), may add to heart-related side effects.
• St. John’s wort and other herbal products can affect how the body processes medicines. Ask before using them.

Do not start, stop, or change any medicine or supplement without speaking with a licensed professional.

Safety & Important Considerations

Not for Sudden Symptoms

This medicine is not meant to treat sudden breathing problems. Keep a fast-acting rescue inhaler available as directed by your doctor. Seek emergency help if the rescue inhaler does not provide relief.

Do Not Use Extra Doses

Using more than the prescribed amount, or using this medicine more often than directed, can cause serious heart problems. Do not use it more than twice a day, and do not use another LABA-containing product at the same time unless your healthcare professional tells you to.

Liver Disease

Fluticasone and salmeterol are cleared by the liver. People with liver disease may have higher medicine levels and need closer monitoring.

Kidney Disease

No specific dose changes are typically required for kidney disease, but tell your provider about any kidney conditions.

Pregnancy and Breastfeeding

• Tell your healthcare professional if you are pregnant, planning pregnancy, or breastfeeding.
• Poorly controlled asthma can also be a risk during pregnancy, so decisions about treatment should be made with your specialist.
• It is not fully known if the ingredients pass into breast milk.

Children and Older Adults

• Children: Approved age ranges and products vary. Growth should be checked regularly in children who use inhaled steroids.
• Older adults: Heart conditions, bone loss, and other health problems may require closer monitoring.

Conditions to Discuss Before Starting

Tell your healthcare professional if you have or have had:

• Heart disease, high blood pressure, or irregular heartbeat
• Seizures
• Thyroid disease or diabetes
• Low potassium levels
• Liver disease
• Osteoporosis
• Glaucoma, cataracts, or other eye problems
• An infection that has not been treated, such as tuberculosis
• Allergies to milk proteins (see below)

Monitoring

Your care team may:

• Track your symptoms, lung function tests, and how often you use your rescue inhaler
• Check your eyes, blood sugar, bone health, or growth (in children) during long-term treatment
• Watch for signs of pneumonia, especially in people with COPD

Switching From Steroid Tablets

If you are switching from oral steroids, your doctor will guide you to lower the steroid dose slowly. Do not stop steroid tablets suddenly.

Safety Information From Regulators

Regulatory agencies advise that medicines containing a long-acting beta2-agonist for asthma should be used together with an inhaled corticosteroid, and not by themselves. Inhaled steroid-containing products also carry warnings about pneumonia in COPD, bone loss, eye changes, and infections. Review the current prescribing information and Medication Guide that come with your inhaler.

Who This Medication Is For

Fluticasone–salmeterol is intended for:

• People with asthma who need regular, long-term controller treatment, as determined by their healthcare professional and within the age ranges allowed by the label.
• Adults with COPD who need ongoing treatment to help keep the airways open and, for some people, to reduce flare-ups.

It is used as a maintenance (controller) medicine. A specialist decides whether this combination is appropriate after reviewing symptoms, lung tests, previous treatments, and overall health.

Who Should Not Take Fluticasone–Salmeterol

Do not use this medicine if:

• You are having a sudden, severe asthma attack (status asthmaticus) or need quick relief of breathing symptoms. This medicine is not for primary treatment of these emergencies.
• You have a severe allergy to milk proteins (applies to the powder inhaler, which contains lactose that may carry trace milk protein).
• You are allergic to fluticasone, salmeterol, or any other ingredient in the inhaler.

Important Precautions

Use extra caution and speak with your specialist if you have heart disease, seizure disorders, thyroid problems, diabetes, low potassium, liver disease, eye conditions, bone loss, or an active infection. Avoid taking strong CYP3A4-inhibiting medicines with this inhaler unless your healthcare professional has reviewed the risks.

What to Do If You Miss a Dose

• If you miss a dose, skip it and take your next dose at the usual time.
• Do not take two doses at once or extra doses to make up for a missed one.
• If you often forget doses, or are unsure what to do, contact your licensed healthcare professional or pharmacist for advice.
• If your symptoms get worse after missing a dose, follow your asthma or COPD action plan and seek medical help if needed.

Related medications to Fluticasone–Salmeterol

Other ICS/LABA combination inhalers are available and include:

• Fluticasone furoate–vilanterol
• Budesonide–formoterol
• Mometasone furoate–formoterol
• Beclometasone–formoterol (available in some countries)

Some people with COPD use triple-therapy inhalers that combine an inhaled steroid, a LABA, and a long-acting muscarinic antagonist (LAMA). Others may use bronchodilators alone or add-on treatments for asthma, depending on their condition.

These medicines differ in devices, dosing schedules, approved ages, and side effects. Do not switch or stop treatment on your own. Any change should be made after consultation with a licensed medical specialist.

Storage Instructions

• Store at room temperature, usually about 68°F to 77°F (20°C to 25°C), unless the label states otherwise. Short trips outside this range are generally allowed.
• Keep the inhaler in a dry place away from moisture, such as steamy bathrooms.
• Powder inhaler: keep it in its sealed foil pouch until ready to use, protect it from humidity, and do not take it apart or wash it. Use within the time stated on the label (commonly about one month after opening the pouch) or until the dose counter reads zero, whichever comes first.
• Aerosol inhaler: the canister is under pressure. Do not puncture it, burn it, or store it near heat or open flame, and protect it from direct sunlight. Store as directed on the label, and stop using it when the dose counter reads zero.
• Keep out of the reach and sight of children and pets. Store in a safe place and never share your inhaler with others.
• Throw away expired or empty inhalers as advised by your pharmacist or local disposal program.

Disclaimer

This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Patients must consult a licensed pulmonologist, allergist, or other relevant medical specialist before starting, changing, or stopping treatment. Treatment decisions must be based on a full clinical evaluation by a qualified specialist. Always follow the prescribing information and Medication Guide provided with your medicine.