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salmeterol and fluticasone

R03AK06

Forms & Strengths

Inhalation powder Diskus: 50 µg salmeterol / 250 µg fluticasone per inhalation
Inhalation powder Diskus: 100 µg salmeterol / 500 µg fluticasone per inhalation
Metered-dose inhaler (MDI): 25 µg salmeterol / 125 µg fluticasone per actuation

Adult Dosing

1 inhalation (or 1 actuation) twice daily; do not exceed 2 inhalations per dose or 4 per day
Maximum daily fluticasone dose 1000 µg (2 inhalations of 500 µg) and salmeterol 200 µg
Use regular schedule; do not use for acute bronchospasm

Pediatric Dosing

Ages 4‑11: 1 inhalation of 25 µg/125 µg (or 50 µg/250 µg) twice daily
Ages 12‑<18: same as adult dosing (1 inhalation BID)
Do not exceed adult maximum daily dose in any age group

Indications

Maintenance treatment of persistent asthma in adults and children ≥4 years
Long‑term management of COPD to reduce exacerbations
Adjunct therapy in patients inadequately controlled on inhaled corticosteroid alone

Mechanism of Action

Salmeterol: long‑acting β2‑adrenergic agonist → sustained bronchodilation (≈12 h)
Fluticasone: potent synthetic glucocorticoid → anti‑inflammatory gene modulation, reduces airway edema and mucus

Contraindications

Hypersensitivity to salmeterol, fluticasone, lactose, or any excipients
Acute asthma attacks or COPD exacerbations requiring rapid‑acting bronchodilator
Use of non‑selective β‑blockers in patients with severe bronchospasm

Adverse Reactions

Oral thrush, dysphonia, sore throat
Headache, tremor, palpitations, tachycardia
Systemic corticosteroid effects: adrenal suppression, growth retardation in children
Hypokalemia (especially with diuretics)
Increased risk of pneumonia in COPD patients

Drug Interactions

Non‑selective β‑blockers antagonize bronchodilator effect
Strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) ↑ fluticasone levels → systemic effects
CYP3A4 inducers (rifampin, carbamazepine) ↓ fluticasone exposure → loss of control
Other sympathomimetics (pseudoephedrine) may augment cardiovascular side effects
Loop diuretics may exacerbate hypokalemia when combined with β2‑agonist

Curated Content: Needs Vetting Before Put to Clinical Use