Version May 2024
Dosage guidance:
Safety: Patients receiving fluticasone/salmeterol twice daily should not use additional salmeterol or other inhaled, long-acting beta-2 agonists (eg, formoterol, arformoterol) for any other reason.
Dosing: The maximum dose is based on the salmeterol component; to increase the dose of the inhaled glucocorticoid component, a separate inhaler with a higher fluticasone dose per inhalation must be prescribed.
Asthma, maintenance therapy: Note: Initial dose is based on previous asthma therapy, current control, and risk of exacerbation. If adequate response is not seen after 2 weeks of initial dose, increase dosage; once adequate control achieved, doses should be titrated to lowest effective dose.
Advair Diskus, Wixela Inhub: Dry powder inhaler: Note: Do not administer more than 1 inhalation twice daily.
Children 4 to 11 years: Fluticasone propionate 100 mcg/salmeterol 50 mcg: Oral inhalation: 1 inhalation twice daily.
Children ≥12 years and Adolescents: Oral inhalation:
Fluticasone propionate 100 mcg/salmeterol 50 mcg: 1 inhalation twice daily.
Fluticasone propionate 250 mcg/salmeterol 50 mcg: 1 inhalation twice daily.
Fluticasone propionate 500 mcg/salmeterol 50 mcg: 1 inhalation twice daily.
AirDuo Digihaler, AirDuo RespiClick: Dry powder inhaler:
Children ≥12 years and Adolescents: Oral inhalation: Dosing based on disease severity and/or previous asthma therapy; may increase dose after 2 weeks of therapy in patients who are not adequately controlled; do not administer more than 1 inhalation twice daily:
No prior treatment with inhaled corticosteroid: Fluticasone propionate 55 mcg/salmeterol 14 mcg: 1 inhalation twice daily.
Prior treatment with inhaled corticosteroid: Note: Base starting dosage on strength of previous inhaled corticosteroid and disease severity.
Fluticasone propionate 55 mcg/salmeterol 14 mcg: 1 inhalation twice daily.
Fluticasone propionate 113 mcg/salmeterol 14 mcg: 1 inhalation twice daily.
Fluticasone propionate 232 mcg/salmeterol 14 mcg: 1 inhalation twice daily.
Advair HFA: Metered-dose inhaler:
Children ≥12 years and Adolescents: Oral inhalation: Note: Do not administer more than 2 inhalations twice daily:
Fluticasone propionate 45 mcg/salmeterol 21 mcg: 2 inhalations twice daily.
Fluticasone propionate 115 mcg/salmeterol 21 mcg: 2 inhalations twice daily.
Fluticasone propionate 230 mcg/salmeterol 21 mcg: 2 inhalations twice daily.
Advair 125 or Advair 250 [Canadian products]: Metered-dose inhaler:
Children ≥12 years and Adolescents: Oral inhalation:
Fluticasone propionate 125 mcg/salmeterol 25 mcg: 2 inhalations twice daily, morning and evening, 12 hours apart.
Fluticasone propionate 250 mcg/salmeterol 25 mcg: 2 inhalations twice daily, morning and evening, 12 hours apart.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied); however, fluticasone and salmeterol are primarily cleared in the liver and may lead to accumulation in patients with hepatic impairment. Use with caution and monitor closely.
(For additional information see "Fluticasone propionate and salmeterol: Drug information")
Dosage guidance:
Safety: The recommended number of inhalations per dose is based on the salmeterol component; do NOT adjust the number of inhalations to change the corticosteroid dose; use an alternative inhaler (Ref). Patients receiving fluticasone/salmeterol should not use additional salmeterol or vilanterol products.
Asthma, maintenance/controller: Note: Product selection: Individualize daily fluticasone dose based on severity of symptoms, typically as follows: low doses for mild persistent asthma; low to medium doses for moderate persistent asthma; and medium to high doses for severe persistent asthma. Select a product with a favorable dosage per actuation to improve convenience and adherence (Ref).
|
Low dose |
Medium dose |
High dose | |
|---|---|---|---|
|
Fluticasone propionate |
100 to 250 mcg/day |
>250 to 500 mcg/day |
>500 mcg/day |
Usual dosage ranges, mild to severe:
Advair Diskus, Wixela Inhub: Dry powder inhaler (fluticasone propionate 100 mcg or 250 mcg or 500 mcg/salmeterol 50 mcg per actuation): Oral inhalation: 1 inhalation twice daily. Maximum dose: fluticasone propionate 1,000 mcg/day and salmeterol 100 mcg/day.
Advair HFA: Metered-dose inhaler (fluticasone propionate 45 mcg or 115 mcg or 230 mcg/salmeterol 21 mcg per actuation): Oral inhalation: 2 inhalations twice daily. Maximum dose: fluticasone propionate 920 mcg/day and salmeterol 84 mcg/day.
Advair [Canadian product]: Metered-dose inhaler (fluticasone propionate 125 mcg or 250 mcg/salmeterol 25 mcg per actuation): Oral inhalation: 2 inhalations twice daily. Maximum dose: fluticasone propionate 1,000 mcg/day and salmeterol 100 mcg/day.
AirDuo Digihaler, AirDuo RespiClick: Dry powder inhaler (fluticasone propionate 55 mcg or 113 mcg or 232 mcg/salmeterol 14 mcg per actuation): Oral inhalation: 1 inhalation twice daily. Maximum dose: fluticasone propionate 464 mcg/day and salmeterol 28 mcg/day.
Titration: For patients whose symptoms are not adequately controlled after 2 to 4 weeks of therapy, may increase controller therapy in a step-wise fashion. For patients whose symptoms are well controlled for 3 to 6 months on a stable regimen, may reduce controller therapy in a step-wise fashion (Ref).
Chronic obstructive pulmonary disease, maintenance: Note: Use of long-acting beta agonist and inhaled corticosteroid is not encouraged. In patients with persistent exacerbations on dual long-acting bronchodilator therapy or elevated eosinophil count (Group E), consider triple therapy (inhaled corticosteroid, long-acting beta agonist, and long-acting muscarinic antagonist). In addition, a short-acting bronchodilator is used for intermittent symptom relief (Ref).
Advair Diskus, Wixela Inhub: Dry powder inhaler (fluticasone propionate 250 mcg/salmeterol 50 mcg per actuation): Oral inhalation: 1 inhalation twice daily; in patients with persistent symptoms or exacerbations, may change to fluticasone propionate 500 mcg/salmeterol 50 mcg 1 inhalation twice daily (Ref).
Advair HFA (off-label use): Metered-dose inhaler (fluticasone propionate 115 mcg/salmeterol 21 mcg per actuation): Oral inhalation: 2 inhalations twice daily (Ref).
Advair [Canadian product] (off-label use): Metered-dose inhaler (fluticasone propionate 125 mcg/salmeterol 25 mcg per actuation): Oral inhalation: 2 inhalations twice daily (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied); however, fluticasone and salmeterol are primarily cleared in the liver and may lead to accumulation in patients with hepatic impairment. Use with caution and monitor closely.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions occur in adults and adolescents unless otherwise specified.
>10%:
Central nervous system: Headache (5% to 21%)
Respiratory: Upper respiratory tract infection (16% to 27%), pneumonia (4% to 18%; higher incidence is associated with older adults), pharyngitis (≤13%)
1% to 10%:
Cardiovascular: Cardiac arrhythmia (1% to 3%), myocardial infarction (1% to 3%), tachycardia (1% to 3%), palpitations (<3%)
Central nervous system: Voice disorder (≤5%), dizziness (≤4%), migraine (1% to 3%), sleep disorder (1% to 3%)
Dermatologic: Dermatitis (1% to 3%), dermatologic disease (1% to 3%; includes dermatosis and disorder of sweat and sebum), eczema (1% to 3%), contact dermatitis (<3%), pruritus (1%)
Endocrine & metabolic: Weight gain (1% to 3%)
Gastrointestinal: Oral candidiasis (1% to 10%; including mouth and throat infections), nausea and vomiting (4% to 6%), nausea (>5%), gastrointestinal distress (≤4%), viral gastrointestinal infection (3% to 4%), diarrhea (2% to 4%), abdominal distress (1% to 3%), abdominal pain (1% to 3%), dental discomfort (1% to 3%), dental disease (disorder of hard tissue of teeth: 1% to 3%), gastrointestinal infection (1% to 3%), infection of mouth (unspecified oropharyngeal plaque: 1% to 3%), toothache (1% to 3%), xerostomia (1% to 3%), dyspepsia (<3%), upper abdominal pain (<3%)
Genitourinary: Genitourinary infection (1% to 3%), urinary tract infection (1% to 3%)
Hypersensitivity: Hypersensitivity reaction (1% to 3%; can be immediate or delayed), local ocular hypersensitivity (1% to 3%)
Infection: Candidiasis (3%), bacterial infection (1% to 3%), viral infection (1% to 3%), influenza (<3%)
Neuromuscular & skeletal: Musculoskeletal pain (4% to 7%), myalgia (≤4%), back pain (3%), arthralgia (1% to 3%), arthritis (1% to 3%), muscle injury (1% to 3%), muscle spasm (1% to 3%), ostealgia (1% to 3%), skeletal muscle disease (inflammation: 1% to 3%), skeletal pain (1% to 3%), limb pain (<3%), muscle cramps (≤3%)
Ophthalmic: Ocular edema (1% to 3%)
Otic: Ear sign or symptom (1% to 3%)
Respiratory: Throat irritation (8% to 9%; children: ≥3%), nasopharyngitis (5% to 9%), bronchitis (8%), upper respiratory tract inflammation (4% to 7%; includes upper respiratory tract irritation), cough (4% to 6%), viral respiratory tract infection (4% to 6%), hoarseness (≤5%), sinusitis (≤5%), ENT infection (children: ≥3%), dry nose (1% to 3%), epistaxis (1% to 3%), laryngitis (1% to 3%), lower respiratory signs and symptoms (1% to 3%), lower respiratory tract infection (1% to 3%), postnasal drip (1% to 3%), respiratory tract hemorrhage (lower respiratory tract: 1% to 3%), nasal congestion (≤3%), allergic rhinitis (<3%), oropharyngeal pain (<3%), respiratory tract infection (<3%), rhinitis (<3%), rhinorrhea (1% to 3%)
Miscellaneous: Fever (4%), inflammation (1% to 3%), laceration (1% to 3%), postoperative complication (1% to 3%), soft tissue injury (1% to 3%), wound (1% to 3%)
Frequency not defined:
Cardiovascular: Edema
Central nervous system: Hypertonia, mouth pain, pain
Dermatologic: Acquired ichthyosis, exfoliation of skin, viral skin infection
Endocrine & metabolic: Fluid retention, hyperglycemia, hypothyroidism
Gastrointestinal: Dysgeusia, oral discomfort, oral lesion, oral mucosa ulcer
Hematologic & oncologic: Hematoma, lymphadenopathy
Hepatic: Increased liver enzymes (incidence may be higher in children but were transient)
Neuromuscular & skeletal: Bone fracture, connective tissue disease (cartilage disorder), muscle rigidity
Ophthalmic: Conjunctivitis, eye infection, keratitis, xerophthalmia
Respiratory: Nasal signs and symptoms, paranasal sinus disease
<1%, postmarketing, and/or case reports: Abnormal hepatic function tests, aggressive behavior, agitation, anaphylaxis, angioedema, anxiety, aphonia, asthma, atrial fibrillation, behavioral changes, blurred vision, bronchospasm (may be immediate), bruise, cataract, chest congestion, chest tightness, choking sensation, cushingoid appearance, Cushing syndrome, decreased linear skeletal growth rate, depression, dysmenorrhea, dyspnea, ecchymoses, esophageal candidiasis, exacerbation of asthma (can be serious), extrasystoles, facial edema, glaucoma, hyperactivity, hypercorticoidism, hypertension, irregular menses, irritability, laryngeal edema, laryngospasm, myositis, oropharyngeal edema, osteoporosis, otalgia, pallor, paradoxical bronchospasm, paresthesia, pelvic inflammatory disease, photodermatitis, restlessness, retinopathy (central serous), sinus pain, skin rash, sore throat, stridor, supraventricular tachycardia, syncope, tonsillitis, tracheitis, upper airway swelling, vaginitis, ventricular tachycardia, vulvovaginal candidiasis, vulvovaginitis, wheezing
Hypersensitivity to fluticasone, salmeterol, or any component of the formulation; status asthmaticus; acute episodes of asthma or chronic obstructive pulmonary disease; severe hypersensitivity to milk proteins (Advair Diskus, AirDuo Digihaler, AirDuo RespiClick, Wixela Inhub)
Canadian labeling: Additional contraindications (not in US labeling): IgE mediated allergic reactions to lactose; cardiac tachyarrhythmias; untreated fungal, bacterial, or tuberculosis infections of the respiratory tract
Concerns related to adverse effects:
• Adrenal suppression: Fluticasone may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis in sensitive patients. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms. Adult patients receiving ≥20 mg per day of prednisone (or equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections. Select surgical patients on long-term, high-dose, inhaled corticosteroid should be given stress doses of hydrocortisone IV during the surgical period and the dose reduced rapidly within 24 hours after surgery (NAEPP 2007).
• Asthma-related deaths: Use of long-acting beta-2 agonists (LABAs) as monotherapy (without inhaled corticosteroids) has been associated with an increased risk of asthma-related death, asthma-related hospitalizations in pediatric and adolescent patients, and an increased risk of severe exacerbations (Nelson 2006; Walters 2007). Data from large randomized, double-blind controlled trials do not show a significant increase in risk of serious asthma-related events (including hospitalizations, intubations, and death) in adults, adolescents, and pediatric patients when fixed-dose LABAs are used with inhaled corticosteroids combined in a single inhaler compared with inhaled corticosteroid monotherapy (FDA 2017). Current asthma guidelines recommend the use of an as-needed low dose inhaled corticosteroid with formoterol as the preferred reliever agent (GINA 2023).
• Bronchospasm: Paradoxical bronchospasm that may be life-threatening may occur with use of inhaled bronchodilating agents; reaction should be distinguished from inadequate response. If paradoxical bronchospasm occurs, discontinue fluticasone/salmeterol and institute alternative therapy.
• Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm, hypotension), including anaphylaxis, have been reported.
• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Avoid use if possible in patients with ocular herpes; tuberculosis (TB) infection (latent TB) or disease (active TB) of the respiratory tract; or untreated viral, fungal, or bacterial or parasitic systemic infections. Exposure to chickenpox or measles should be avoided; if the patient is exposed, prophylaxis with varicella zoster immune globulin or pooled intramuscular immunoglobulin, respectively, may be indicated; if chickenpox develops, treatment with antiviral agents may be considered.
• Lower respiratory infections: Pneumonia and other lower respiratory tract infections have been reported in patients with chronic obstructive pulmonary disease (COPD) following the use of inhaled corticosteroids; monitor COPD patients closely since pneumonia symptoms may overlap symptoms of exacerbations.
• Oral candidiasis: Local oropharyngeal Candida infections have been reported; if this occurs, treat appropriately while continuing fluticasone therapy. Patients should be instructed to rinse mouth with water without swallowing after each use.
• Serious effects/fatalities: Do not exceed recommended dose or frequency or use with other medications containing LABAs; serious adverse events, including fatalities, have been associated with excessive use of inhaled sympathomimetics.
• Upper airway symptoms: There have been reports of laryngeal spasm, irritation, and swelling (stridor, choking) with use.
• Vasculitis: Rare cases of vasculitis (eosinophilic granulomatosis with polyangiitis [formerly known as Churg-Strauss]) or other systemic eosinophilic conditions can occur; often associated with decrease and/or withdrawal of oral corticosteroid therapy following initiation of inhaled corticosteroid.
Disease-related concerns:
• Asthma: Appropriate use: Supplemental steroids (oral or parenteral) may be needed during stress or severe asthma attacks. Not to be used in status asthmaticus. For acute asthma exacerbations, budesonide/formoterol is preferred as a reliever; however, short-acting beta-2 agonists (SABAs) may be used. In patients presenting to primary care or acute care facility, SABAs are recommended for the acute management of exacerbations (GINA 2023).
• Bone mineral density: Use with caution in patients with major risk factors for decreased bone mineral count such as prolonged immobilization, family history of osteoporosis, postmenopausal status, tobacco use, advanced age, poor nutrition, or chronic use of drugs that can reduce bone mass (eg, antiseizure medications or oral corticosteroids); high doses and/or long-term use of inhaled corticosteroids have been associated with decreases in bone mineral density.
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (arrhythmia, coronary insufficiency, hypertension, or heart failure); beta-agonists may cause elevation in blood pressure, heart rate, increase risk of arrhythmia; may also cause ECG changes (eg, flattening of the T wave, QTc prolongation, ST segment depression).
• Chronic obstructive pulmonary disease: Appropriate use: Do not use for acute episodes of COPD. Do not initiate in patients with significantly worsening or acutely deteriorating COPD. Data are not available to determine if LABA use increases the risk of death in patients with COPD.
• Diabetes: Use with caution in patients with diabetes mellitus; beta-2 agonists may increase serum glucose and aggravate preexisting diabetes mellitus and ketoacidosis.
• Hepatic impairment: Use with caution in patients with hepatic impairment; may lead to accumulation of fluticasone in plasma; monitor closely.
• Hypokalemia: Use with caution in patients with hypokalemia; beta-2 agonists may decrease serum potassium (effect is usually transient).
• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged fluticasone use. Consider routine eye exams in chronic users.
• Seizure disorders: Use with caution in patients with seizure disorders; beta-agonists may result in CNS stimulation/excitation.
• Thyroid disease: Changes in thyroid status may necessitate dosage adjustments; metabolic clearance of corticosteroids increases in patients with hyperthyroidism and decreases in hypothyroidism.
Special populations:
• Pediatric: LABAs, when used as monotherapy, increase the risk of asthma-related hospitalization in pediatric and adolescent patients. Orally inhaled and intranasal corticosteroids may cause a reduction in growth velocity in pediatric patients (~1 centimeter per year [range 0.3 to 1.8 cm per year] and related to dose and duration of exposure). To minimize the systemic effects of orally inhaled and intranasal corticosteroids, each patient should be titrated to the lowest effective dose. Growth should be routinely monitored in pediatric patients.
Dosage form specific issues:
• Lactose: Powder for oral inhalation (Advair Diskus, AirDuo Digihaler, AirDuo RespiClick, Wixela Inhub) may contain lactose; very rare anaphylactic reactions have been reported in patients with severe milk protein allergy.
Other warnings/precautions:
• Discontinuation of systemic corticosteroids: Withdraw systemic corticosteroid therapy with gradual tapering of dose; consider reducing the daily prednisone dose by 2.5 to 5 mg on a weekly basis beginning after at least 1 week of inhalation therapy. Monitor lung function, beta-agonist use, asthma symptoms, and for signs and symptoms of adrenal insufficiency (fatigue, lassitude, weakness, nausea and vomiting, hypotension) during withdrawal.
• Patient information: Patients must be instructed to use short-acting beta-2 agonist (eg, albuterol) for acute asthmatic or COPD symptoms and to seek medical attention in cases where acute symptoms are not relieved, or a previous level of response is diminished. The need to increase frequency of use of inhaled short-acting beta-2 agonist may indicate deterioration of asthma, and medical evaluation must not be delayed. Therapy should not be used more than twice daily; do not use with other long-acting beta-2 agonists.
Advair HFA 8 g canisters contain 60 inhalations, and the 12 g canisters contain 120 inhalations.
AirDuo Digihaler, AirDuo RespiClick, and Wixela Inhub contain 60 inhalations.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol, Inhalation:
Advair HFA: Fluticasone propionate 45 mcg and salmeterol 21 mcg per dose (8 g, 12 g); Fluticasone propionate 115 mcg and salmeterol 21 mcg per dose (8 g, 12 g); Fluticasone propionate 230 mcg and salmeterol 21 mcg per dose (8 g, 12 g)
Generic: Fluticasone propionate 115 mcg and salmeterol 21 mcg per dose (12 g); Fluticasone propionate 230 mcg and salmeterol 21 mcg per dose (12 g); Fluticasone propionate 45 mcg and salmeterol 21 mcg per dose (12 g)
Aerosol Powder Breath Activated, Inhalation:
Advair Diskus: Fluticasone propionate 100 mcg and salmeterol 50 mcg per dose (14 ea, 60 ea); Fluticasone propionate 500 mcg and salmeterol 50 mcg per dose (14 ea, 60 ea); Fluticasone propionate 250 mcg and salmeterol 50 mcg per dose (14 ea, 60 ea) [contains milk protein]
AirDuo Digihaler: Fluticasone propionate 55 mcg and salmeterol xinafoate 14 mcg per dose (1 ea); Fluticasone propionate 232 mcg and salmeterol xinafoate 14 mcg per dose (1 ea); Fluticasone propionate 113 mcg and salmeterol xinafoate 14 mcg per dose (1 ea) [contains lactose monohydrate]
AirDuo RespiClick 55/14: Fluticasone propionate 55 mcg and salmeterol 14 mcg per dose (1 ea) [contains lactose monohydrate]
AirDuo RespiClick 232/14: Fluticasone propionate 232 mcg and salmeterol 14 mcg per dose (1 ea) [contains lactose monohydrate]
AirDuo RespiClick 113/14: Fluticasone propionate 113 mcg and salmeterol 14 mcg per dose (1 ea) [contains lactose monohydrate]
Wixela Inhub: Fluticasone propionate 100 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 250 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 500 mcg and salmeterol 50 mcg per dose (60 ea) [contains milk protein]
Generic: Fluticasone propionate 100 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 113 mcg and salmeterol 14 mcg per dose (1 ea); Fluticasone propionate 232 mcg and salmeterol 14 mcg per dose (1 ea); Fluticasone propionate 250 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 500 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 55 mcg and salmeterol 14 mcg per dose (1 ea)
Yes
Aerosol (Advair HFA Inhalation)
45-21 mcg/ACT (per gram): $25.28
115-21 mcg/ACT (per gram): $23.47
230-21 mcg/ACT (per gram): $38.36
Aerosol (Fluticasone-Salmeterol Inhalation)
45-21 mcg/ACT (per gram): $31.02
115-21 mcg/ACT (per gram): $38.55
230-21 mcg/ACT (per gram): $50.70
Aerosol powder (Advair Diskus Inhalation)
100-50 mcg/ACT (per each): $3.90
250-50 mcg/ACT (per each): $3.90
500-50 mcg/ACT (per each): $6.36
Aerosol powder (AirDuo Digihaler Inhalation)
55-14 mcg/ACT (per each): $526.87
113-14 mcg/ACT (per each): $526.87
232-14 mcg/ACT (per each): $592.90
Aerosol powder (AirDuo RespiClick 113/14 Inhalation)
113-14 mcg/ACT (per each): $482.52
Aerosol powder (AirDuo RespiClick 232/14 Inhalation)
232-14 mcg/ACT (per each): $482.52
Aerosol powder (AirDuo RespiClick 55/14 Inhalation)
55-14 mcg/ACT (per each): $482.52
Aerosol powder (Fluticasone-Salmeterol Inhalation)
55-14 mcg/ACT (per each): $153.42
100-50 mcg/ACT (per each): $5.96 - $6.02
113-14 mcg/ACT (per each): $153.42
232-14 mcg/ACT (per each): $153.42
250-50 mcg/ACT (per each): $7.41 - $7.48
500-50 mcg/ACT (per each): $9.74 - $9.84
Aerosol powder (Wixela Inhub Inhalation)
100-50 mcg/ACT (per each): $6.02
250-50 mcg/ACT (per each): $7.48
500-50 mcg/ACT (per each): $9.84
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol, Inhalation:
Advair 125: Fluticasone propionate 125 mcg and salmeterol 25 mcg per dose (1 ea)
Advair 250: Fluticasone propionate 250 mcg and salmeterol 25 mcg per dose (1 ea)
Aerosol Powder Breath Activated, Inhalation:
Advair 100 Diskus: Fluticasone propionate 100 mcg and salmeterol 50 mcg per dose (1 ea) [contains lactose, milk protein]
Advair 250 Diskus: Fluticasone propionate 250 mcg and salmeterol 50 mcg per dose (1 ea) [contains lactose, milk protein]
Advair 500 Diskus: Fluticasone propionate 500 mcg and salmeterol 50 mcg per dose (1 ea) [contains lactose, milk protein]
Wixela Inhub: Fluticasone propionate 100 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 250 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 500 mcg and salmeterol 50 mcg per dose (60 ea) [contains milk protein]
Generic: Fluticasone propionate 100 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 250 mcg and salmeterol 50 mcg per dose (60 ea); Fluticasone propionate 500 mcg and salmeterol 50 mcg per dose (60 ea)
When fluticasone/salmeterol is initiated in patients previously receiving a short-acting beta agonist, instruct the patient to discontinue regular use of the short-acting beta agonist and to utilize the shorter-acting agent for symptomatic acute episodes only.
AirDuo Digihaler contains an electronic module that can be used with a companion mobile app; however, this is not required for administration of medication.
Oral inhalation: Rinse mouth with water after use and spit to reduce risk of oral candidiasis.
Advair Diskus, Wixela Inhub: Dry powder inhaler: After removing from box and foil pouch, write the "Pouch opened" and "Use by" dates on the label on the device. The "Use by" date is 1 month from date of opening the pouch. Do not use with a spacer or volume holding chamber. Do not take inhaler apart or wash or place any part of inhaler in water. Every time the lever is pushed back, a dose is ready to be inhaled. Do not close or tilt the device after the lever is pushed back. Do not play with the lever or move the lever more than once. The dose indicator tells you how many doses are left. When the numbers 5 to 0 (Diskus) or 9 to 0 (Inhub), appear in red, only a few doses remain. Discard device 1 month after you remove it from the foil pouch or when the dose counter reads “0” (whichever comes first).
Advair HFA: Metered-dose inhaler: Shake well for 5 seconds before each spray. Inhaler must be primed before first use by releasing 4 test sprays into the air away from the face, shaking well for 5 seconds before each spray. If canister is dropped or not used for >4 weeks, prime with 2 sprays. Use a spacer device for children <5 years of age and consider adding a face mask for infants and children <4 years of age (Ref). Patient should contact pharmacy for refill when the dose counter reads "020." Discard device when the dose counter reads "000." Do not spray in eyes. Never immerse canister into water. Clean the inhaler at least once weekly; use a dry cotton swab to clean circular opening where medication sprays out of canister and wipe the inside of the mouthpiece with a tissue dampened with water.
AirDuo Digihaler, AirDuo RespiClick: Dry powder inhaler: Inhaler does not require priming and do not use with a spacer or volume holding chamber. There is no activation button for this inhaler; when cap is opened, dose will be activated; do not open until ready for dose. Do not wash or place any part of inhaler in water; if mouthpiece needs cleaning, gently wipe with a dry cloth or tissue. When the number 20 appears in red, only a few doses remain. Discard inhaler 30 days after opening the foil pouch or when the counter reads "0," whichever comes first (device is not reusable).
Following administration, rinse mouth with water after use (do not swallow) to reduce risk of oral candidiasis.
Advair Diskus, Wixela Inhub: Dry powder inhaler: After removing from box and foil pouch, write the “Pouch opened” and “Use by” dates on the label on top of the device. The “Use by” date is 1 month from date of opening the pouch. Every time the lever is pushed back, a dose is ready to be inhaled. Do not close or tilt the device after the lever is pushed back. Do not play with the lever or move the lever more than once. The dose indicator tells you how many doses are left. When the numbers 5 to 0 appear in red, only a few doses remain. Discard device 1 month after you remove it from the foil pouch or when the dose counter reads “0” (whichever comes first).
Advair HFA: Metered dose inhaler: Shake well for 5 seconds before each spray. Prime with 4 test sprays (into air and away from face) before using for the first time. If canister is dropped or not used for >4 weeks, prime with 2 sprays. Patient should contact pharmacy for refill when the dose counter reads “020”. Discard device when the dose counter reads “000”. Do not spray in eyes.
AirDuo Digihaler, AirDuo RespiClick: Dry powder inhaler: Inhaler does not require priming and do not use with a spacer or volume holding chamber. Do not wash or place any part of inhaler in water; if mouthpiece needs cleaning, gently wipe with a dry cloth or tissue. When the number 20 appears in red, only a few doses remain. Discard inhaler 30 days after opening the foil pouch or when the counter reads "0", whichever comes first (device is not reusable).
Advair Diskus, Wixela Inhub: Store at 20°C to 25°C (68°F to 77°F). Store in a dry place out of direct heat or sunlight. Device should be discarded 1 month after removal from foil pouch, or when dosing indicator reads “0” (whichever comes first); device is not reusable.
Advair HFA: Store at 20°C to 25°C (68°F to 77°F), excursions permitted from 15°C to 30°C (59°F to 86°F). Store with mouthpiece down. Discard after 120 inhalations. Discard device when the dose counter reads “000”. Device is not reusable.
AirDuo Digihaler, AirDuo RespiClick: Store at 15°C to 25°C (59°F to 77°F); excursions permitted from 15°C to 30°C (59°F to 86°F). Avoid extreme heat, cold, or humidity. Discard 30 days after removal from foil pouch, or when dose counter reads “0” (whichever comes first); device is not reusable.
Advair Diskus, Wixela Inhub: Maintenance treatment of asthma (All strengths: FDA approved in ages ≥4 years and adults); maintenance treatment of airflow obstruction in patients with COPD associated with chronic bronchitis and emphysema (250/50 strength only: FDA approved in adults).
Advair HFA, AirDuo Digihaler, AirDuo RespiClick: Maintenance treatment of asthma (FDA approved in ages ≥12 years and adults).
NOT indicated for the relief of acute bronchospasm.
Advair may be confused with Adcirca
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Atomoxetine: May enhance the tachycardic effect of Beta2-Agonists. Risk C: Monitor therapy
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Atosiban: Beta2-Agonists may enhance the adverse/toxic effect of Atosiban. Specifically, there may be an increased risk for pulmonary edema and/or dyspnea. Risk C: Monitor therapy
Beta2-Agonists (Long-Acting): May enhance the adverse/toxic effect of other Beta2-Agonists (Long-Acting). Risk X: Avoid combination
Beta-Blockers (Beta1 Selective): May diminish the bronchodilatory effect of Beta2-Agonists. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. Risk C: Monitor therapy
Beta-Blockers (Nonselective): May diminish the bronchodilatory effect of Beta2-Agonists. Risk X: Avoid combination
Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
Cobicistat: May increase the serum concentration of Salmeterol. Risk X: Avoid combination
Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification
Cosyntropin: Corticosteroids (Orally Inhaled) may diminish the diagnostic effect of Cosyntropin. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Salmeterol. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Fluticasone (Oral Inhalation). Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Salmeterol. Risk X: Avoid combination
Desmopressin: Corticosteroids (Orally Inhaled) may enhance the hyponatremic effect of Desmopressin. Risk X: Avoid combination
Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy
Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Haloperidol: QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of Haloperidol. Risk C: Monitor therapy
Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination
Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider therapy modification
Loop Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Loxapine: Agents to Treat Airway Disease may enhance the adverse/toxic effect of Loxapine. More specifically, the use of Agents to Treat Airway Disease is likely a marker of patients who are likely at a greater risk for experiencing significant bronchospasm from use of inhaled loxapine. Management: This is specific to the Adasuve brand of loxapine, which is an inhaled formulation. This does not apply to non-inhaled formulations of loxapine. Risk X: Avoid combination
Methacholine: Beta2-Agonists (Long-Acting) may diminish the therapeutic effect of Methacholine. Management: Hold long-acting beta2 agonists for 36 hours before methacholine use. Risk D: Consider therapy modification
Monoamine Oxidase Inhibitors: May enhance the adverse/toxic effect of Beta2-Agonists. Risk C: Monitor therapy
Nirmatrelvir and Ritonavir: May increase the serum concentration of Salmeterol. Risk X: Avoid combination
Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy
Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Theophylline Derivatives: Beta2-Agonists may enhance the adverse/toxic effect of Theophylline Derivatives. Specifically, sympathomimetic effects may be increased. Theophylline Derivatives may enhance the hypokalemic effect of Beta2-Agonists. Risk C: Monitor therapy
Thiazide and Thiazide-Like Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy
Tipranavir: May increase the serum concentration of Salmeterol. Risk X: Avoid combination
Tobacco (Smoked): May diminish the therapeutic effect of Corticosteroids (Orally Inhaled). Risk C: Monitor therapy
Tricyclic Antidepressants: May enhance the adverse/toxic effect of Beta2-Agonists. Risk C: Monitor therapy
Some products may contain lactose; very rare anaphylactic reactions have been reported in patients with severe milk protein allergy.
Fluticasone can be detected in cord blood following maternal use via oral inhalation during pregnancy.
Refer to individual monographs for additional information.
Monitor growth in pediatric patients (via stadiometry). Check mucous membranes for signs of fungal infection. Monitor asthma symptoms, FEV1, peak flow, and/or other pulmonary function tests; HPA axis suppression; ocular effects (eg, cataracts, increased intraocular pressure, glaucoma); bone mineral density. Monitor blood pressure, heart rate, CNS stimulation, serum glucose, and serum potassium. Monitor for increased use of short-acting beta2-agonist inhalers; may be marker of a deteriorating asthma condition.
Combination of fluticasone (corticosteroid) and salmeterol (long-acting beta2-agonist) designed to improve pulmonary function and control over what is produced by either agent when used alone. Because fluticasone and salmeterol act locally in the lung, plasma levels do not predict therapeutic effect.
Fluticasone: The mechanism of action for all topical corticosteroids is believed to be a combination of three important properties: Anti-inflammatory activity, immunosuppressive properties, and antiproliferative actions. Fluticasone has extremely potent vasoconstrictive and anti-inflammatory activity.
Salmeterol: Relaxes bronchial smooth muscle by selective action on beta2-receptors with little effect on heart rate
See individual agents.
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