fluticasone and salmeterol oral inhaler, Advair Diskus, Advair HFA
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: fluticasone propionate and salmeterol oral inhaler
BRAND NAME: Advair Diskus, Advair HFA
DRUG CLASS AND MECHANISM: Advair is a combination of inhaled drugs that is used to treat asthma and chronic bronchitis. In patients with asthma, the smaller airways (bronchioles) through which air moves in and out of the lungs can be narrowed by accumulation of mucus, spasm of the muscles that surround these airways, or swelling of the lining of the airways due to inflammation. Airway narrowing leads to symptoms of shortness of breath, wheezing, cough, and congestion. Medications used in treating asthma include those that open airways, called bronchodilators, and those that reduce inflammation.
Advair contains a combination of salmeterol, a bronchodilator of the beta-2 agonist type, and fluticasone propionate, an anti-inflammatory corticosteroid. Beta-2 agonists are medications that attach to beta-2 receptors on the smooth muscle cells that surround the airways, causing the muscle cells to relax and open the airways. Fluticasone propionate is a synthetic (man-made) corticosteroid of the glucocorticoid family which is related to the natural hormone, cortisol or hydrocortisone, produced by the adrenal glands. Glucocorticoid steroids have potent anti-inflammatory actions. In asthmatic patients, the suppression of inflammation within the airways reduces the swelling caused by inflammation that narrows the airways. At the same time, production of mucus is reduced. When used in lower doses, very little inhaled fluticasone propionate is absorbed into the body and side effects are infrequent. When higher doses are used, fluticasone is absorbed and may cause side effects elsewhere in the body. The FDA approved Advair Diskus in August, 2000 and Advair HFA in June 2006.
GENERIC AVAILABLE: No
PREPARATIONS: Advair Diskus is an oral inhalation powder available in three different forms containing the same amount of salmeterol, 50 mcg, but differing in the amount of fluticasone propionate. 100/50 provides 100 mcg of fluticasone propionate, 250/50 provides 250 mcg of fluticasone propionate, and 500/50 contains 500 mcg of fluticasone propionate per inspiration.
Advair HFA is an oral aerosol containing 21 mcg of salmeterol combined with 45, 115, or 230 mcg fluticasone.
STORAGE: Advair should be stored at room temperature, 68 F to 77 F (20 C to 25 C). It should be kept away from heat or flames and should not be punctured; it should not be frozen or placed in direct sunlight.
PRESCRIBED FOR: Advair Diskus is used for the treatment of asthma or chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis. Its action starts within 30 to 60 minutes and can last more than 12 hours. Advair Diskus is generally not needed in patients whose asthma can be controlled easily with infrequent administration of short acting inhalers. Advair HFA is used for treating asthma in individuals 12 years old or older. Advair Diskus or HFA should not be used to treat acute episodes of asthma or COPD.
DOSING: The recommended Advair Diskus regimen for asthma in individuals 12 years and older is one inhalation twice daily (morning and evening) approximately 12 hours apart. The lowest effective strength should be used and the maximum dose is 500/50 mcg twice daily. For children 4 to 11 years old the recommended treatment is one inhalation of 100/50 mcg twice daily. The recommended regimen of Advair Diskus for COPD is one inhalation of 250/50 mcg twice daily. Higher doses are not more effective.
The recommended dose for Advair HFA is 2 inhalations twice daily. The lowest effective dose should be used.
The Diskus device is held in one hand with the thumb of the other hand placed on the thumb-grip. The thumb is then pulled away as far as the device allows until the mouthpiece seems to click into position. With the Diskus then held horizontally and with the mouthpiece towards the patient, the lever is then slid away as far as it can go until it clicks. The patient breathes out as far as comfortable, then placing his mouth to the mouthpiece, breathes in quickly and deeply and holds his breath for about ten seconds. The patient then washes his or her mouth without swallowing after inhalation.
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