A fixed-dose combination inhaler containing a long-acting beta2-adrenergic agonist (LABA) and an inhaled corticosteroid (ICS). Salmeterol provides bronchodilation by relaxing airway smooth muscle, while Fluticasone Propionate exerts potent anti-inflammatory action in the lungs. This combination is a cornerstone of maintenance therapy for moderate to severe persistent asthma and COPD, improving lung function, reducing exacerbations, and enhancing quality of life. It is not indicated for the relief of acute bronchospasm.
Adult: Asthma & COPD: One inhalation (Salmeterol 50mcg + Fluticasone Propionate 250mcg) twice daily (morning and evening, approximately 12 hours apart). The dose should be individualized. Maximum: 2 inhalations twice daily (total Fluticasone 1000mcg/day).
Note: For use with Diskus/Accuhaler/Dry Powder Inhaler (DPI). Instructions: 1) Open the device. 2) Slide the lever until it clicks to load a dose. 3) Breathe out gently away from the mouthpiece. 4) Place lips tightly around the mouthpiece. 5) Breathe in deeply and forcefully through the mouth. 6) Hold breath for about 10 seconds, then breathe out slowly. 7) Close the device. Rinse mouth with water and spit out after each use to prevent oral candidiasis and systemic absorption.
The combination provides complementary and synergistic actions. Salmeterol acts as a bronchodilator by relaxing bronchial smooth muscle, while Fluticasone Propionate targets the underlying inflammation, reducing mucosal edema, inflammatory cell infiltration, and cytokine release. This dual action leads to improved airway patency, reduced hyperresponsiveness, and prevention of exacerbations.
Pregnancy: Category C (US FDA). Adequate and well-controlled studies in pregnant women are lacking. Use only if the potential benefit justifies the potential risk to the fetus. Inhaled therapy is preferred over oral systemic therapy for asthma control during pregnancy, as uncontrolled asthma poses a greater risk.
Driving: Unlikely to affect the ability to drive or use machines. However, patients should be aware of potential side effects like tremor, dizziness, or palpitations which could impair these abilities.
| Ketoconazole, Itraconazole, Ritonavir, Clarithromycin | Potent CYP3A4 inhibitors. Significantly increase systemic exposure to both Salmeterol and Fluticasone, increasing risk of systemic corticosteroid effects (Cushing's syndrome, adrenal suppression) and cardiovascular effects (QT prolongation, tachycardia). | Major - Contraindicated or requires extreme caution and dose reduction. |
| Beta-blockers (e.g., Propranolol) | Antagonize the bronchodilator effect of Salmeterol and may cause severe bronchospasm in asthmatic patients. Cardioselective beta-blockers (e.g., Metoprolol) may be used with caution. | Major |
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | May potentiate hypokalemia induced by beta2-agonists. | Moderate |
| Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants (TCAs) | May potentiate the cardiovascular effects of Salmeterol. | Moderate |
| Other Corticosteroids (Oral/Injectable) | Increased risk of systemic corticosteroid side effects and adrenal suppression. | Moderate |
Same composition (Salmeterol (50mcg) + Fluticasone Propionate (250mcg)), different brands: