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Overview: Fluticasone/salmeterol is a powder or spray that you inhale to help manage breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD). It reduces inflammation and relaxes the muscles around your airways to make it easier to breathe. Common side effects include sore throat or common cold symptoms. Notify your healthcare provider right away if your breathing gets worse instead of better after using fluticasone/salmeterol.

Uses

What is fluticasone/salmeterol used for?

Fluticasone/salmeterol is commonly used as a controller (maintenance) inhaler for the following conditions. 

Fluticasone/salmeterol may also be used for other conditions as determined by your healthcare provider.

How does fluticasone/salmeterol work (mechanism of action)?

People with asthma or COPD have chronic and ongoing airflow problems in the lungs. Fluticasone/salmeterol contains two medicines. Fluticasone reduces swelling or inflammation in the lungs. Salmeterol relaxes the muscles around the airways. This can help to make it easier to breathe.

How is fluticasone/salmeterol supplied (dosage forms)?

Brand and other names

  • Advair Diskus
  • Advair HFA
  • AirDuo RespiClick
  • AirDuo Digihaler
  • Wixela Inhub

Dosage forms and strengths

  • 45 mcg/21 mcg, 115 mcg/21 mcg, and 230 mcg/21 mcg inhalation aerosol
  • 55 mcg/14 mcg, 113 mcg/14 mcg, 232 mcg/14 mcg, 100 mcg/50 mcg, 250 mcg/50 mcg, 
    and 500 mcg/50 mcg inhalation powder

How should I store fluticasone/salmeterol?

Fluticasone/salmeterol should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Inhaled Powder. Keep fluticasone/salmeterol inhaled powder inside of its unopened pouch until you are ready to use it. Once the pouch has been opened, fluticasone/salmeterol inhaled powder is only good for 30 days. If the inhaler is not empty after 30 days, it should be thrown out and replaced.

Inhaled Spray. Store fluticasone/salmeterol inhaled spray (aerosol) with the mouthpiece down. Keep it in a dry place away from sunlight and heat. It may burst if exposed to temperatures over 120 F (49 C).

Side Effects

What are the most common side effects of fluticasone/salmeterol?

The most common side effects of fluticasone/salmeterol are listed below. These side effects may vary depending on the condition that is being treated. Tell your healthcare provider if you have any of these side effects that bother you.

  • Infection in the nose or throat, sore throat, or common cold symptoms
  • Oral thrush (see below)
  • Headache
  • Cough 
  • Back pain
  • Nausea and vomiting 
  • Hoarseness or change in voice

There may be other side effects of fluticasone/salmeterol that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of fluticasone/salmeterol?

While less common, the most serious side effects of fluticasone/salmeterol are described below, along with what to do if they happen.

Severe Allergic Reactions. Fluticasone/salmeterol may cause allergic reactions, which can be serious. Stop using fluticasone/salmeterol and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Reduced Adrenal Function. Long-term use of fluticasone/salmeterol can cause your body’s adrenal glands to stop making as much cortisol (the stress hormone). This is known as adrenal insufficiency. This is especially a concern if you have been taking a corticosteroid by mouth, such as prednisone, and you stop it and switch to fluticasone/salmeterol. Adrenal insufficiency can get worse if your body is under stress because of fever, surgery, or trauma. Tell your healthcare provider if you have any of the following symptoms of adrenal insufficiency.

  • Nausea and vomiting
  • Weakness, tiredness, or lack of energy
  • Low blood pressure

Sudden Breathing Problems. Fluticasone/salmeterol may cause the muscles around your airways to tighten (bronchospasm) right after you use it, instead of relaxing these muscles. In some cases, this can be serious. Stop using fluticasone/salmeterol and contact your healthcare provider right away if your breathing gets worse instead of better right after using fluticasone/salmeterol.

Glaucoma. Fluticasone/salmeterol may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. Tell your healthcare provider right away if you have any of the following symptoms of glaucoma.

  • Loss of vision
  • Eye pain or redness
  • Severe headache or vomiting
  • Seeing bright, colorful circles around lights (vision halos)

Heart Effects. Fluticasone/salmeterol may increase your risk of certain effects on the heart, such as raising your heart rate, blood pressure, or causing an abnormal heart rhythm (arrhythmia). If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Also call your healthcare provider or get medical attention right away if you have chest pain, a fast or irregular heartbeat, or if you feel your heartbeat more than usual.

Increased Blood Sugar. Fluticasone/salmeterol may increase your blood sugar levels. Talk to your healthcare provider about how to maintain healthy blood sugar levels.

Infection. Fluticasone/salmeterol can increase the risk of infections, including serious infections. Call your healthcare provider right away if you have an infection or any of the following symptoms.

  • Cough or coughing up blood
  • Fever, sweats, chills, or muscle aches
  • Shortness of breath
  • Diarrhea or stomach pain
  • Weight loss

Pneumonia. Pneumonia is an infection of the lungs that can make it hard to breathe. Some people with COPD who use fluticasone/salmeterol have developed pneumonia. Contact your healthcare provider right away if you have any of the following symptoms of pneumonia. 

  • Trouble breathing
  • Increased mucus or change in mucus color
  • Worsening cough
  • Fever or chills

Low Potassium Level (Hypokalemia). Fluticasone/salmeterol can cause a low potassium level, which can be serious and may lead to death. Your healthcare provider may check your potassium levels, especially if you take certain other medicines. Keep all appointments to have your blood checked. Call your healthcare provider if you have any of the following symptoms of a low potassium level.

  • Weakness
  • Unusual tiredness
  • Muscle cramps or twitching
  • Constipation

Nervous System Effects. Fluticasone/salmeterol may cause nervous system effects, including tremor or nervousness. Contact your healthcare provider right away if you develop these symptoms.

Oral Thrush. Fluticasone/salmeterol can cause a fungal infection in your mouth and throat, a condition known as oral thrush or oral candidiasis. To help prevent thrush, rinse your mouth with water and spit out the water (do not swallow it) after each dose of fluticasone/salmeterol. Contact your healthcare provider if you notice any of the following symptoms of oral thrush. 

  • Cracking in the corners of the mouth
  • Loss of taste
  • Red or white patches in the mouth or throat
  • Raised white spots in the mouth or throat

Slow Growth. In people who are still growing, such as children and adolescents, fluticasone/salmeterol may slow down growth. Keep all appointments with your healthcare provider to monitor growth rate.

Weak Bones. Using fluticasone/salmeterol for a long time may cause the bones to become weaker, leading to reduced bone density (osteopenia). It may also cause a more serious condition called osteoporosis, which can cause bones to break (or fracture) more easily. Your healthcare provider may monitor your bone density while you are using fluticasone/salmeterol. 

Warnings & Precautions

Who should not use fluticasone/salmeterol?

Allergies to Ingredients. People who are allergic to any of the following should not use fluticasone/salmeterol.

  • AirDuo RespiClick
  • Wixela Inhub
  • Advair HFA
  • Advair DIskus
  • Fluticasone
  • Salmeterol
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific fluticasone/salmeterol products they stock.

Sudden COPD or Asthma Symptoms. If you are currently having a sudden worsening of symptoms, such as from an asthma attack or a COPD flare-up, you should not use fluticasone/salmeterol to treat these symptoms. Fluticasone/salmeterol should be used daily to prevent and manage symptoms. Do not use it as a quick-relief (rescue) inhaler.

What should I know about fluticasone/salmeterol before using it?

Do not use fluticasone/salmeterol unless it has been prescribed to you by a healthcare provider. Use it as prescribed. Using fluticasone/salmeterol more often than prescribed may increase your risk of serious side effects.

Ask your pharmacist or other healthcare provider to show you how to correctly use and clean fluticasone/salmeterol. Follow the “Instructions for Use” that comes with your fluticasone/salmeterol before using it for the first time and whenever you are not sure how to use it. The inhaled spray (aerosol inhaler) needs to be primed so you get the correct dose. 

You need to shake fluticasone/salmeterol inhaled spray (aerosol inhale) well before each spray. 

You should not shake the fluticasone/salmeterol inhaled powder products.

Do not share fluticasone/salmeterol with other people, even if they have the same condition as you. It may harm them.

Keep fluticasone/salmeterol out of the reach of children.

Fluticasone/salmeterol is a medicine used daily to prevent symptoms. Do not use it when a quick response to breathing problems is needed. Other inhaled medicines, sometimes called quick-relief (or rescue) inhalers, should be used to treat sudden symptoms. Get medical help right away if your breathing does not get better after using a rescue inhaler.

After using fluticasone/salmeterol, rinse your mouth out with water and spit the water out. This helps lower your chance of getting a fungal infection in your mouth or throat, called oral thrush.

Do not stop using or change your fluticasone/salmeterol dose without talking to your healthcare provider first.

Try to use your fluticasone/salmeterol around the same time each day.

What should I tell my healthcare provider before using fluticasone/salmeterol?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if fluticasone/salmeterol is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Any allergies, including to medicines or foods
  • An infection, a history of immune system problems or severe infections, or if you have been exposed to chickenpox or measles
  • Diabetes or high blood sugar
  • Eye problems, such as glaucoma or cataracts
  • Heart problems, including arrhythmias
  • High blood pressure
  • History of bone conditions, such as osteomalacia, osteopenia, or osteoporosis, or if you are at risk for weak bones, such as if you use tobacco or are inactive for a long period of time
  • Liver problems
  • Seizures
  • Thyroid problems

Other Medicines and Supplements. Fluticasone/salmeterol may interact with other medicines and supplements. Before using fluticasone/salmeterol, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how fluticasone/salmeterol could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should use fluticasone/salmeterol while you are pregnant or trying to get pregnant.

Breastfeeding. It is not known if fluticasone/salmeterol passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should use fluticasone/salmeterol while breastfeeding.

Interactions

Does fluticasone/salmeterol interact with foods or drinks?

There are no known interactions between fluticasone/salmeterol and foods or drinks.

It is unknown if drinking alcohol will affect fluticasone/salmeterol.

Does fluticasone/salmeterol interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using fluticasone/salmeterol.

  • A beta-blocker, such as metoprolol (Lopressor), atenolol (Tenormin), or propranolol (Inderal LA), which is a medicine that may be used for certain heart conditions or to reduce blood pressure
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • A long-acting beta-2 agonist (LABA), such as salmeterol (Serevent), formoterol (Perforomist), arformoterol (Brovana), or olodaterol (Striverdi), which is an inhaled medicine used for asthma or COPD
  • A medicine for HIV or AIDS
  • A monoamine oxidase inhibitor (MAOI) within the past two weeks, which is a medicine usually used for depression or Parkinson’s disease
  • A tricyclic antidepressant within the past two weeks, such as amitriptyline, nortriptyline, or protriptyline, even if it is not used for depression
  • Ketoconazole, itraconazole (Sporanox, Tolsura), posaconazole (Noxafil), or voriconazole (Vfend), which is a medicine used for fungal infections

Some other medicines may alter the blood levels of fluticasone/salmeterol. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with fluticasone/salmeterol. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much fluticasone/salmeterol?

If you or someone else has used too much fluticasone/salmeterol, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of fluticasone/salmeterol?

If you miss a dose, skip it. Use fluticasone/salmeterol when you normally would for the next dose. Do not use double or extra doses.