Fluticasone-Salmeterol

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 31, 2023

Warnings

Fluticasone-Salmeterol Risks, Warnings, and Complications

Fluticasone-salmeterol may cause or worsen health problems in some people. Talk to your doctor or pharmacist about other treatments for asthma and chronic obstructive pulmonary disease if you are at an increased risk of adverse reactions or complications from this medication. Some of the risks of taking fluticasone-salmeterol include the following:

ASTHMA-RELATED DEATHS: Long-acting beta agonists (LABAs) such as salmeterol can increase the risk of asthma-related deaths. They can also increase the risk of asthma-related hospitalizations in children and adolescents. It is unclear if inhaled corticosteroids or other asthma medications can reduce this risk. Other inhalers that also contain LABA should not be used with fluticasone-salmeterol as it can increase the risk of an overdose.
Fluticasone-salmeterol is not recommended for people who have adequate asthma control on low- or medium-dose inhaled corticosteroids alone. Your healthcare provider will only prescribe combination fluticasone-salmeterol if your asthma is not adequately controlled on a long-term asthma medication such as an inhaled corticosteroid or if your asthma severity requires treatment with both a LABA and an inhaled corticosteroid.
Your doctor will reassess you periodically and step down therapy, i.e., discontinue fluticasone-salmeterol, if it is possible to do so without losing asthma control and maintain you on an inhaled corticosteroid only.
WORSENING ASTHMA OR COPD SYMPTOMS: Fluticasone and salmeterol can cause worsening of the disease and increase the risk of serious asthma-related symptoms if treatment is initiated in people with uncontrolled, severe asthma or COPD. This worsening of symptoms can even be life-threatening. Do not start taking fluticasone-salmeterol if you are currently experiencing a severe asthma attack.
INCREASED RISK OF PNEUMONIA: Fluticasone-salmeterol can increase the risk of getting respiratory infections, including pneumonia and other viral respiratory infections. Tell your doctor if you have symptoms such as fever, cough, shortness of breath, increased sputum, chest pain that is worse with deep breathing, fatigue, and low energy (these symptoms can resemble worsening COPD).
MOUTH AND THROAT INFECTIONS: Fluticasone-salmeterol can cause oral thrush (Candida), which are fungal infections in the mouth and throat. Rinse your mouth after using the inhaler. Tell your doctor if you develop white patches in your mouth or throat or have difficulty swallowing.
WORSENING INFECTIONS: Taking fluticasone-salmeterol can potentially worsen existing infections, including fungal, bacterial, viral, and parasitic infections. This is due to the suppressive effects of the steroid medicine on the immune system. This medication should be used with caution if you have tuberculosis or ocular herpes simplex. Susceptible patients can develop serious or even fatal chickenpox or measles.
ACUTE BRONCHOSPASM: Very rarely, fluticasone-salmeterol can cause paradoxical bronchospasm (sudden contraction of the airways), leading to an asthma attack and difficulty breathing. This can happen even if your asthma episodes have been well controlled. Use your rescue inhaler if you have difficulty breathing. Tell your doctor if your asthma worsens after starting fluticasone-salmeterol.
OTHER HEALTH PROBLEMS: Fluticasone-salmeterol can cause systemic effects, resulting in increased blood pressure, fast heart rate, and other heart problems, especially if you take the medicine at higher doses than prescribed. This combination medication contains a steroid, and it can lead to adrenal insufficiency at high doses. The steroid can also cause a decrease in bone mineral density. Your provider may check bone mineral density before starting fluticasone-salmeterol and at regular intervals thereafter. Fluticasone-salmeterol can affect a child’s growth. Your child’s doctor will regularly monitor growth if your child is taking this medicine for asthma symptoms. There is an increased risk of glaucoma and cataracts while on this medicine. Your provider will recommend regular eye checks during treatment with fluticasone and salmeterol.
SERIOUS ALLERGIC REACTIONS: Advair Diskus and AirDuo Respiclick contain milk proteins and are not a good option for people with severe milk allergies. Call 911 and seek emergency medical care if you develop signs and symptoms of an allergic reaction such as skin rash, hives, itching, swelling, or difficulty breathing. Advair HFA doesn't contain milk proteins and is safe for people with milk allergies.

Precautions Before Starting Fluticasone-Salmeterol

Tell your doctor if you have ever had an allergic reaction to fluticasone (Flovent, Flonase), salmeterol (Serevent), milk proteins or other foods, any of the active or inactive substances in fluticasone-salmeterol inhalers, or any other medications. Your pharmacy can give you a list of ingredients.

Tell your doctor and pharmacist all the medications you are taking, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal remedies. This can help avoid possible interactions between your medications.

Inform your doctor if you are taking another LABA, such as salmeterol alone (Serevent) or formoterol (Perforomist, in Symbicort, in Dulera). Taking fluticasone-salmeterol with other LABAs is not recommended due to the risk of overdose. Your doctor will tell you which medications to continue and which ones to stop. Follow these instructions carefully.

Give your doctor a complete medical history. Fluticasone-salmeterol may not be right for people with certain medical conditions such as osteoporosis (weak bones), irregular heartbeat, high blood pressure, heart disease, liver disease, diabetes, hyperthyroidism (overactive thyroid), seizures, tuberculosis (TB), eye conditions such as cataracts or glaucoma, and conditions affecting the immune system.

Also, tell your doctor if you have never had measles or chickenpox and have not been immunized for protection against these infections. Avoid sick contact and especially stay away from people with chickenpox or measles. If you get exposed to anyone who has one of these infections or if you develop any symptoms, inform your doctor without delay.

Ask your doctor if it is okay to eat grapefruit and drink grapefruit juice while on this medicine.

Tell your health care professional if you are pregnant, could be pregnant, plan to get pregnant, or are nursing an infant with breast milk.

Precautions During Use of Fluticasone-Salmeterol

Doctors may want to change the dose based on asthma control and monitor patients for serious adverse effects during fluticasone-salmeterol treatment. Take your medication regularly as prescribed. Keep all your medical and lab appointments.

Call your doctor if you become pregnant while taking fluticasone-salmeterol.

Tell all your doctors you are on fluticasone-salmeterol, especially before any surgery, including dental procedures.

Fluticasone-Salmeterol Drug Interactions

Other drugs can affect how fluticasone and salmeterol work. Possible drug interactions with other medicines can increase the risk of severe adverse reactions. The following medications can have interactions with fluticasone-salmeterol:

Other medications used to treat asthma and COPD
Beta-blockers such as labetalol (Trandate), propranolol (Inderal), metoprolol (Lopressor, Toprol XL), atenolol (Tenormin), and nadolol (Corgard)
Diuretics or water pills
Certain antifungals such as ketoconazole and itraconazole (Sporanox, Onmel)
Antibiotics such as clarithromycin (Biaxin, in Prevpac) and metronidazole (Flagyl)
HIV drugs such as indinavir (Crixivan), atazanavir (Reyataz), ritonavir (Norvir), nelfinavir (Viracept), and saquinavir (Invirase)
Anti-seizure medications
Antidepressants such as nefazodone

Also tell your doctor and pharmacist if you are currently taking or have taken the following medications in the past 2 weeks:

Tricyclic antidepressants such as amoxapine, amitriptyline, clomipramine (Anafranil), doxepin (Silenor), desipramine (Norpramin), nortriptyline (Pamelor), imipramine (Tofranil), trimipramine (Surmontil) and protriptyline (Vivactil)
Monoamine oxidase (MAO) inhibitors such as phenelzine (Nardil), linezolid (Zyvox), isocarboxazid (Marplan), selegiline (Eldepryl, Emsam, Zelapar), methylene blue, and tranylcypromine (Parnate)

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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