fluticasone / salmeterol
Advair is a combination inhaler that contains fluticasone (an inhaled corticosteroid) and salmeterol (a long-acting beta agonist, or LABA). Advair Diskus is used for maintenance treatment of chronic obstructive pulmonary disease (COPD) and asthma in adults and children, where as Advair HFA is for asthma only. Advair (fluticasone / salmeterol) is inhaled through the mouth, typically 1 to 2 puffs twice daily. Some common side effects of this medication include upper respiratory tract infection, sore throat, and headache.
What is Advair (fluticasone / salmeterol)?
What is Advair (fluticasone / salmeterol) used for?
How Advair (fluticasone / salmeterol) works
Advair (fluticasone / salmeterol) is a combination of two medications that work together to help treat asthma and COPD symptoms.
Fluticasone is an inhaled corticosteroid. The exact way that it works to treat asthma isn't well-understood. But it's thought to work directly in your lungs to lower inflammation and swelling, thus making it easier for you to breathe.
Salmeterol is a long-acting beta agonist. It works by relaxing the muscles in your lungs to open up your airways, making it easier to breathe.
Drug Facts
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What are the side effects of Advair (fluticasone / salmeterol)?
Common Side Effects
- Upper respiratory infection (up to 27%)
- Sore throat (up to 13%)
- Headache (up to 13%)
- Bronchitis (up to 8%)
- Cough (up to 6%)
- Nausea and vomiting (up to 6%)
- Hoarseness (up to 5%)
- Upper respiratory infection (up to 24%)
- Headache (up to 21%)
- Throat irritation (up to 9%)
- Muscle and bone pain (up to 7%)
- Nausea and vomiting (up to 5%)
Other Side Effects
- Dizziness
- Oral thrush (fungal infection in the mouth)
- Stomach pain or discomfort
- Diarrhea
- Muscle pain
Serious Side Effects
- Serious allergic reaction: hives, swelling of your face, lips, or tongue, difficulty breathing
- Sudden narrowing of your airways: difficulty breathing, wheezing, chest pain or tightness, cough
- Heart problems: dizziness, fatigue, tremor, nausea, rapid heartbeat, weakness, or difficulty sleeping
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Flu-like symptoms—fever, chills, muscle pain, cough, headache, fatigue
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Increase in blood pressure
- Low adrenal gland function—nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness
- Muscle pain or cramps
- Pain, tingling, or numbness in the hands or feet
- Sinus pain or pressure around the face or forehead
- Thrush—white patches in the mouth
- Wheezing or trouble breathing that is worse after use
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Change in taste
- Cough
- Dry mouth
- Headache
- Hoarseness
- Sore throat
- Tremors or shaking
- Trouble sleeping
Pros and cons of Advair (fluticasone / salmeterol)
Pros
Works well to lower the risk of asthma or COPD symptoms
Combines two medications into a single inhaler for convenience
Available as two different types of inhalers (Advair Diskus and Advair HFA)
Cons
Can cause fungal infections (thrush) in your mouth and throat
Advair Diskus contains lactose, so it might not be safe for people with severe milk protein allergies
Doesn't replace your rescue inhaler
Pharmacist tips for Advair (fluticasone / salmeterol)
Use Advair (fluticasone / salmeterol) twice daily at the same times every day. This medication works best if it's taken regularly every day.
Make sure to rinse your mouth with water and spit after each time you use Advair (fluticasone / salmeterol). This helps prevent fungal infections in your mouth and throat (thrush).
If you have sudden trouble breathing during a COPD or asthma attack, use your rescue inhaler. Advair (fluticasone / salmeterol) won't treat an asthma attack as it's happening.
Call your provider if your breathing or peak flow meter results worsen. Also contact your provider if you're using your rescue inhaler more often than usual. These could be signs that your Advair (fluticasone / salmeterol) dose is too low, or you need another long-acting medication to help manage your asthma.
Don't start any new medications while you're taking Advair (fluticasone / salmeterol) without asking your provider or pharmacist first. Advair (fluticasone / salmeterol) can interact with other medications, such as blood pressure medications (e.g., beta blockers), tricyclic antidepressants, and certain water pills (diuretics). Your providers can check for interactions to make sure your medications are safe to take.
Store Advair (fluticasone / salmeterol) at room temperature in a dry place away from heat or sunlight. Keep unused inhalers in the original foil pouch.
Tips for using Advair Diskus:
Let your provider know if you're severely allergic to milk proteins because Advair Diskus contains lactose.
After removing the Advair Diskus inhaler from the foil pouch, it's good for 1 month. Write the expiration ("use by") date on the first blank line on the inhaler.
There's a dose counter on the front face of the Diskus inhaler. It should say "60" for a new inhaler. Use this counter to keep track of when you need to get a refill.
You don't need to prime or shake the Advair Diskus before using it.
When you're ready to take your dose, slide the lever on the inhaler until it clicks and hold in a flat position, like a hamburger. Then, breathe out as long as you can. Then, place your lips firmly around the mouthpiece and take a fast and deep breath. Try to hold your breath for up to 10 seconds or for as long as you comfortably can so that the medication can reach deep into your lungs. Then, rinse and spit with water.
Don't wash the Diskus inhaler. Clean the mouthpiece every once in a while by wiping it with a dry cloth. Just make sure you don't get water or moisture on or near the inhaler. Moisture can make the dry powder medication clump together and clog the inhaler.
Tips for using Advair HFA:
You'll need to prime your inhaler to make sure you get the full dose. To prime the inhaler for the first time, shake it well for 5 seconds and spray into the air away from your face 4 times. To prime the inhaler after not using it for more than 4 week, or if you dropped it, shake the inhaler and spray 2 times into the air. Make sure to shake the inhaler after each spray.
Shake the inhaler well for 5 seconds before each dose to mix the medication. When you're ready, place your lips firmly around the mouthpiece. Then, take a slow and deep breath while you push the top of the canister down to deliver the medication. Try to hold your breath for up to 10 seconds or for as long as you comfortably can so that the medication can reach deep into your lungs. Wait at least 30 seconds between inhalations. After you've taken your dose, rinse and spit with water.
Ask your provider about using a spacer with your inhaler to help you take your complete dose if you're having a hard time using your HFA inhaler.
Clean your HFA inhaler at least once a week. Remove the cap and canister and set them aside. Then, rinse the mouthpiece with warm running water for 30 seconds. Shake off any extra water and let it fully air dry before putting your inhaler back together.
Use the dose counter to track how many doses you have left so you know when to get a refill. When the display window shows you only have 20 inhalations left, you should get a refill. When the display window reads "000", throw your inhaler away, even if the canister isn't completely empty.
Frequently asked questions about Advair (fluticasone / salmeterol)
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What are the risks and warnings for Advair (fluticasone / salmeterol)?
Advair (fluticasone / salmeterol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not for use in asthma attack or for worsening breathing
Don't use Advair (fluticasone / salmeterol) if you're experiencing sudden trouble breathing because this medication won't provide immediate relief. Use a rescue inhaler, such as albuterol (Ventolin HFA), if you've breathing problems.
If you're using your rescue inhaler more often than usual, let your provider know because this could be a sign that your condition is getting worse. Don't use more doses Advair (fluticasone / salmeterol) than recommended because this won't improve your breathing. Rather, this can raise your risk for serious side effects, such as heart problems, tremors, and dizziness.
Fungal infection in the mouth
Risk factor: Not rinsing and spitting after using Advair (fluticasone / salmeterol) | Weakened immune system from medical conditions or medications
Advair (fluticasone / salmeterol) includes a steroid medication. When inhaled through the mouth, it can cause a fungal infection in your mouth and throat called thrush. To lower your risk for thrush, make sure to rinse your mouth with water and spit after each inhalation of Advair (fluticasone / salmeterol). If you develop thrush, your provider might still ask you to continue Advair (fluticasone / salmeterol). Sometimes, they might prescribe you a medication to treat this condition. Let your provider know if you notice symptoms of thrush, such as white patches in your mouth, cotton-like feeling in your mouth, pain while eating or swallowing, or loss of taste.
Narrowing of your airways (bronchospasm)
Inhaled medications, including Advair (fluticasone / salmeterol), can sometimes cause a muscle spasm in your lungs (bronchospasm). This can lead to difficulty breathing, wheezing, cough, and chest discomfort. If you have a hard time breathing after inhaling Advair (fluticasone / salmeterol), use your rescue inhaler and get medical attention right away.
Higher risk of infections
Like all corticosteroid-containing medications, Advair (fluticasone / salmeterol) can weaken your immune system and raise your risk for infections, including upper respiratory infections and pneumonia. And if you do get sick, this medication can make it harder for you to heal. Your risk for infections is higher if you're also taking other medications that also weaken your immune system. If you're currently being treated for a serious infection, such as tuberculosis, let your provider know. They might need to consider a different medication for your condition. Let your provider know right away if you have symptoms of infections, such as fever, chills, body aches.
Altered stress hormone levels
Risk factors: Using Advair (fluticasone / salmeterol) for a long time | Using too much Advair (fluticasone / salmeterol)
Use Advair (fluticasone / salmeterol) only as directed. Don't use more than the maximum number of inhalations each day. Using more doses of Advair (fluticasone / salmeterol) than recommended can cause more steroid to be absorbed into the body and you might experience symptoms such as higher blood sugar or blood pressure.
On the other hand, if you're transitioning to Advair (fluticasone / salmeterol) from oral steroids, you might experience symptoms of low steroid hormone, such as stomach pain, loss of appetite, and nausea. When you transition to Advair (fluticasone / salmeterol), your provider will work with you to lower your dose of oral steroids slowly over time to prevent these side effects.
Delayed growth in children
Children who use inhaled steroids, like Advair (fluticasone / salmeterol), might experience a delay in growth. To lower the risk of growth problems, your child's provider will only prescribe the lowest dose needed to help their condition. The provider will check your child's growth regularly while they're receiving this medication. If you're concerned about how Advair (fluticasone / salmeterol) might affect your child's growth, discuss with your child's provider to see if this medication is right for them.
Eye and vision problems
Risk factors: History of glaucoma or cataracts
Though rare, people using inhaled steroids over a long period of time have reported having higher pressure in the eyes, glaucoma, and cataracts. Talk to your eye provider before using Advair (fluticasone / salmeterol) if you have glaucoma or cataracts because they might ask you to come in more often for eye exams. Also speak with them if you notice any changes to your vision while using the medication.
Heart problems
Risk factors: High blood pressure | Heart failure | Heart rate or rhythm problems | Using more Advair (fluticasone / salmeterol) than recommended
The salmeterol in Advair might cause changes in your blood pressure, heart rate, and heart rhythm. But these side effects are typically unlikely to happen if you're taking the recommended dose of Advair (fluticasone / salmeterol). Your provider might ask you to regularly check your blood pressure and heart rate at home if you have high blood pressure or other heart problems. Don't use Advair (fluticasone / salmeterol) more often than recommended. If you find that you need to use Advair (fluticasone / salmeterol) more often, let your providers know so they can see if you need any changes to your treatment plan. Tell your provider if you have dizziness, fatigue, tremor, rapid heartbeat, or weakness after you use Advair (fluticasone / salmeterol).
Low potassium levels in the blood
Risk factors: Using Advair (fluticasone / salmeterol) too much
Advair (fluticasone / salmeterol) can cause the potassium levels in your blood to drop too low. In most cases, this happens if you use more Advair (fluticasone / salmeterol) than recommended. Drops in blood potassium levels are typically mild and your levels should go back to usual with time. Sometimes, low potassium can cause tiredness, weakness, muscle cramps, a racing heart, and a "pins and needles" feeling in your hands and feet. Tell your provider if you experience any of these symptoms while you're using Advair (fluticasone / salmeterol). Also let your provider know if you need to use Advair (fluticasone / salmeterol) more often than instructed. Your treatment plan might need to be adjusted to better control your symptoms.
Allergic reactions
Allergic reactions to Advair (fluticasone / salmeterol) are possible. These reactions can include life-threatening facial swelling, shock, and anaphylaxis (closing of the throat). Get medical attention right away if you notice hives, rash, red skin, swelling of the lips or tongue, or difficulty breathing after you use Advair (fluticasone / salmeterol).
Advair (fluticasone / salmeterol) dosage forms
Typical dosing for Advair (fluticasone / salmeterol)
Advair Diskus is available in 3 different strengths: 100 mcg/50 mcg (fluticasone / salmeterol), 250 mcg/50 mcg (fluticasone / salmeterol), and 500 mcg/50 mcg (fluticasone / salmeterol).
Asthma:
Adults and children ages 12 years and older: Your provider will determine your dose based on how severe your asthma is and what other medications you've taken. The typical dose is 1 inhalation by mouth twice daily.
Children ages 4 to 11 years old: The typical dose is 1 inhalation of Advair Diskus 100 mcg/50 mcg (fluticasone / salmeterol) by mouth twice daily.
COPD:
The typical dose is 1 inhalation of Advair Diskus 250 mcg/50 mcg (fluticasone / salmeterol) by mouth twice daily.
Advair HFA is available in 3 different strengths: 45 mcg/21 mcg (fluticasone / salmeterol), 115 mcg/21 mcg (fluticasone / salmeterol), and 230 mcg/21 mcg (fluticasone / salmeterol).
Asthma
Adults and children ages 12 years and older: Your provider will determine your dose based on how severe your asthma is and what other medications you've taken. The typical dose is 2 puffs inhaled through the mouth twice daily.
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How much does Advair (fluticasone / salmeterol) cost?
Advair (fluticasone / salmeterol) contraindications
Treatment of sudden, severe asthma attack
Allergy to fluticasone (inhaled corticosteroid) or salmeterol (long-acting beta agonist)
Allergy to lactose or milk proteins
What are alternatives to Advair (fluticasone / salmeterol)?
Maintenance treatment of asthma in people ages 5 years and older
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References
Best studies we foundAmerican Academy of Allergy, Asthma, and Immunology. (n.d.). Bronchospasm defined.
American Lung Association. (2022). How to use a metered-dose inhaler without a valved holding chamber.
American Lung Association. (2023). How to use a Diskus asthma inhaler.
American Lung Association. (2023). Measuring your peak flow rate.
DelGaudio, J. M., et al. (2002). Steroid inhaler laryngitis. Journal of the American Medical Association Otolaryngology- Head and Neck Surgery.
Donohue, J. F., et al. (2021). Wixela Inhub: A generic equivalent treatment option for patients with asthma or COPD. Pulmonary Therapy.
GlaxoSmithKline LLC. (2023). Advair Diskus- fluticasone propionate and salmeterol powder [package insert]. DailyMed.
GlaxoSmithKline LLC. (2023). Advair HFA- fluticasone propionate and salmeterol xinafoate aerosol, metered [package insert]. DailyMed.
MedlinePlus. (2016). Cushing’s syndrome.
Mylan Pharmaceuticals Inc. (2022). Wixela Inhub- fluticasone propionate and salmeterol powder [package insert]. DailyMed.
Namazy, J. A., et al. (2014). The safety of asthma medications during pregnancy: An update for clinicians. Therapeutics Advances in Respiratory Disease.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Definition & facts of adrenal insufficiency & Addison's disease.
Tashkin, D. P., et al. (2018). Concomitant inhaled corticosteroid use and the risk of pneumonia in COPD: A matched-subgroup post hoc analysis of the UPLIFT® trial. Respiratory Research.
van Boven, J. F. M., et al. (2013). Inhaled corticosteroids and the occurrence of oral candidiasis: A prescription sequence symmetry analysis. Drug Safety.
Wang, Z., et al. (2022). Medication cost-savings and utilization of generic inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) drug products in the USA. Therapeutic Innovation & Regulatory Science.
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