What to Know About Advair Diskus (fluticasone propionate and salmeterol)

Advair Diskus is an asthma controller medication that combines two drugs into one dry powder inhaler so the medications can be taken simultaneously. They are:

• Fluticasone propionate, an inhaled corticosteroid (ICS) that reduces airway inflammation
• Salmeterol, a long-acting beta agonist (LABA) that works as a bronchodilator to help relax the muscles of the airways

Advair Diskus is approved for adults and for children with asthma who are at least 4 years old. It is also approved as a maintenance treatment for chronic obstructive pulmonary disease (COPD) for adults only. A generic alternative is available.

Uses

As a controller medication, Advair Diskus is formulated to be used daily to prevent wheezing, chest tightness, shortness of breath, and chronic cough. It is not a first-line treatment for asthma, but rather is prescribed after a low-dose inhaled corticosteroid (ICS) is unable to fully stave off symptoms in people whose disease is classified as moderate to severe persistent asthma.

It is meant to help improve lung function and prevent asthma attacks. It can also be taken daily for airway obstruction and to help reduce exacerbations of symptoms in COPD.

Advair Diskus is not a treatment for acute symptoms of asthma or COPD. A fast-acting rescue inhaler should be used for acute symptoms.

Before Taking

Inhaled corticosteroids are a first-line treatment for asthma. When used daily, the anti-inflammatory properties in these inhalers are highly effective at reducing airway inflammation and preventing asthma symptoms in adults and children.

Everyone with asthma is also prescribed a quick-relief inhaler for acute symptoms. Rescue inhalers are typically short-acting beta-agonists (SABAs), which are fast-acting bronchodilators to help quickly widen the airways, allowing for improved breathing.

Those who do not have a reduction in frequency or severity of asthma symptoms within four to six weeks of starting inhaled corticosteroids likely need to have their treatment adjusted. This may include an increased dose and/or an add-on controller medication. The same is true for those with COPD whose symptoms are not adequately managed with an inhaled corticosteroid plus occasional use of a rescue inhaler.

LABAs are long-acting bronchodilators that are effective for 12 hours or more. When a LABA is added to control asthma, it can improve lung function, decrease symptoms, and reduce symptom exacerbations and use of rescue inhalers in most patients to a greater extent than doubling the dose of inhaled corticosteroids.

One exception is children ages 5 to 11, for whom the option of increasing the dose of inhaled corticosteroids may be considered before LABAs are added. LABAs are, however, the preferred add-on therapy for adults and children ages 12 and older.

Once a LABA is deemed necessary, it is often prescribed as a combination therapy so that both controller medications can be conveniently delivered at the same time. One such option is Advair Diskus.

Talk to your healthcare provider about all medications, supplements, and vitamins you currently take. While some drugs pose minor interaction risks, others may contraindicate the use of Advair Diskus outright or prompt careful consideration of whether the pros of treatment outweigh the cons in your case.

Precautions and Contraindications

Certain medical circumstances can increase the risks of Advair Diskus or even prohibit its use, including:

• Allergy or hypersensitivity: Do not take Advair Diskus if you have a known allergy or hypersensitivity to Advair Diskus or milk proteins.
• Exposure to chickenpox or measles: Advair Diskus can lead to worsening of infections; chickenpox and measles can become severe or fatal. This is particularly risky if you are unvaccinated.
• Pregnancy: There are no adequate, well-controlled studies of Advair Diskus use in pregnant persons, but animal studies suggest there may be risks of birth defects or fetal loss. Your healthcare provider can help you evaluate if the benefits justify the risks for you.
• Nursing: It is not known whether or not fluticasone propionate may be transferred to a baby via breast milk. Other corticosteroids have been detected in breastmilk.

Other Combination Therapies

Combination therapies of inhaled corticosteroids and LABAs can be delivered by either a powder or an aerosol (which uses propellant to release the medication). Advair Diskus is a powder.

Airduo Respiclick is another brand of a powder inhaler, and it is available in a lower dose of salmeterol (the LABA) than Advair Diskus.

Aerosol options include:

• Advair HFA (fluticasone and salmeterol)
• Dulera (mometasone and formoterol)
• Symbicort (budesonide and formoterol)

Your healthcare provider will determine which delivery method, medications, and doses are right for you or your child. For example, if someone struggles to inhale forcefully, they may have more success with Advair HFA—which uses a propellant to deliver the medication into the lungs—than Advair Diskus.

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Dosage

Advair Diskus is typically used twice per day, with approximately 12 hours separating each dose.

Advair Diskus comes in three strengths in micrograms (mg):

• Advair Diskus 100/50 (100 mcg fluticasone propionate, 50 mcg salmeterol)
• Advair Diskus 250/50 (250 mcg fluticasone propionate, 50 mcg salmeterol)
• Advair Diskus 500/50 (500 mcg fluticasone propionate, 50 mcg salmeterol)

Children ages 4 to 11 may only be prescribed Advair Diskus 100/50.

Adults and children with asthma who are 12 years or older are typically prescribed a starting dose of either Advair Diskus 100/50 or Advair Diskus 250/50 taken twice a day, depending on asthma severity. If your asthma symptoms worsen or do not improve, your healthcare provider will likely step you up to one of the formulations with more fluticasone, up to a maximum dose of Advair Diskus 500/50 taken twice a day.

The recommended dose for adults with COPD is Advair Diskus 250/50 taken twice a day.

Advair needs to be taken every day to improve asthma or COPD symptoms.

How to Take and Store

Dry powder inhalers like Advair Diskus are breath-activated, meaning a dose is released from the inhaler when you breathe in deeply and forcefully. This allows the medication to be inhaled quickly into the lungs. You don't have to shake Advair or use a spacer.

After using the inhaler, rinse out your mouth with water to reduce your risk of getting oral thrush (yeast infection).

If you forget a dose, take it as soon as you remember, but if it is close to your next dose, skip it. And if you take more than your recommended daily dose of Advair Diskus, seek medical attention; heart monitoring may be needed.

The Advair dispenser contains a dose counter built into it, so you'll always know when it's getting close to the time you should refill your prescription. As the inhalation device itself is not reusable, you will get a new one with each medication refill.

The inhaler should be discarded one month after removal from the moisture-protective foil overwrap pouch or after all doses have been used (when the dose indicator reads “0”), whichever comes first. Do not attempt to take the device apart.

Store at room temperature (ideally 68 to 77 degrees F) in a dry place away from direct heat or sunlight. As with all medications, keep it out of the reach of children.

Side Effects

Only a small percentage of patients experience adverse effects when using Advair Diskus, and they are similar to those of both inhaled steroids and LABAs. However, some potential side effects of using this drug are severe. This includes severe asthma exacerbations that, while rare, increase the risk of asthma-related deaths.

LABAs may also increase the risk of hospitalizations in children and adolescents. As Advair Diskus is part LABA, this applies to this medication as well.

Common

Common side effects of Advair Diskus when it's taken for asthma include:

• Throat irritation
• Hoarseness and voice changes
• Thrush in your mouth or throat
• Bronchitis
• Cough
• Headache
• Nausea and vomiting

In children with asthma, infections in the ear, nose, and throat are also common.

Common side effects when Advair Diskus is taken for COPD include:

• Thrush in the mouth or throat
• Throat irritation
• Hoarseness and voice changes
• Viral respiratory infections
• Headache
• Muscle and bone pain

Severe

When Advair Diskus is taken for asthma or COPD, it can cause severe and life-threatening adverse events, including paradoxical bronchospasm or allergic reactions. Taking Advair Diskus can also increase your risk of upper respiratory tract infections and pneumonia.

Seek urgent medical attention if you experience any of the following symptoms when using Advair Diskus:

• Breathing problems immediately after inhaling your medicine
• Increased cough
• Increased breathing problems
• Rash or hives
• Swelling of your face, mouth, and tongue
• Rapid heartbeat
• Chest pain
• Tremor
• Nervousness
• Changes in vision
• Increase in mucus (sputum)
• Change in mucus color
• Fever or chills

Warnings and Interactions

A healthcare provider may order blood tests to monitor blood sugar, potassium (to check for a decrease), and certain types of white blood cells in people who use this inhaler.

Changes in vision, glaucoma, and cataracts can occur with long-term use of inhaled corticosteroids. Schedule eye exams at least once a year and alert your healthcare provider if you experience vision changes between check-ups.

If patients with any of the following conditions use Advair Diskus, they should do so cautiously and under close oversight by a healthcare provider:

• Heart conditions or hypertension: Salmeterol can sometimes increase heart rate, blood pressure, and heart-related symptoms. In addition, fluticasone propionate in excessive doses can lead to cardiac emergencies. Careful monitoring of those with heart conditions, especially coronary insufficiency, arrhythmias, or hypertension may be needed. This may include the use of heart monitors and regularly checking pulse and blood pressure.
• Osteoporosis or risk factors for osteoporosis: The long-term use of inhaled corticosteroids can lead to decreases in bone mineral density over time. Your healthcare provider may want to check your bone mineral density prior to starting Advair Diskus and then periodically while you are on the medication. If reductions in bone mineral density occur, your healthcare provider may want to add a medication to reduce or prevent bone loss or revaluate your asthma or COPD treatments.
• Glaucoma, cataracts, or history of increased eye pressure: Those with these eye diseases or who are at risk for such issues should undergo careful monitoring while using Advair Diskus to look for any increases in eye pressure or changes in vision.
• Convulsive disorders, thyrotoxicosis, or diabetes: You may need close monitoring for signs of worsening of these conditions while taking Advair Diskus for asthma or COPD.
• Weakened immune systems or active infections: Worsening of existing tuberculosis, fungal/ bacterial/viral/parasitic infections, or herpes infections of the eye can occur while taking Advair Diskus.
• Liver impairment: Salmeterol and fluticasone propionate are mostly cleared from your system through metabolism by the liver, so those with liver impairment should be carefully monitored and doses of Advair Diskus may need to be lowered.

If you stopped taking an oral corticosteroid such as prednisone prior to using Advair Diskus, there is a transition period of several months during which you may experience reduced adrenal function. If your body is under stress, such as from fever, trauma, infection, or surgery, adrenal insufficiency can worsen or even lead to death.

Seek urgent medical attention if you develop symptoms of adrenal insufficiency, such as fatigue, weakness, nausea, vomiting, or low blood pressure.

There are also drug interactions that may increase the risk of certain side effects or require you to be monitored by your healthcare provider when using Advair Diskus.

It is generally recommended that you avoid taking the following medications with Advair, since increased corticosteroid and heart-related adverse events can occur:

• Biaxin (clarithromycin)
• Crixivan (indinavir)
• Onmel (itraconazole)
• Nefazodone
• Viracept (nelfinavir)
• Invirase (saquinavir)
• Nizoral (ketoconazole)
• Ketek (telithromycin)
• Norvir (ritonavir)
• Reyataz (atazanavir)

Other medications that can interact with Advair Diskus and should only be used with caution and careful monitoring include:

• Monoamine oxidase inhibitors (MAOIs)
• Tricyclic antidepressants
• Beta blockers
• Diuretics

Disclose all medications you are taking to your healthcare provider and never stop a medication you are on without the prescribing practitioner's OK.

A Word From Verywell

Advair Diskus can be a useful medication for people who are not able to achieve control of their asthma or COPD on an inhaled corticosteroid alone. You and your healthcare provider should discuss the possible risks and benefits before you take a combination therapy like Advair Diskus. Make sure you notify your practitioner of any worsening of your symptoms while taking it.