Home Drug Guide Fluticasone Propionate and Salmeterol Xinafoate

Drug Guide

Generic Name

Fluticasone Propionate and Salmeterol Xinafoate

Brand Names Advair Diskus 100/50, Advair Diskus 250/50, Advair Diskus 500/50, Advair Hfa, Fluticasone Propionate And Salmeterol Xinafoate, Airduo Respiclick, Airduo Digihaler, Wixela Inhub

Classification

Therapeutic: Bronchodilator and Anti-inflammatory for asthma/COPD

Pharmacological: Corticosteroid and Long-acting Beta-2 adrenergic agonist

FDA Approved Indications

Maintenance treatment of asthma in patients 4 years and older
Prevention of exercise-induced bronchospasm in patients 4 years and older
Maintenance treatment of airflow obstruction in patients with COPD

Mechanism of Action

Fluticasone propionate reduces inflammation by inhibiting multiple cell types and mediator substances; salmeterol stimulates beta-2 adrenergic receptors leading to bronchodilation.

Dosage and Administration

Adult: Inhalation twice daily, as prescribed by physician, using the specific device and dose.

Pediatric: Typically starting at the lowest dose, titrated based on response; consult specific product labeling.

Geriatric: Adjust doses cautiously, considering potential for increased systemic effects and comorbidities.

Renal Impairment: No specific dosage adjustment needed.

Hepatic Impairment: No specific dosage adjustment needed.

Pharmacokinetics

Absorption: Rapid absorption through pulmonary tissue.

Distribution: Extensively bound to plasma proteins, predominantly to albumin.

Metabolism: Fluticasone is metabolized in the liver via CYP3A4, salmeterol is metabolized by CYP3A4.

Excretion: Metabolites excreted primarily in feces and urine.

Half Life: Fluticasone: approx. 7.8 hours; Salmeterol: approx. 5.5 hours.

Contraindications

Hypersensitivity to glucocorticoids or salmeterol.
Acute episodes of asthma or COPD exacerbation requiring oral or IV corticosteroids.

Precautions

Use with caution in patients with infections, ocular herpes simplex, or osteoporosis.
Monitor for systemic corticosteroid effects, such as adrenal suppression, especially in long-term use.

Adverse Reactions - Common

Oral candidiasis (Common)
Headache (Common)
Throat irritation (Common)
Rhinitis (Common)

Adverse Reactions - Serious

Paradoxical bronchospasm (Rare)
Immunosuppression leading to infections (Rare)
Cardiovascular effects (tachycardia, hypertension) (Rare)
Bone fractures (Rare)
Ocular effects (glaucoma, cataracts) (Rare)

Drug-Drug Interactions

Other beta-blockers, monoamine oxidase inhibitors, tricyclic antidepressants, CYP3A4 inhibitors (e.g., ketoconazole)

Drug-Food Interactions

Avoid concurrent use with grapefruit juice (due to CYP3A4 inhibition).

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor respiratory status, lung sounds, and peak expiratory flow rate.

Diagnoses:

Impaired gas exchange
Risk for infection
Ineffective airway clearance

Implementation: Administer inhaler/device properly, educate patient on inhalation technique, rinse mouth after use.

Evaluation: Assess symptom control, lung function tests, and side effects.

Patient/Family Teaching

Use inhaler/device as prescribed, do not stop medication abruptly.
Rinse mouth to prevent oral thrush.
Report any signs of paradoxical bronchospasm or systemic effects.

Special Considerations

Black Box Warnings:

Severe asthma episodes if used for acute symptoms.
Potential risk of asthma-related death with long-term use if not properly managed.

Genetic Factors: Genetic variations in CYP3A4 may affect drug metabolism.

Lab Test Interference: May cause false decrease in serum cortisol levels.

Overdose Management

Signs/Symptoms: Severe systemic corticosteroid effects, such as hyperglycemia, hypertension, or adrenal suppression.

Treatment: Discontinue medication, supportive measures, systemic corticosteroids if necessary.

Storage and Handling

Storage: Store at room temperature, away from moisture, heat, and light.

Stability: Stable under recommended storage conditions for the duration specified on the label.