fluticasone propionate + salmeterol xinafoate: clinical use

Prescribing considerations

• Confirm that fixed inhaled corticosteroid and LABA therapy is appropriate and that the selected product is licensed for the patient's condition and age.
• Do not initiate during an acute exacerbation or rapidly deteriorating asthma; ensure access to an appropriate fast-acting reliever.
• Review symptom control, reliever use, adherence and inhaler technique regularly.
• Consider systemic corticosteroid exposure from all routes and whether a steroid treatment or emergency card is appropriate.
• AirFluSal MDI spacer choice affects lung and systemic exposure; maintain the same compatible spacer unless treatment is reassessed.

Contraindications and cautions

• Hypersensitivity to fluticasone propionate, salmeterol xinafoate or a formulation excipient.
• Seretide Accuhaler contains lactose that includes milk proteins.
• Use caution with pulmonary tuberculosis or airway infection, significant cardiovascular disease or arrhythmia, thyrotoxicosis, diabetes, hypokalaemia and susceptibility to systemic corticosteroid effects.

Monitoring

• Asthma or COPD control, exacerbations, reliever use and inhaler technique.
• Growth in children receiving prolonged inhaled corticosteroid treatment.
• Clinical evidence of adrenal suppression or other systemic corticosteroid effects when exposure is high or prolonged.
• Blood glucose or potassium where clinical risk factors or interacting treatments are present.
• Pneumonia features in COPD, recognising overlap with exacerbation symptoms.
• Visual symptoms, with ophthalmic assessment where indicated.

Clinical pharmacology

Salmeterol is a selective long-acting beta2-adrenoceptor agonist that provides sustained bronchodilation. Inhaled fluticasone propionate produces local glucocorticoid anti-inflammatory activity; swallowed fluticasone undergoes extensive first-pass CYP3A4 metabolism, although strong CYP3A4 inhibition can substantially increase systemic exposure.

Formulation and product differences

• AirFluSal MDI is a pressurised suspension requiring coordinated actuation and inhalation; compatible spacers may be used. It is licensed for adults with asthma and not for COPD.
• Seretide Accuhaler is a breath-actuated, pre-dispensed dry-powder device with an indicator. It contains lactose with milk proteins, has broader age-specific asthma licensing and includes a presentation licensed for defined adults with COPD.
• Device technique, inspiratory requirements, excipients and licensing are not interchangeable; prescribe and train for the specific inhaler.

Inhaled preparation

Route: Inhaled

Strengths: 25 micrograms + 125 micrograms/actuation, 25 micrograms + 125 micrograms/metered dose, 25 micrograms + 250 micrograms/actuation, 25 micrograms + 250 micrograms/metered dose, 25 micrograms + 50 micrograms/metered dose, 50 micrograms + 100 micrograms/dose, 50 micrograms + 250 micrograms/dose, 50 micrograms + 500 micrograms/actuation, 50 micrograms + 500 micrograms/dose