Fluticasone + salmeterol

Fluticasone sounds like (flu-tic-a-sone) and salmeterol sounds like (sal-Me-ter-ol)

Easy-to-read medicine information about fluticasone + salmeterol – what it is, how to use fluticasone + salmeterol safely and possible side effects.

Type of medicine Also called
  • This is a combination medicine. It contains a corticosteroid (fluticasone) + a bronchodilator (salmeterol) 
  • Seretide® 
  • RexAir®

What is fluticasone + salmeterol?

Fluticasone and salmeterol are mixed together in an inhaler (puffer) or an accuhaler. The combination is used to treat the symptoms of asthma and COPD and to prevent them from recurring.

  • Fluticasone works by preventing the swelling and irritation in the walls of the small air passages in the lungs. It belongs to a group of medicines known as inhaled corticosteroids. It is also called a preventer (because when used every day it prevents asthma attacks). 
  • Salmeterol works by relaxing and opening up the air passages and in that way makes breathing easier. 

In New Zealand, fluticasone + salmeterol inhalers are available in different brands, devices and strengths:

  • metered dose inhaler (MDI or puffer): Seretide and RexAir
  • accuhaler (a dry powder inhaler): Seretide.  

Using an inhaler device enables the medicine to go straight into your airways when you breathe in. This means that your airways and lungs are treated, but very little of the medicine gets into the rest of your body.

Both the MDI and accuhaler are effective inhaler devices. The choice of device is personal preference. Read more about the different inhaler devices and deciding on the right inhaler for you.

Fluticasone and salmeterol does not give immediate relief from an asthma attack
If you need quick relief from asthma symptoms or breathing problems, use your ‘reliever’ medicine such as salbutamol or terbutaline.

Dose

  • MDI:  the usual dose is 2 puffs two times a day.
  • Accuhaler: the usual dose is 1 inhalation once or two times a day.

The dose of fluticasone + salmeterol will be different for different people depending on the severity of your symptoms and the strength of your MDI or accuhaler.

  • Some people may need lower doses. For example, once at night, if you have night-time symptoms or once in the morning,  if you have daytime symptoms.
  • Always use your inhaler exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.
  • Fluticasone + salmeterol inhalers are available in different strengths. Ask your doctor or pharmacist what strength you are taking. If your inhaler looks different to what you were expecting, ask your pharmacist.
  • Keep using your inhaler every day. Do not stop using it, even if you feel better. Since asthma and COPD are long-term conditions, prevention with fluticasone + salmeterol is ongoing and it will need to be used every day.
  • Try to use your inhaler at the same time each day, to help you to remember to use it regularly.
  • Fluticasone can cause a sore throat and hoarse voice – rinse your mouth after each use to prevent this.
  • If you miss a dose, you can take it as soon as you remember. But if it is nearly time for your next dose, just take your next dose at the right time.

How to use your MDI (puffer) 

You will get the most benefit from your medicine if you use the correct technique when using your inhaler. Ask your doctor, pharmacist, or nurse to explain how to use your inhaler. Even if you have been shown before, ask your doctor, pharmacist, or nurse to explain how to use your inhaler if you still have any questions. Here is some guidance.

 How to use your MDI (puffer)
Take off the cap and hold the inhaler upright.
Shake the inhaler to mix the medication.
  Sit upright, tilt your head back slightly (as if you are sniffing) and breathe out gently.
Hold the device upright, insert the inhaler into your mouth, ensuring that your lips firmly seal the mouthpiece.
At the beginning of a slow, deep breath, breathe in through the mouthpiece as you press the inhaler to release one dose or 'puff'.
Breathe in fully, remove the inhaler from your mouth and hold your breath for 10 seconds or as long as is comfortable.
Breathe out gently through your nose.

Note: Before using the inhaler for the first time, test the inhaler by releasing puffs into the air until the counter reads 120 to make sure that it works. If the inhaler has not been used for a week or more, release 2 puffs into the air before using. Learn more about metered dose inhalers and how to use metered dose inhalers

Using a spacer with your inhaler

A spacer is an attachment to use with your MDI. Using a spacer with your MDI makes it easier to use the inhaler and helps to get the medicine into your lungs, where it’s needed (with less medicine ending up in your mouth and throat). Spacers improve how well your medicine works. Read more about spacers.

How to use your accuhaler

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist, or nurse to explain how to use your accuhaler. Here is some guidance:

(NHS UK, 2016)

Using your accuhaler

  • Open: hold the accuhaler in one hand, and with the thumb of the other hand push the thumb grip away from you until you hear a click. This reveals the mouth piece.
  • Load the dose: hold the inhaler in a horizontal position. Slide the lever away from you until you hear a click.
  • Breath out: breathe out, away from the accuhaler. Do not blow directly into your device.
  • Inhale your dose: place the mouth piece in your mouth and form a seal with your lips. Breathe in deeply and forcefully through your mouth. Remove the accuhaler and hold your breath for up to 10 seconds. If you need another dose, wait for 30 seconds and then repeat the process.
  • Close: the inhaler by sliding the thumb grip towards you.

Cleaning and storing your accuhaler: wipe the mouthpiece with a clean dry tissue. Do not wash the mouthpiece or allow it to get wet when cleaning. Close the device when not in use. 

When to start a new accuhaler: there is a window on the side of the accuhaler called a dose counter. When it turns red it is time to get a new accuhaler.

Precautions – before using fluticasone + salmeterol

  • Are you breastfeeding?
  • Are you lactose intolerant?
  • Have you ever had pulmonary tuberculosis (TB)?
  • Do you have heart disease?
  • Do you have an overactive thyroid (hyperthyroid)?
  • Do you have high blood pressure (hypertension)?
  • Do you have an irregular heartbeat or rhythm, including a very fast pulse?
  • Do you play competitive or professional sport?

If so, it’s important that you tell your doctor or pharmacist before you start using fluticasone + salmeterol. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines, fluticasone + salmeterol can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.  

Side effects What should I do?
  • Change in voice (hoarse voice)
  • Different taste in your mouth
  • Dry mouth or throat
  • Cough
  • These are quite common when you are taking fluticasone. Rinse your mouth after each use
  • Tell your doctor if troublesome
  • Signs of oral thrush (a fungal infection in the mouth) such as a very sore tongue, throat or mouth, with white sores on the tongue, or in the mouth
  • Tell your doctor or pharmacist
  • Feeling shaky
  • Nervousness
  • Tremor
  • Headache
  • Muscle cramps
  • Problems sleeping
  • These are quite common when you first start using salmeterol and usually go away with time.
  • Tell your doctor if troublesome
  • Changes in your heartbeat (faster)
  • Chest pain
  • Blurred vision or changes to your eyesight
  • Tell your doctor or ring HealthLine 0800 611 116 

Learn More

Seretide Medsafe Consumer Information Sheets
Fluticasone + salmeterol New Zealand Formulary Patient Information

References

  1. Fluticasone + salmeterol New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 06 Jun 2019