Fluticasone Propionate + Salmeterol

Fluticasone Propionate + Salmeterol is a inhaled corticosteroid + long-acting beta-2 agonist (ics/laba) combination medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

Fluticasone Propionate + Salmeterol is prescribed for the regular, long-term treatment of:

• Asthma — in patients whose symptoms are not adequately controlled with an inhaled corticosteroid alone, or who need both an inhaled steroid and a long-acting bronchodilator
• Chronic obstructive pulmonary disease (COPD) — to improve breathing and reduce repeated flare-ups (exacerbations) in suitable patients

It is a maintenance treatment that works gradually with daily use. It is not suitable for relieving a sudden asthma attack — a separate fast-acting reliever inhaler (such as salbutamol) is needed for that. Your doctor decides whether Fluticasone Propionate + Salmeterol is appropriate for your condition.

Use Fluticasone Propionate + Salmeterol exactly as prescribed — usually one or two inhalations twice daily (morning and evening), every day, even when you feel well. Children should use it only at the dose a doctor sets.

• It is a controller, not a reliever: it will not stop a sudden attack — always carry a fast-acting reliever inhaler such as salbutamol
• Use the correct technique: breathe out fully, seal your lips around the mouthpiece, breathe in deeply as you release the dose, then hold your breath for about 10 seconds. Ask your doctor or pharmacist to check your technique regularly
• Rinse your mouth with water and spit it out after every use to prevent oral thrush and hoarseness
• Do not stop or change the dose without consulting your doctor

Possible side effects of Fluticasone Propionate + Salmeterol include:

• Oral thrush (white patches in the mouth) and a hoarse voice — much less likely if you rinse your mouth after each use
• Throat irritation or cough
• Headache
• Trembling of the hands, palpitations or a fast heartbeat, muscle cramps
• In COPD patients — a slightly higher chance of pneumonia; report increased phlegm, fever or worsening breathlessness

Rarely, an inhaler can cause sudden wheezing right after use (paradoxical bronchospasm) — use your reliever and seek medical help. Long-term high doses may affect bones, eyes, blood sugar, adrenal function and children's growth, so regular medical review is important.

• Take it every day, even when symptom-free — stopping suddenly can let airway inflammation and attacks return
• Always keep a reliever inhaler with you. If you need the reliever more often than usual, your asthma is worsening — see your doctor promptly
• Rinse your mouth after every dose to prevent thrush and hoarseness
• Tell your doctor if you have heart disease, high blood pressure, an irregular heartbeat, diabetes, thyroid problems, or current or past tuberculosis or other chest infections
• Do not use any other inhaler containing a long-acting bronchodilator (LABA) at the same time unless your doctor says so
• Attend regular reviews so the doctor can keep you on the lowest effective dose, and have your inhaler technique checked

Tell your doctor about all medicines you use before starting Fluticasone Propionate + Salmeterol. Important interactions include:

• Strong CYP3A4 inhibitors — ketoconazole, itraconazole, ritonavir and some other HIV medicines, clarithromycin: these can raise fluticasone and salmeterol levels and increase steroid and heart-related side effects
• Beta-blockers — including propranolol tablets and even timolol eye drops — can block the effect of salmeterol and may trigger airway narrowing; usually avoided in asthma
• Diuretics, theophylline and other steroids — may add to potassium lowering, causing weakness or palpitations
• Other LABA-containing inhalers — must not be duplicated

Do not use Fluticasone Propionate + Salmeterol if you:

• Are allergic to fluticasone propionate, salmeterol or any other ingredient
• Have a severe allergy to milk proteins — some dry-powder devices contain lactose with milk protein

Fluticasone Propionate + Salmeterol must not be used as the first treatment of a sudden, severe asthma attack (status asthmaticus) — fast-acting reliever medicines and emergency care are needed instead. Use with extra medical supervision in uncontrolled heart disease, severe high blood pressure, diabetes, thyroid disease and active tuberculosis. Your doctor will judge whether it is suitable for you.

Pregnancy: Poorly controlled asthma is itself dangerous for both mother and baby, so doctors usually continue inhaled asthma treatment during pregnancy when it is needed. Use Fluticasone Propionate + Salmeterol in pregnancy only under your doctor's supervision — do not stop it on your own, as an asthma attack can harm the baby more than the medicine.

Breastfeeding: Inhaled doses are small and very little reaches breast milk, so breastfeeding is usually possible while using Fluticasone Propionate + Salmeterol. Still, confirm with your doctor, who will weigh the benefits and choose the lowest effective dose.

Store Fluticasone Propionate + Salmeterol below 30°C in a dry place, away from heat and direct sunlight. Keep the mouthpiece cap closed and clean.

• Pressurised inhaler canisters must not be pierced, broken or burned, even when they seem empty
• Keep dry-powder devices away from moisture and do not breathe out into the device
• Note the dose counter and replace the inhaler when doses run out or by the discard date on the label
• Keep out of the reach and sight of children