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What is fluticasone and salmeterol inhalation?
Fluticasone is a steroid. It prevents the release of substances in the body that cause inflammation. Salmeterol is a bronchodilator. It works by relaxing muscles in the airways to improve breathing. Fluticasone and salmeterol inhalation is used to prevent asthma attacks. It is also used prevent flare-ups or worsening of chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis and/or emphysema. Fluticasone and salmeterol may also be used for other purposes not listed in this medication guide.

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What are the possible side effects of this medication?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• bronchospasm (wheezing, chest tightness, trouble breathing);

• fast or uneven heart beats, restless feeling, tremor;

• fever, chills, stabbing chest pain, cough with yellow or green mucus;

• blurred vision, eye pain, or seeing halos around lights;

• white patches or sores inside your mouth or on your lips; or

• worsening asthma symptoms.

Less serious side effects include:

• headache, dizziness;

• nausea, vomiting, diarrhea;

• dryness in your mouth, nose, or throat;

• stuffy nose, sinus pain, cough, sore throat; or

• hoarseness or deepened voice.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

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How should I use this medication?
Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the directions on your prescription label. This medication comes with patient instructions for safe and effective use, and directions for priming the inhaler device. Follow these directions carefully. Do not use fluticasone and salmeterol inhalation to treat an asthma attack that has already begun. It will not work fast enough. Use only a fast-acting inhalation medication.

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What is the most important information I should know about this medication?
Do not use fluticasone and salmeterol to treat an asthma attack that has already begun. Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. Salmeterol has been shown to increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication.

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What happens if I miss a dose?
Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

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What other drugs will affect this medication?
Before using fluticasone and salmeterol inhalation, tell your doctor if you are using any of the following drugs: amiodarone (Cordarone); a diuretic or "water pill"; HIV medicines such as atazanavir (Reyataz), ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), or saquinavir (Invirase); an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam); an antidepressant such as amitriptyline (Elavil), desipramine (Norpramin), fluoxetine (Prozac), nefazodone, or imipramine (Tofranil);

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

Fluticasone-salmeterol for inhalation has been assigned to pregnancy category C by the FDA. Animal studies have revealed evidence of teratogenicity when corticosteroids are administered orally or potent steroids are applied topically. Fluticasone has been shown to be teratogenic when administered subcutaneously at high doses to mice. Animal studies with salmeterol have demonstrated a teratogenic effect when given orally at several times the dosage used clinically. There are no controlled data in human pregnancy. Fluticasone-salmeterol is only recommended for use during pregnancy when benefit outweighs risk.

There are no data on the excretion of fluticasone or salmeterol into human milk. The manufacturer recommends that due to the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug the mother.

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What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include angina or chest pain, fast or irregular heartbeats, seizures, tremor, weakness, headache, nausea, and vomiting.

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What should I discuss with my healthcare provider before using this medication?
Do not use this medication if you are allergic to fluticasone (Flonase, Flovent), salmeterol (Serevent), or milk proteins, or if you are having an asthma attack or severe COPD symptoms. Salmeterol has been shown to increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication. Before using fluticasone and salmeterol, tell your doctor if you are allergic to any medications, or if you have:

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Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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