Medication Safety Alert

Volume IV, Number 3 | May/June 2001

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Advair™ Diskus® (fluticasone/salmeterol powder for oral inhalation) is a new medication used twice daily for chronic treatment of asthma in patients 12 years of age or older. For appropriate dose titration, various strengths of fluticasone/salmeterol are available (100 mcg/50 mcg, 250 mcg/50 mcg, and 500 mcg/50 mcg). All strengths should be administered as one inhalation twice daily (BID). Advair™ contains salmeterol 50 mcg per inhalation which differs from Serevent® (salmeterol inhalation aerosol) which contains salmeterol 25 mcg per inhalation. If a patient requires an increase in the fluticasone component, higher doses should be achieved by changing to a higher fluticasone strength, NOT by increasing the number of inhalations. For example, if Advair™ 250/50 as a single inhalation twice daily is not sufficient, the product should be changed to Advair™ 500/50 one inhalation twice daily, instead of using Advair™ 250/50 two inhalations twice daily. The safety and efficacy of Advair™ doses greater than one inhalation twice daily has not been established. Salmeterol doses greater than 100 mcg per day have been associated with significant increases in heart rate, reductions in diastolic pressure, and prolongation of the QTc interval which may potentially produce life-threatening arrhythmias. Therefore, patients who are receiving fluticasone/salmeterol twice daily should not use other salmeterol products (Serevent®) for any reason.

Salmeterol also is available as Serevent® Diskus® which, like Advair™ Diskus®, is administered as one inhalation rather than the two inhalations needed with Serevent® inhalation aerosol.

CCF Applications: The CCF Department of Pharmacy stocks and dispenses these medications as Formulary agents.