Prevalence rates of asthma and chronic obstructive pulmonary disease in the US is relatively high with about 25 million Americans living with asthma. Similarly, close to 4% adults it the US are estimated to have COPD. Various treatment options are presently available for the conditions, and one particular combination treatment is prescribed when other medications do not work effectively. The combination of fluticasone and salmeterol comes in powder form and as an aerosol.  The following subsections offer in-depth information about the combination drug, including possible fluticasone / salmeterol side effects. This is intended to help users be fully aware of how to identify, prevent and handle the undesirable outcomes.

Overview of fluticasone and salmeterol

The combination drug comprises drugs belonging to two different categories. One drug helps in the reduction of the inflammation, while the other is bronchodilator. This combination of reduction of the inflammation and relaxing of the muscles around the airways, delivers the much-needed relief for patients suffering from asthma and COPD. Here is a quick look at each of the two drugs separately.

Fluticasone – the glucocorticoid is prescribed for treating asthma, rhinitis that is non allergic and dermatoses that are inflammatory in nature. The drug is typically available as an inhaler, or a nasal spray for treating the inflammatory conditions.

Salmeterol – the beta-2 adrenergic receptor agonist is used in the treatment of COPD and asthma. It is a long-acting drug and this longer duration of action makes it a better option for use as a combination medication.

How to use the Fluticasone-Salmeterol?

The medication is prescribed to be taken only as per the specific instructions of the specialist. While it is available as a branded drug and as a generic version, it is to be taken as per prescription.  Ideally, the drug is to be inhaled twice a day, with FDA recommendations stipulating that the doses should not exceed two within a span of one day. In most circumstances, the patient is likely to experience relief in less than 30 minutes from the time of inhalation. While it is known to be effective in offering relief, it is not to be used when the patient is in the throes of an acute or aggravated asthma attack. It is also recommended that after every dosage of the combination drug, the patient is to perform a small mouth gargle. Ideally, a little water is to be taken, gargled and spat out.

Ideal dosage of Fluticasone-Salmeterol

One of the main reasons of possible undesirable effects of any drug is excessive dosage and incorrect schedule. It is important to follow dosage instructions diligently and stick to the recommended schedule. There should be no effort to take a stronger or excessive dosage in an attempt to quicken the outcome or bring about faster, better relief. It is also important to keep intake within the maximum recommended limit of two doses per day. This is especially important in the case of this combination medication as Salmeterol is known to have a longer duration of action. This essentially means that the patient will be exposed to higher doses of the drug if the frequency of intake is beyond the schedule.

The actual dosage will depend on the condition of the patient and various other factors. As mentioned above, the combination of fluticasone and salmeterol is typically prescribed when other medications have not delivered the desired outcomes. Therefore, the dosage of this combination drug will also depend on the previous medication and the dosage of the earlier drugs. Patients who are not on inhaled corticosteroids and switching other medication for this combination are generally recommended the same dosage as the previous drug. During the course of treatment, the specialist will also work on determining the least dosage that is effective enough.

Important information on missed doses

As the medication is to be taken twice a day for a relatively longer period, there is every likelihood, that the patient may miss a dose at some point of time due to any of many possible scenarios. In such eventualities, it is necessary to avoid a common urge that many patients have in common. For instance, the drug is ideally to be taken with a gap of twelve hours between doses. When one of these doses are missed, the individual may take the missed dose immediately if it has been an hour or two since the scheduled time. However, if it is beyond two hours, the missed dose is to be skipped entirely. This will help prevent possible fluticasone / salmeterol side effects.

Unsuitability of the combination drug for certain categories of patients

The combination drug is not to be administered to children below the age of 12, and for patients with a history of milk protein allergies. Similarly, patients who have had a history of some kind of allergic reaction to any ingredients or compounds in the combination drug are to avoid the medication. In such instances, there is every likelihood, that the individual may have been sensitized to the allergy causing substance, and the next episode of allergic reaction could be stronger.

Women who are either breastfeeding or women who are planning a pregnancy, are t seek medical advice on the suitability of the medication.  Individuals with certain health conditions are expected to intimate the treating specialist about the problems, to avoid complications. For instance, patients with vision related issues, and individuals with a history of heart ailments/blood pressure are to take necessary precautions as recommended by the doctor. Similarly, patients with thyroid and liver problems also belong to the category that require additional evaluation. Other issues that need to be assessed before treatment include osteoporosis and diabetes. Patients known to experience bouts of seizures and individuals with immune system complications are also advised to report the same to the specialist.

Possible fluticasone / salmeterol side effects

All medications come with the possibility of undesirable effects and this combination drug is no exception. The nature of side effects depends on various factors, including the condition being treated, the age of the patient, the overall health of the patient, existing ailments, and medications in use. This also depends to a large extent on the dosage and the schedule of intake. Side effects of medications could either be mild or moderate in nature or could be serious and adverse in nature. Mild effects do not require medical intervention and are known to resolve naturally, while serious effects require medical intervention.

It is also necessary to note that not all patients will experience undesirable effects. Some are known to be free from all unwanted outcomes, and this category of patients are typically a significant percentage of users. Here is a compilation of some of the commonly reported and known effects of the combination drug. This is neither exhaustive nor complete in nature and is intended to serve as a reference to help individuals avoid and mitigate any possible undesirable outcomes.

Individuals may commonly experience oral thrush when on the drug, while some are known to end up with common cold. Other commonly experienced effects include cough and back pain, while many are known to experience headaches. There are slight variations in the effects of the medication among brands, though the category or type of effects may be the same. For instance, in some brands the effect could be cough or cold, while in others this could also manifest as slight variations in the voice of the patient.

Similarly, some brands of the combination drug may trigger nausea and vomiting, while others may not cause these side effects. Other effects that are of concern include infections in the respiratory tract, bronchitis, and possible pharyngitis. Pain in the musculoskeletal area is another commonly experienced effect when the drug is used for treating COPD in patients. Other possible undesirable effects from the drug include pneumonia and other viral respiratory infections. It is necessary for patients to be aware of these possible outcomes and take suitable precautions to identify the symptoms and mitigate the effects.

Drug interactions of fluticasone salmeterol

All medications come with the possibility of interactions with other drugs and formulations. This includes prescriptions, OTC medications, supplements, natural remedies and herbal preparations. Interactions are primarily attributed to the way a drug works, and the properties of ingredients/compounds in the two formulations. The outcome of interactions is typically experienced in three different manners. For instance, either of the two drugs/substances may end up with reduced potency or less than desired outcome. Similarly, either of the two may deliver more than desired outcomes due to the interaction. Finally, there is the possibility of either or both the medications causing stronger side effects than when taken alone.

Drugs that may interact with Fluticasone Salmeterol include certain categories of beta blockers and diuretics. There is also the possibility of interaction with specific antifungal medications. Drugs that belong to the category of tricyclic antidepressants and MAOIs, acronym for monoamine oxidase inhibitors are also known to interact with the combination medication. Other drugs that may interact with the combination asthma treatment includes specific antiretroviral medications. It is therefore necessary for patients to clearly list out all medications and substances in use, to help the doctor identify substances that may trigger interactions.

In most instances, either of the two interacting medications are temporarily stopped, depending on the importance of either. In certain circumstances, it may be necessary for the patient to take both the medications, due to the expected outcomes. In such instances, specialists either modify the dosage, or alter the schedule or intake so as to reduce the possibility of interactions.

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