Advair Diskus
Our prices
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100/50mcg 1inhaler |
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$156.00 $129.99 $129.99 per inhaler |
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+ Next orders 10% discount
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100/50mcg 2inhalers |
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$250.00 $207.99 $104.00 per inhaler |
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+ Next orders 10% discount
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100/50mcg 3inhalers |
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$337.00 $280.99 $93.66 per inhaler |
+ Free standard airmail service
+ Package delivery insurance
+ Next orders 10% discount
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Pharmaceutical form
Concave-bottomed aluminum inhaler hermetically closed with a metering valve. The inner surface and valve should not have visible defects. The inhaler content is a suspension of white or almost white color.
Mechanism of action
The composition of Advair Diskus includes salmeterol and fluticasone propionate. They obtain different mechanisms of action.
Salmeterol is a selective long-acting β2-adrenoreceptor agonist. Its effect lasts for 12 hours. It possesses a long side chain that binds to the external receptor binding site.
Salmeterol provides a long bronchodilating effect. This effect lasts for at least 12 hours. The duration of salmeterol action exceeds the recommended dose of conventional short-acting β2-adrenergic agonists.
Fluticasone has an expressed anti-inflammatory effect. It is characteristic of glucocorticoids in the lungs, which contributes to a decrease in the severity of symptoms and a decrease in the frequency of exacerbations of asthma. It provokes fewer side effects in comparison with systemic corticosteroids.
Pharmacokinetics
The pharmacokinetic characteristics of each active substance were similar to those found when applying these substances independently.
Salmeterol
Salmeterol performs locally in the lung tissue. As a result, its therapeutic effect is not defined by the concentration in the blood plasma. Additionally, data on the pharmacokinetics of salmeterol are limited, because it is technically difficult to define very low plasma concentrations of the drug (200 pg/ml or less) after its inhalation in therapeutic doses.
Fluticasone
The absolute bioavailability of a fluticasone single dose in healthy volunteers varies from about 5% to 11% of the recommended dose Its effectiveness is dependent on the drug delivery system. Patients with asthma have a lower systemic effect of inhaled fluticasone propionate.
Systemic absorption occurs mainly through the lungs. Firstly, it acts faster, then the effect slows down. The rest of the inhaled dose can be swallowed, but its systemic effect is minimal because due to poor solubility in water and presystemic metabolism. Oral bioavailability is less than 1%.
The distribution of fluticasone is characterized by a high plasma clearance (1150 ml/min), a large volume in equilibrium (about 300 l). The half-life is about 8 hours.
Indications for use
Advair Diskus (Salmeterol/fluticasone propionate) is intended for the continuous treatment of bronchial asthma.
Dosages and mode of application
Asthma
Adults and children over 12 years old:
- one puff (50 μg of salmeterol/100 μg of fluticasone) twice a day;
- one puff (50 μg of salmeterol/250 μg of fluticasone) twice a day;
- one puff (50 μg of salmeterol/500 μg of fluticasone) twice a day.
Advair Diskus can be used as a starting maintenance therapy if it is necessary to achieve rapid control over the disease symptoms. In such cases, the drug is recommended to be used in a starting dose of 1 inhalation of 50 μg of salmeterol and 100 μg of fluticasone twice a day.
- Children from 4 to 12 years old are prescribed one puff (50 μg of salmeterol/100 μg of fluticasone propionate) twice a day.
- The maximum daily dose of fluticasone in the composition of this drug in children is 100 mcg twice a day.
- There is no data on this inhaler use in children under 4 years of age, therefore, it is not recommended.
Chronic obstructive pulmonary disease
Adults: one puff (50 μg of salmeterol/500 μg of fluticasone propionate) twice a day.
Individual patient groups
There is no need to adjust the dose to elderly patients and patients with pathology of the kidneys or liver.
Side effects
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Body Systems
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Side Effects
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Frequency
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Infections
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Candidosis of mouth and throat
Oesophageal candidiasis
Pneumonia
Bronchitis
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often
rare
often
often
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Immune System
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Hypersensitivity reactions:
skin reactions
circumscribed edema
dyspnea
bronchospasm
anaphylactic shock
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not often
rare
not often
rare
rare
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Endocrine System
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Cushing’s syndrome, cushingoid symptoms, inhibited adrenal function, growth retardation in children and adolescents
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rare
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Metabolism and Digestive System
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hypokalemia
hyperkalemia
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often
not often
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Mental Health
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Anxiety, sleep disturbances
Change in behavior, including hyperactivity
Depression, aggression (in children)
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not often
rare
unknown
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Nervous System
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Headache
Tremor
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very often
not often
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Organs of Vision
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Cataract
Glaucoma
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rare
not often
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Cardiovascular System
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Tachycardia
Brachicardia
Arrythmia
Atrial fibrillation
Stenocardia
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not often
not often
rare
not often
not often
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Respiratory Organs
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Nasopharyngitis
Sore throat
Voice hoarseness/dysphonia
Sinusitis
Bronchospasm
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very often
often
often
often
rare
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Subcutaneous galnds and tissues
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Bruises
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often
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Musculoskeletal system and connective tissue
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Muscular convulsions
Fracture
Arthralgia
Myneuralgia
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often
often
often
often
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Contraindications
- Hypersensitivity to the drug;
- Pregnancy and lactation;
- Fertility.
There are no data on the effect on human fertility. At the same time, the results of animal studies indicated the absence of salmeterol or fluticasone effect on fertility.
Overdose
According to clinical trials, there is no information about an overdose caused by Advair Diskus.
Signs and symptoms that can be expected with an overdose of salmeterol. Typical symptoms are dizziness, tremor, headache, tachycardia, increased systolic blood pressure. In addition, hypokalemia may occur, therefore, the need for potassium replacement therapy should be considered.
Acute overdose
Inhalation of fluticasone in doses higher than recommended may cause temporary suppression of adrenal function. This does not require urgent measures since the adrenal function is restored in a few days, can be checked by the determination of cortisol in blood plasma.
Chronic overdose
There is a risk of suppression of adrenal function when using the highest approved dose of Advair for a long time.
The very rare acute adrenal crisis has been reported to occur mainly in children who have been given doses higher than recommended for a long time (several months or years). In this case, hypoglycemia was manifested, which is associated with confusion and convulsions. Situations that can trigger acute adrenal crises include trauma, surgery, infection, and any rapid reduction in the dose of inhaled fluticasone.
There is no specific treatment for an overdose of salmeterol and fluticasone, it is necessary to use maintenance therapy with monitoring the patient’s condition.
Pregnancy
There is a large amount of data on the drug use in pregnant women, indicating the absence of malformation effect and fetal/neonatal drug toxicity. Animal studies indicate the reproductive toxicity of β2-adrenergic receptor agonists and glucocorticosteroids.
The drug usage during pregnancy is not prohibited only when the expected benefit to the mother outweighs any possible risk to the fetus. The minimum effective dose of fluticasone is required to maintain adequate asthma control.
Breastfeeding
It has not been established whether salmeterol and fluticasone with breast milk are excreted. Animal studies have shown that salmeterol and fluticasone are excreted in milk in rats.
The risk for newborns/infants cannot be excluded. The decision to discontinue breastfeeding or to withdraw the drug should be made taking into account the benefits of breastfeeding for the baby and the therapeutic benefits for the mother.