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 will not treat an asthma attack that has already begun. Fluticasone and salmeterol inhalation is also used to treat chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis.

Fluticasone and salmeterol may also be used for purposes other than those listed in this medication guide.

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.

Do not use fluticasone and salmeterol inhalation to treat an asthma attack that has already begun. It will not work fast enough to reverse your symptoms. Use another, faster-acting inhalation medication to treat an asthma attack.

Asthma is usually treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor. Do not change your doses or medication schedule without advice from your doctor.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Advair Diskus is a powder form of fluticasone and salmeterol that comes with a special inhaler device preloaded with blister packs containing measured doses of the medicine. The device opens and loads a blister each time you use the inhaler. This device is not to be used with a spacer.

Do not exhale or blow into the Diskus device. Do not take the device apart or allow it to get wet. Do not reuse the Advair Diskus device. Throw it away 1 month after you have taken it out of the foil pouch, or if the dose indicator shows a zero, whichever comes first. Each Diskus device contains 60 doses.

Advair HFA is an aerosol form of fluticasone and salmeterol that comes in a canister that is used with an actuator inhaler device. Use only the inhaler device provided with Advair HFA. This device is not to be used with a spacer.

Shake the Advair HFA inhaler for at least 5 seconds before each spray. When using the inhaler device for the first time, prime it by spraying 4 test sprays into the air, away from your face. Shake the canister for 5 seconds before each spray. Also prime the inhaler if you have not used it in more than 4 weeks, or if you have dropped the canister.

Keep track of the number of sprays you have used and throw away the Advair HFA canister after 120 sprays, even if it feels like there is still medicine in it.

To reduce the chance of developing a yeast infection in your mouth, rinse with water after using fluticasone and salmeterol inhalation. Do not swallow.

It is important to use fluticasone and salmeterol inhalation regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

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. An increased need for medication could be an early sign of a serious asthma attack. If you use a peak flow meter at home, call your doctor if your numbers are lower than normal.

If you were switched from an oral (taken by mouth) steroid to fluticasone and salmeterol inhalation, you may need to go back to taking the oral medicine if you are under stress or have an asthma attack or other medical emergency. Carry an identification card or wear a medical alert ID to let others know that you may need an oral steroid in an emergency.

Store this medication at room temperature away from moisture and heat. Keep the Atrovent HFA canister away from high heat, such as open flame or in a car on a hot day. The canister may explode if it gets too hot.

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 ritonavir (Norvir), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept);

• an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam);

• antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), or imipramine (Tofranil);

• certain antibiotics such as ketoconazole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), erythromycin (E-Mycin, Ery-Tab, E.E.S.); or

• medicines for depression such as fluoxetine (Prozac), or fluvoxamine (Luvox).

If you are using any of these drugs, you may not be able to use fluticasone and salmeterol, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect fluticasone and salmeterol inhalation. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Do not use a second form of salmeterol (such as Serevent) or use a similar inhaled bronchodilator such as formoterol (Foradil) unless your doctor has told you to.

This medication can lower the blood cells that help your body fight infections. This can make it easier for you to get sick. Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medicines.

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a fluticasone and salmeterol overdose may include angina or chest pain, fast or irregular heartbeats, seizures, tremor, weakness, headache, nausea, and vomiting.

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.

Do not use this medication to treat an asthma attack that has already begun. It will not work fast enough to reverse your symptoms. Use another, faster-acting inhalation medication to treat an asthma attack.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

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. An increased need for medication could be an early sign of a serious asthma attack. If you use a peak flow meter at home, call your doctor if your numbers are lower than normal.

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. Talk with your doctor about your individual risks and benefits in using fluticasone and salmeterol.

Do not use this medication if you are allergic to fluticasone (Flonase, Flovent) or salmeterol (Serevent), or if you are having an asthma attack.

Before using this medication, tell your doctor if you have been sick or had an infection of any kind. You may not be able to use fluticasone and salmeterol inhalation until you are well.

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. Talk with your doctor about your individual risks and benefits in using fluticasone and salmeterol.

Before using fluticasone and salmeterol, tell your doctor if you are allergic to any medications, or if you have:

• a food or drug allergy;

• heart disease or high blood pressure;

• epilepsy or other seizure disorder;

• diabetes;

• glaucoma;

• tuberculosis;

• osteoporosis;

• a thyroid disorder; or

• liver disease.

If you have any of these conditions, you may not be able to use fluticasone and salmeterol, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether this medication passes into breast milk or if it could harm a nursing baby. Do not use fluticasone and salmeterol inhalation without telling your doctor if you are breast-feeding a baby.

Fluticasone and salmeterol inhalation can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medication.

Do not give this medication to a child younger than 12 years old.

Long-term use of steroids may lead to bone loss (osteoporosis), especially if you smoke, if you do not exercise, if you do not get enough vitamin D or calcium in your diet, or if you have a family history of osteoporosis. Talk with your doctor about your risk of osteoporosis.

Your pharmacist has additional information about fluticasone and salmeterol inhalation written for health professionals that you may read.

Fluticasone and salmeterol inhalation is available with a prescription under the brand name Advair Diskus. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is unfamiliar to you.

• Advair Diskus—disposable, purple-colored device

• Advair HFA—canister and purple actuator with a light purple strap cap mouthpiece cover