Non Selective Beta Blockers
Severe
Database
Antagonism of salmeterol
Avoid; use cardioselective if essential
Source: Kimi deep-research + Cla
Drug reference
Fluticasone Propionate + Salmeterol Xinafoate
Inhaled corticosteroid + long-acting beta2-agonist (fixed combination) · Anti-asthmatic, Anti-COPD
Also known as Seroflo, Esiflo, Airtec-SF, Forair, Flohale SF
START
1 inhalation BID at severity-matched strength
TYPICAL MAX
500/50 DPI one inhalation twice daily (asthma)
STOP IF
Paradoxical bronchospasm or worsening asthma control
WATCH
Inhaler technique, oral candidiasis, growth (children), COPD pneumonia
CDSCO approvedSchedule HATC R03AK06
KDIGO 2024 + manufacturer label
- ONSET
- 15min · bronchodilation
- PEAK
- 3.5h · salmeterol Cmax
- t½
- 7h · t½ (combined)
- DURATION
- 12h · twice-daily
EXCRETION
Mainly faecal; minimal renal
route + CYP
INTERACTIONS
3 major
SEVERE in our sources
PREGNANCY
Use if benefit outweighs risk; maintain asthma control in pregnancy.
FDA category + note
Top interactionssee all 5 →
- Non Selective Beta BlockersSevereDatabaseKimi deep-research + Cla
- Other LabasSevereDatabaseKimi deep-research + Cla
- Strong Cyp3a4 InhibitorsSevereDatabaseKimi deep-research + Cla
Available in India
3 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Fluticasone propionate (ICS) suppresses airway inflammation via glucocorticoid-receptor gene modulation; salmeterol (LABA) provides sustained beta2-mediated bronchodilation — combined maintenance control of asthma/COPD.
Indications
Asthma (maintenance, ≥4 y)COPD maintenance (including exacerbation reduction)
Dosing
- Adult
- Asthma: 1 inhalation BID of strength matched to severity (e.g., 100/50–500/50 DPI; 45/21–230/21 MDI). COPD: 250/50 DPI one inhalation BID.
- Pediatric
- ≥4–11 y asthma: 100/50 DPI one inhalation BID.
- Renal adjustment
- No dose adjustment required.
- Hepatic adjustment
- Caution in hepatic impairment (reduced fluticasone clearance — adrenal effects).
- Geriatric
- No specific adjustment; monitor.
- Max dose
- 500/50 DPI one inhalation twice daily (asthma)
Pharmacokinetics
Onset
Salmeterol bronchodilation 10–20 min; ICS effect over days
Peak effect
Salmeterol ~3–4 h; steroid control days–weeks
Duration
~12 h (twice-daily dosing)
Half-life
Salmeterol ~5.5 h; fluticasone ~7.8 h
Bioavailability
Low oral (high first-pass); lung-delivered fraction active
Protein binding
Salmeterol ~96%; fluticasone ~91%
Metabolism
Both hepatic CYP3A4
Excretion
Mainly faecal; minimal renal
Contraindications
- Primary treatment of status asthmaticus/acute bronchospasm
- LABA monotherapy in asthma (combination only)
- Hypersensitivity to components or milk proteins (DPI)
Side effects
Common
Oral candidiasisDysphonia/hoarsenessHeadacheThroat irritationTremorPalpitations
Serious
- Asthma-related events (LABA class — mitigated by ICS)
- Pneumonia (COPD)
- Adrenal suppression (high dose)
- Paradoxical bronchospasm
- Severe hypokalaemia
Pregnancy & lactation
Pregnancy
Use if benefit outweighs risk; maintain asthma control in pregnancy.
Lactation
Likely compatible; inhaled exposure low.
Drug interactions
Other Labas
Severe
Database
Additive beta-agonism
Do not co-prescribe additional LABA
Source: Kimi deep-research + Cla
Strong Cyp3a4 Inhibitors
Severe
Database
Reduced fluticasone/salmeterol clearance
Avoid; use alternative
Source: Kimi deep-research + Cla
Diuretics
Moderate
Database
Additive hypokalaemia
Monitor potassium
Source: Kimi deep-research + Cla
Qt Prolonging Drugs
Moderate
Database
Additive QT effect
Monitor ECG/electrolytes
Source: Kimi deep-research + Cla
Related guidelines
Ask House about Fluticasone Propionate + Salmeterol Xinafoate
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