What is Advair Diskus?
Advair Diskus is an adrenergic pharmaceutical agent, which is used in the form of inhalation. This drug belongs to the bronchodilator group with salmeterol and fluticasone propionate as active ingredients.
How does it work?
Salmeterol is a selective beta-two-adrenoreceptor agonist, which has a long-lasting effect (valid for half a day). Its molecular structure has a long side link that is able to bind to the receptor section that is outside. Salmeterol prevents bronchospasms provoked by exposure to histamines (the most common cause of asthma attacks), while it has a longer bronchodilatation when compared with ordinary short-term beta-adrenergic agonists. It inhibits the release of the mediators of some cells, in particular, histamines, leukotrienes, and others. The substance is able to cause depression of the allergic reaction in the early and late stages. Even a single dose can reduce hyperreactivity in the bronchi. Half an hour after administration, the late stage of the attack of bronchospasm is inhibited.
Fluticasone is a glucocorticosteroid, which is used for topical treatment. If it is administered in the form of an inhalation injection, then the drug goes directly into the lower respiratory tract (trachea, bronchi, lungs). This produces a pronounced anti-inflammatory effect, as a result of which the activity of painful symptoms is reduced, the frequency of attacks decreases.
Indications for use
Advair Diskus is prescribed for the treatment of chronic bronchial asthma when the patient is recommended treatment with a combination of long-acting β2-agonists and inhaled GCS. In particular, for:
- patients with insufficient control of bronchial asthma during therapy with inhaled GCS and short-acting β2-agonists;
- patients with adequate control of asthma during therapy with inhaled GCS and long-acting β2-agonists.
Side effects
Advair Diskus can cause the following side effects:
- headache;
- glaucoma;
- candidiasis of the mouth and pharynx, hoarseness;
- pneumonia (in patients with COPD);
- muscle cramps, arthralgia;
- tremor;
- heartbeat, atrial fibrillation;
- irritation of the mucous membrane of the oropharynx;
- skin allergic reactions;
- shortness of breath;
- hematomas;
- anaphylactic reactions;
- angioedema (especially swelling of the face and oropharynx), paradoxical bronchospasm;
- cataract;
- hyperglycemia;
- a sense of fear, sleep disturbance;
- behavioral changes, including increased activity and irritability (especially in children);
- heart rhythm disturbance (including atrial fibrillation, supraventricular tachycardia, extrasystole);
- Cushing’s syndrome, adrenal suppression, growth retardation in children and adolescents, a decrease in bone mineral density.
Contraindications
If you decide to buy Advair Diskus, you need to remember that this drug has 2 absolute contraindications for use:
- hypersensitivity to salmeterol, fluticasone and other components of the drug;
- age under 4 years.
Used with caution in the following diseases and conditions:
- tuberculosis, fungal, viral or bacterial infections, anesthesia, anesthesia, anesthesia, respiratory tract disorders, hypothyroidism, diabetes mellitus, uncontrolled hypokalemia, uncontrolled arterial hypertension, arrhythmias, ischemic heart disease, lengthening of the QT interval, stenosis, cataract, glaucoma, osteoporosis, pregnancy, lactation.
Mode of application and dosage
The medication is prescribed in the minimum effective dose that provides control of symptoms of the disease. The dosage of fluticasone/salmeterol should correspond to the severity of the disease.
Intervals between doses must be approximately 12 hours.
- Asthma: adults and children over 12yrs: initially 1 inhalation of 100/50 or 250/50 or 500/50 twice daily, based on disease severity and previous asthma therapy. If the effect is insufficient after 2 weeks, the dose should be increased. Maximum dosage is 1 inhalation of 500/50 twice daily;
- COPD: adults and children over 12yrs: 1 inhalation of 250/50 twice daily. Rinse mouth after use.
To get the best effect, the drug is used regularly, even in the absence of symptoms of bronchial asthma and COPD. The course of treatment and the dose of the drug should be selected by a doctor individually. There is no need for dose adjustment in elderly patients and patients with pathology of the liver or kidneys.
Overdose
An overdose of this drug can cause increased side effects. Common adverse effects include:
- trembling limbs, tachycardia;
- a decrease in work of adrenal glands;
- headache, hypokalemia, hyperkalemia;
- nausea, hypoglycemia, convulsions.
Treatment: selective beta-blockers, withdrawal of the drug.
Interactions
The use of non-selective and selective ß-blockers should be avoided unless it is really necessary and justified.
Since the concentration of fluticasone propionate in the blood plasma is very low, adverse interactions with other drugs are unlikely.
Ritonavir (an inhibitor of cytochrome P450 3A4) can significantly increase plasma concentrations of fluticasone, resulting in a marked decrease in serum cortisol concentration. Therefore, the simultaneous use of Advair Diskus and ritonavir should be avoided, unless the expected benefit to the patient exceeds the possible side effect of a systemic corticosteroid.
Other cytochrome P450 3A4 inhibitors (erythromycin, ketoconazole) cause an increase in the systemic effect of fluticasone without a noticeable decrease in serum cortisol concentration.
The simultaneous use of salmeterol and ketoconazole leads to a significant increase in the level of salmeterol in plasma (Cmax increase 1.4 times and AUC – 15 times) and may lead to QT prolongation interval.
Special instructions
Pregnant and breastfeeding women can use the drug only if the intended benefit to the mother outweighs the potential risk to the fetus or child.
Patients should be informed that for best effect this medication should be used daily, even in the absence of symptoms.
Advair Diskus is not a drug for the relief of asthma attacks. Short-acting bronchodilators are used to relieve seizures. The patient should be advised to always have medication for the relief of bronchospasm at hand. The increased need for short-acting bronchodilators indicates a worsening of the course of the disease. A sudden and increasing deterioration in the control of the bronchospastic syndrome represents a potential threat to life. In such a situation, it is necessary to consult a doctor since the dose of fluticasone/salmeterol provides adequate disease control.
Like other inhalation drugs containing GCS, Advair should be used with caution in patients with active or latent pulmonary tuberculosis, severe cardiovascular diseases, including cardiac arrhythmias, hypokalemia, thyrotoxicosis.
Any inhalation corticosteroids can cause systemic effects, especially with prolonged use in high doses. It should be noted, however, that the likelihood of such symptoms is much lower than in the treatment of oral GCS. Possible systemic effects include depression of adrenal function, growth retardation in children and adolescents, reduced bone mineral density, cataracts and glaucoma. Considering the above, the dose of inhaled corticosteroids should be titrated to the minimum, which ensures the maintenance of effective control.
There is no need for special precautions for persons driving a car or managing mechanisms.