What is the proper prescription for Advair (salmeterol/fluticasone)?

Prescription for Advair (Salmeterol/Fluticasone) 50/250 mcg

For Advair (salmeterol/fluticasone) 50/250 mcg, prescribe one inhalation twice daily (morning and evening), approximately 12 hours apart. This dosing regimen provides optimal therapeutic effect while minimizing potential adverse effects 1, 2.

Prescription Details

• Medication: Advair Diskus (salmeterol/fluticasone) 50/250 mcg
• Dosage: 1 inhalation twice daily
• Timing: Morning and evening, approximately 12 hours apart
• Duration: 30-day supply with refills as appropriate
• Special Instructions: Rinse mouth with water after use to prevent oral candidiasis

Rationale for Dosing

The 50/250 mcg strength of Advair contains:

• Salmeterol 50 mcg (long-acting beta-agonist)
• Fluticasone propionate 250 mcg (inhaled corticosteroid)

This combination provides:

• Long-acting bronchodilation (salmeterol) that lasts approximately 12 hours 1
• Anti-inflammatory effects (fluticasone) to control underlying airway inflammation

Important Clinical Considerations

Proper Administration

• Patient should be instructed on proper Diskus inhaler technique
• Advair should never be used for acute symptom relief 3
• A short-acting beta-agonist should be prescribed separately for rescue use

Monitoring

• Reassess the patient in 2-4 weeks after starting therapy to evaluate:
  • Symptom control
  • Frequency of rescue medication use
  • Proper inhaler technique
  • Medication adherence
  • Any side effects 3

Safety Precautions

• Advair contains a LABA (salmeterol) which should never be used alone for asthma due to increased risk of asthma-related death 3
• Instruct patient to rinse mouth after use to prevent oral candidiasis 3
• Monitor for potential steroid side effects with long-term use

Dose Adjustments

• If symptoms are well-controlled after 3 months of therapy, consider stepping down therapy 3
• If symptoms persist, consider stepping up to a higher dose formulation and reevaluate in 2 weeks 3

Common Pitfalls to Avoid

1. Incorrect frequency: Advair must be used twice daily, not as needed or once daily. Studies show that once-daily dosing does not maintain improvements in lung function for a full 24 hours compared to twice-daily dosing 4.

2. Using for acute symptoms: Advair is not for rescue use and should not be prescribed for acute symptom relief. A separate short-acting beta-agonist should be prescribed for breakthrough symptoms.

3. Poor inhaler technique: Ensure the patient can properly use the Diskus device, as improper technique significantly reduces medication delivery.

4. Abrupt discontinuation: Never discontinue Advair abruptly, especially in patients with chronic asthma. The dose should be tapered gradually under physician supervision 3.

5. Inadequate monitoring: Regular follow-up is essential to assess response and adjust therapy as needed.