Maximum Dosage of Seroflo (Fluticasone Propionate/Salmeterol) Per Day
The maximum recommended daily dosage of Seroflo (fluticasone propionate/salmeterol) for adults is 1000 mcg of fluticasone propionate component (500 mcg twice daily) with 100 mcg of salmeterol (50 mcg twice daily). 1
Dosing Guidelines by Age Group
Adults and Adolescents (≥12 years):
- Maximum fluticasone propionate dosage: 500 mcg twice daily (1000 mcg total daily dose) 1
- Maximum salmeterol dosage: 50 mcg twice daily (100 mcg total daily dose) 1
- Higher doses of fluticasone propionate (>1000 mcg/day) have been used in specific conditions but are associated with increased risk of systemic side effects 1
Children (4-11 years):
- Recommended fluticasone propionate dosage: 100-250 mcg twice daily (200-500 mcg total daily dose) 1
- Recommended salmeterol dosage: 50 mcg twice daily (100 mcg total daily dose) 1
Dosing Considerations and Cautions
Systemic Effects and Safety
- Fluticasone propionate doses higher than 750 mcg per day may lead to bone loss, though this risk may be lower with swallowed topical steroids due to first-pass metabolism 1
- Higher doses of inhaled corticosteroids may cause systemic effects including adrenal suppression, osteoporosis, skin thinning, and bruising 1
- In children, suppression of growth velocity has been observed with inhaled corticosteroids, though this effect may be transient 1
Optimal Dosing Strategy
- Once asthma control is achieved, the dose should be carefully titrated to the minimum dose required to maintain control 1
- Stepping down treatment to a lower dose of fluticasone propionate/salmeterol (100/50 mcg twice daily) is more effective than switching to an inhaled corticosteroid alone 2
- Twice daily dosing is more effective than once daily dosing, even at higher strengths (250/50 mcg once daily vs 100/50 mcg twice daily) 3
Administration Recommendations
- The inhaler should be used with proper technique to ensure optimal drug delivery 1
- For metered dose inhalers, a spacer or valved holding chamber with non-breath-actuated MDIs can decrease local side effects 1
- Mouth washing and spitting after inhalation can reduce the risk of oral thrush (candidiasis) 1
Common Side Effects
- Local effects: Pharyngitis, oral thrush (candidiasis), dysphonia, cough 1
- Potential systemic effects at high doses: Adrenal suppression, decreased bone mineral density, growth suppression in children 1
- Salmeterol-related effects: Tachycardia, skeletal muscle tremor, headache 1
Clinical Efficacy Considerations
- The combination of salmeterol 50 mcg and fluticasone 250 mcg is superior to twice the dose of fluticasone propionate (500 mcg) alone for symptom control in moderate asthma 4, 5
- Adding salmeterol to fluticasone propionate provides better asthma control than doubling the dose of fluticasone propionate 5
Remember that the maximum dosage should be determined based on the patient's clinical response, and the lowest effective dose should be used to minimize potential adverse effects.