Recommended Dosage for Douvent (Fluticasone and Salmeterol) Inhaler
The recommended dose for Douvent (fluticasone and salmeterol) inhaler is 50 mcg of salmeterol with 100-500 mcg of fluticasone twice daily, with the exact dosage depending on asthma severity. 1
Dosage Guidelines Based on Age and Asthma Severity
Adults and Children ≥12 Years:
- For mild to moderate persistent asthma: fluticasone 100 mcg/salmeterol 50 mcg (2 inhalations twice daily, total daily dose of 200/100 mcg) 1
- For moderate persistent asthma: fluticasone 250 mcg/salmeterol 50 mcg (2 inhalations twice daily, total daily dose of 500/100 mcg) 1
- For severe persistent asthma: fluticasone 500 mcg/salmeterol 50 mcg (2 inhalations twice daily, total daily dose of 1000/100 mcg) 2
Children 5-11 Years:
- Lower doses are typically used: fluticasone 50-100 mcg/salmeterol 50 mcg twice daily 1
- Dosing should be adjusted based on response and control of symptoms 1
Clinical Considerations for Dosing
Stepwise Approach to Dosing
- Start with the lowest effective dose based on asthma severity 1
- For patients with mild persistent asthma (Step 2), begin with low-dose inhaled corticosteroid alone 1
- For moderate persistent asthma (Step 3), use low-dose fluticasone/salmeterol combination or medium-dose inhaled corticosteroid alone 1
- For severe persistent asthma (Steps 4-6), use medium to high-dose fluticasone/salmeterol combination 1
Dose Titration
- Once asthma control is achieved, the dose should be carefully titrated to the minimum dose required to maintain control 1
- Allow 1-3 months of stability before attempting to reduce the dose 1
- When reducing, decrease the dose by 25-50% at each step 1
Efficacy and Safety Considerations
Efficacy
- Combination therapy with fluticasone/salmeterol provides better overall asthma control than inhaled corticosteroids alone or inhaled corticosteroids plus montelukast 3, 4
- The combination improves lung function, reduces symptoms, and decreases the frequency of asthma exacerbations 5, 6
- Studies show that combination therapy results in a 40% reduction in mild exacerbations and 29% reduction in severe exacerbations compared to inhaled corticosteroids alone 1
Safety Precautions
- Salmeterol should never be used as monotherapy for asthma control; it must always be used in combination with an inhaled corticosteroid 1
- The FDA has issued a black-box warning against using long-acting beta agonists (like salmeterol) alone 1
- Common side effects include cough, dysphonia (voice changes), and oral thrush 1
- Using a spacer device and rinsing the mouth after use can reduce local side effects 1
Important Clinical Pearls
- The combination of fluticasone and salmeterol in a single inhaler ensures appropriate use of both medications and may improve compliance 4, 2
- Most patients achieve satisfactory control with salmeterol 50 mcg twice daily; higher doses do not provide additional benefit but may increase side effects 1
- Patients who require their short-acting beta agonist more than twice weekly for symptom control should be considered for step-up therapy 1
- Preparations are not interchangeable on a mcg or per-puff basis; follow specific product labeling 1