What is the recommended dose for Seretide (Fluticasone/Salmeterol) Accuhaler?

Seretide Accuhaler Dosing

For adults and adolescents ≥12 years with asthma, start with Seretide Accuhaler 100/50 mcg (fluticasone 100 mcg/salmeterol 50 mcg) twice daily for mild to moderate disease, escalating to 250/50 mcg twice daily for moderate persistent asthma, or 500/50 mcg twice daily for severe persistent asthma. 1, 2

Standard Dosing by Age and Severity

Adults and Adolescents (≥12 years)

• Mild to moderate asthma: Seretide 100/50 mcg twice daily (fluticasone 100 mcg + salmeterol 50 mcg per inhalation) 1, 2
• Moderate persistent asthma: Seretide 250/50 mcg twice daily 1, 2
• Severe persistent asthma: Seretide 500/50 mcg twice daily (maximum recommended dose) 1, 2
• The maximum daily fluticasone dose is 1000 mcg (500 mcg twice daily) with maximum salmeterol of 100 mcg daily (50 mcg twice daily) 1

Children (4-11 years)

• Recommended dose: Seretide 100/50 mcg twice daily 1
• Fluticasone range: 100-250 mcg twice daily (200-500 mcg total daily dose) 1
• Salmeterol: 50 mcg twice daily (100 mcg total daily dose) 1

Dosing Algorithm Based on Current Treatment

• If using short-acting beta-agonists ≥2-3 times daily: Initiate Seretide 100/50 mcg twice daily rather than inhaled corticosteroid monotherapy 2
• If already on inhaled corticosteroids with poor control: Add salmeterol by switching to combination therapy (Seretide) rather than doubling the corticosteroid dose alone 2
• If inadequate control on medium-dose ICS: Step up to Seretide 250/50 mcg or 500/50 mcg twice daily depending on severity 2, 3

Administration Technique

• Exhale fully, place mouthpiece between lips, inhale deeply while activating the device, and hold breath for 10 seconds 2
• Rinse mouth and spit after each use to prevent oral thrush (candidiasis) 1, 2
• Proper inhaler technique is essential for optimal drug delivery 1

Dose Titration Strategy

• Allow 1-3 months of stability before reducing the dose 2
• Decrease by 25-50% at each step-down 2
• Reassess asthma control every 2-6 weeks initially 3
• If inadequate control persists after 4-6 weeks, consider alternative diagnoses or adjunctive therapies 3

Critical Safety Considerations

• Never use long-acting beta-agonists (salmeterol) alone for asthma—they must always be combined with inhaled corticosteroids due to increased risk of severe exacerbations and deaths when used as monotherapy 2, 3
• Monitor for salmeterol-related effects: tachycardia, skeletal muscle tremor, and headache 1
• Monitor for fluticasone-related effects: oral thrush, dysphonia, and cough 1

High-Dose Risks

• Doses >1000 mcg/day of fluticasone are associated with increased risk of systemic side effects including bone loss, adrenal suppression, osteoporosis, skin thinning, and bruising 1
• In children, growth velocity suppression has been observed with inhaled corticosteroids, though this effect may be transient 1

Special Circumstances

• Short-term dose doubling: If asthma control deteriorates acutely, doubling the dose of Seretide for up to 2 weeks is safe and well tolerated in adults 4
• Once daily dosing: Seretide 250/50 mcg once daily in the evening is less effective than twice daily dosing for maintaining 24-hour lung function improvements, though it may be considered for select patients with compliance issues 5