Wixela Inhub Dosing Recommendations
Standard Dosing for Adults and Adolescents ≥12 Years
For mild to moderate asthma, initiate Wixela Inhub at the 100 mcg fluticasone/50 mcg salmeterol strength (one inhalation twice daily, approximately 12 hours apart), which provides 200 mcg/day total fluticasone and falls within low-dose inhaled corticosteroid therapy. 1
Dosing by Asthma Severity
- Mild persistent asthma: 100/50 mcg strength, one inhalation twice daily 1
- Moderate persistent asthma: 250/50 mcg strength (the formulation in your question), one inhalation twice daily 1, 2
- Severe persistent asthma: 500/50 mcg strength, one inhalation twice daily 1
The 250/50 mcg strength provides medium-dose ICS therapy (500 mcg/day total fluticasone) and is more effective than fluticasone 500 mcg alone for moderate to severe asthma. 1
Administration Guidelines
Administer twice daily, approximately 12 hours apart, to maintain steady therapeutic levels. 1
- Consistency in timing is critical for maintaining therapeutic drug concentrations 1
- Wixela Inhub demonstrates bioequivalence to Advair Diskus for both acute bronchodilation (day 1) and sustained anti-inflammatory effects (day 29) 3
- The device shows low flow dependency across patient-relevant flow rates (30-90 L/min), ensuring consistent dose delivery even in patients with severe COPD 4, 5
Dose Titration Strategy
Show 1-3 months of stability before reducing the inhaled steroid dose, then decrease by 25-50% at each step when stepping down. 1
- Reassess asthma control every 2-6 weeks initially 2
- If symptoms are not controlled on twice daily dosing at standard doses, increase to the next strength rather than increasing frequency 6
- The goal is to find the minimum effective dose that maintains asthma control 2
Critical Safety Warnings
Long-acting beta-agonists (LABAs) like salmeterol should never be used alone for asthma and must always be combined with inhaled corticosteroids. 1
- Monotherapy with LABAs increases risk of severe exacerbations and asthma-related deaths 1
- Common salmeterol-related side effects include tremor, tachycardia, hypokalemia, headache, and muscle cramps 1
- Fluticasone-related side effects include oral candidiasis, dysphonia, and cough 1
- Rinse mouth after each use to prevent oral thrush 2
Pediatric Dosing (Ages 4-11 Years)
Wixela Inhub 100/50 mcg is approved for children 4-11 years, with one inhalation twice daily. 1
- Most children ≥4 years can generate sufficient inspiratory flow (≥30 L/min) for the Diskus-type device 1, 7
- For children under 4 years, budesonide nebulizer suspension is the only FDA-approved ICS 1
- Always use a large volume spacer device with MDI formulations in young children, though Wixela Inhub is a dry powder inhaler that does not require a spacer 2
Geriatric Considerations
No dose adjustment is required based on age alone for elderly patients. 1
- Monitor closely for tremor from salmeterol and systemic corticosteroid effects in elderly patients 1
Device-Specific Considerations
The Inhub inhaler has been validated for safe and effective use by patients naive to dry powder inhalers, with 100/110 subjects in usability testing holding the device in correct orientation and achieving adequate inhalation parameters. 7 The device maintains pharmaceutical performance after 3 weeks of outpatient use, confirming its robustness in real-world conditions. 7