What is the recommended dosage of WIXELA (fluticasone propionate and salmeterol) inhaler for adult or adolescent patients with asthma or chronic obstructive pulmonary disease (COPD)?

WIXELA INHUB Dosage Recommendations

For asthma in adults and adolescents ≥12 years, start with Wixela Inhub 100/50 mcg (fluticasone propionate 100 mcg/salmeterol 50 mcg) one inhalation twice daily, approximately 12 hours apart, with a maximum dose of 500/50 mcg twice daily; for COPD, use only the 250/50 mcg strength twice daily. 1

Asthma Dosing

Adults and Adolescents (≥12 years)

• Starting dose: One inhalation of Wixela Inhub twice daily (approximately 12 hours apart), with strength selection based on asthma severity and prior ICS dosing 1
• Available strengths: 100/50 mcg, 250/50 mcg, or 500/50 mcg 1
• Maximum dose: Wixela Inhub 500/50 mcg twice daily 1

Dose titration algorithm:

• Improvement typically occurs within 30 minutes, but maximum benefit may require ≥1 week 1
• If inadequate control after 2 weeks, escalate to the next higher strength 1
• If a previously effective regimen fails, consider stepping up to higher strength, adding additional ICS, or initiating oral corticosteroids 1

This aligns with guideline recommendations for fluticasone propionate dosing at 88-264 mcg twice daily for adults with asthma, with upward titration if peak expiratory flow remains <80% of predicted 2

Pediatric Patients (4-11 years)

• Fixed dose: One inhalation of Wixela Inhub 100/50 mcg twice daily for children not controlled on ICS alone 1
• This corresponds to guideline recommendations of 88-176 mcg/day divided twice daily for this age group 2

COPD Dosing

All Adult Patients with COPD

• Fixed dose: One inhalation of Wixela Inhub 250/50 mcg twice daily, approximately 12 hours apart 1
• No dose escalation: The 500/50 mcg strength has not demonstrated efficacy advantage over 250/50 mcg in COPD and is not approved for this indication 1
• Indication specifics: Approved for maintenance treatment of airflow obstruction and reduction of exacerbations in patients with history of exacerbations 1

Important caveat: Guidelines recommend fluticasone propionate should NOT be first-line for COPD, but is appropriate for severe disease (FEV1 <50% predicted) with frequent exacerbations (≥2 per year) 2

Critical Administration Instructions

Technique and Safety

• Route: Oral inhalation only 1
• Post-inhalation: Rinse mouth with water without swallowing to reduce oropharyngeal candidiasis risk 1
• Frequency restriction: Do NOT exceed one inhalation twice daily; higher doses increase adverse effects from salmeterol 1
• LABA restriction: Patients must NOT use additional LABA medications for any reason while on Wixela Inhub 1

Rescue Medication

• For breakthrough symptoms between doses, use an inhaled short-acting beta2-agonist for immediate relief 1
• Wixela Inhub is NOT indicated for acute bronchospasm relief 1

Common Pitfalls to Avoid

• Never use for acute exacerbations: Wixela Inhub is contraindicated as primary treatment for status asthmaticus or acute COPD episodes requiring intensive measures 1
• Device technique matters: Patients must generate adequate inspiratory flow for effective drug delivery; proper DPI technique is essential 2
• Monitor for oral candidiasis: Mouth rinsing after each dose is critical 2, 1
• COPD pneumonia risk: Inhaled corticosteroids increase pneumonia risk in COPD patients; weigh this against exacerbation reduction benefits 2
• Contraindication: Severe hypersensitivity to milk proteins contraindicates use 1