What is the normal dose of Wixela (fluticasone propionate and vilanterol) 500 for a patient with Chronic Obstructive Pulmonary Disease (COPD) or asthma?

Normal Dose of Wixela 500

The normal dose of Wixela 500/50 mcg is one inhalation twice daily (approximately 12 hours apart) for both asthma and COPD. 1

Dosing by Indication

For Asthma (Adults and Adolescents ≥12 years)

• Standard dosing: 1 inhalation of Wixela 500/50 mcg twice daily, approximately 12 hours apart 1
• This represents the maximum recommended dosage for asthma treatment 1
• After inhalation, patients should rinse their mouth with water without swallowing to reduce the risk of oral candidiasis 1

For COPD

• Important limitation: Wixela 500/50 is NOT the recommended strength for COPD 1
• Only Wixela 250/50 is approved for COPD because no efficacy advantage of the 500/50 strength over the 250/50 strength has been demonstrated 1
• The approved COPD dose is 1 inhalation of Wixela 250/50 twice daily 1

Key Administration Points

Frequency and Timing

• Never exceed: More than 1 inhalation twice daily is not recommended, as higher doses of salmeterol increase the likelihood of adverse effects 1
• Patients should not use additional long-acting beta-agonists (LABAs) for any reason while on Wixela 1

Device Considerations

• Wixela uses the Inhub device (similar to Advair Diskus), which differs from other combination inhalers like Trelegy that use the Ellipta device 2
• The Inhub inhaler demonstrates low flow dependency across severe COPD patient profiles, ensuring consistent dose delivery even in patients with reduced inspiratory capability 3

Rescue Medication

• For breakthrough symptoms between doses, patients should use an inhaled short-acting beta2-agonist for immediate relief 1

Clinical Context and Comparisons

Comparison to Once-Daily Alternatives

• Unlike Wixela (twice-daily), fluticasone furoate/vilanterol (FF/VI) offers once-daily dosing 2, 4
• FF/VI demonstrated significant improvements in 24-hour pulmonary function with once-daily morning dosing in COPD patients 4
• Studies comparing once-daily FF/VI 100/25 mcg to twice-daily fluticasone propionate/salmeterol 500/50 mcg showed similar efficacy and safety profiles 5

Important Safety Considerations

• The combination of inhaled corticosteroid with LABA reduces the risk of serious asthma-related events compared to LABA monotherapy 1
• Patients on high-dose inhaled corticosteroids (≥1,000 mcg/day) should use large-volume spacers or dry-powder systems 6

Common Pitfalls to Avoid

• Do not use Wixela 500/50 for COPD: This is a critical error, as only the 250/50 strength is indicated for COPD 1
• Do not increase frequency: Doubling the frequency or number of inhalations increases adverse effects without proven additional benefit 1
• Do not forget mouth rinsing: This simple step significantly reduces oral candidiasis risk 1
• Do not add other LABAs: Concurrent use of multiple LABAs increases cardiovascular and other adverse effects 1