Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Asthma: When used for alone for asthma treatment, salmeterol has been linked to an increase in asthma-related deaths. Salmeterol - fluticasone should only be used when a regular inhaled corticosteroid (e.g., fluticasone) and a fast acting "reliever" medication (e.g., salbutamol) do not adequately control your symptoms.
If you start developing asthma symptoms, be sure to use your reliever medication for rapid relief of your asthma symptoms. It is very important that you have your reliever medication with you at all times. If you experience worsening symptoms or your reliever medications are not as effective as usual, contact your doctor or seek medical attention immediately.
Diabetes: Both fluticasone and salmeterol may cause an increase in blood sugar levels. If you have diabetes, you may find it necessary to monitor your blood sugar more frequently while using this medication. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Eye problems: If you are at risk of developing glaucoma or cataracts, have your eyes checked by your doctor before starting long-term treatment with this medication. You should have your eyes monitored at regular intervals while using this medication.
Growth effects: Long-term use of corticosteroids, including inhaled forms such as this medication, may slow the growth of children and adolescents. It is important to use the lowest effective dose for managing asthma symptoms. Talk to your doctor if you have any concerns.
Heart rhythm: Beta-agonists such as salmeterol can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death.
Salmeterol can cause a fluttering of the heartbeat (atrial fibrillation) or rapid heart beat, increased blood pressure, chest pain and decreased oxygen reaching the heart muscle.
If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Infections: Corticosteroids, such as fluticasone, can reduce your body’s ability to fight infections and may hide signs of infection that is developing. Infections such as chickenpox and measles can be more serious in people taking medications such as fluticasone. If you are exposed to someone with chickenpox or measles, contact your doctor.
Inhalation-induced bronchospasm: Inhaled forms of medications may cause spasms of the airways, which make breathing difficult. If you experience this problem when using salmeterol - fluticasone, stop using this medication immediately. Speak to your doctor if you experience any problems with breathing while taking this or other inhaled medication.
Oral hygiene: Adequate oral hygiene, such as rinsing your mouth with water after using this medication, helps reduce the chances of developing a yeast infection of the mouth or throat (thrush). If you develop symptoms of thrush, such as white patches in your mouth, contact your doctor.
Osteoporosis: Long-term use of corticosteroids, including inhaled corticosteroids such as fluticasone, may increase the risk of bone loss and osteoporosis. If your doctor recommends that you use this medication for a lengthy period of time, talk to your doctor about supplements and strategies to slow down and reduce bone loss.
Steroid medication use: If you have taken oral steroid medications over the last several months or are still taking oral corticosteroids, consult with your doctor before using this medication. In times of stress or during a severe asthma attack, your doctor may want you to start your oral steroid medication again.
Stopping medication: Do not stop this medication abruptly, as this may cause your condition to get worse. When this medication is stopped, it should be stopped gradually as directed by your doctor.
Thyroid disease: People who have an over-active thyroid gland may be more sensitive to the effects of salmeterol - fluticasone. If you have thyroid disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Worsening symptoms: If you find you need to use your short-acting "rescue" inhaler more often or if your condition seems to worsen, call your doctor. If you have not been given instructions beforehand, contact your doctor immediately about what to do if any of the following situations occur (they may be signs of seriously worsening asthma):
- decreased effectiveness of short-acting, inhaled bronchodilators such as salbutamol, terbutaline, or fenoterol (less than 4 hours of relief)
- need for more inhalations than usual of short-acting, inhaled bronchodilators
- peak flow meter showing results in the below-normal range
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking salmeterol - fluticasone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
The safety and effectiveness of the Diskus form of this medication have not been established for children less than 4 years of age. The safety and effectiveness of the inhaler form of this medication have not been established for children less than 12 years of age.