Advair side effects and drug information

Advair is a medicine that is used to prevent asthma attacks as well as to avoid the worsening of COPD that is linked with emphysema and/or chronic bronchitis.

MedlinePlus a699063
PubChem CID 9811567
Trade name Advair, Seretide
ChemSpider ID  7987322
ATC code R03AK06 (WHO)
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Its content is a combination of salmeterol, a bronchodilator that functions by relaxing the muscles in the airways, thus improving breathing; and fluticasone, a steroid that inhibits the release of certain substances that leads to inflammation.

Advair Diskus is for both adults and children who are at least four years of age, while Advair HFA is for adults and children starting at the age of 12.

Some essential information:

This medication should not be used by those who are allergic to any of the components and milk proteins. It is preventive sildenafil medicine, so it does not work as a rescue treatment for asthma or bronchospasm attack.  

If Advair seems not to be working or if the condition is worsening, seek medical help right away. This drug may also cause fungal infections of the throat and mouth, so it is recommended that you rinse your mouth with water after using Advair to avoid these infections. This medicine may also cause an increased risk of developing pneumonia for those with COPD.


Before taking this medicine:


Prior to using Advair, inform your doctor about your past medical condition, including the infections that you might have had in the last several weeks, such as:

  • Thyroid disorder 
  • Liver or kidney disease
  • Glaucoma or cataracts
  • Seizure
  • Diabetes
  • Heart disease
  • High blood pressure
  • Osteoporosis
  • Food or drug allergy
  • Chronic infections like fungal, viral, bacterial, tuberculosis, parasitic or herpes of the eye

Also, discuss with your doctor if you have the following condition to know about your potential risk. Let him or her know if you are:

  • A smoker
  • Have a family history of osteoporosis
  • Not getting enough calcium or vitamin D
  • Pregnant
  • Breastfeeding

Advair should also not be given to a child without the doctor’s advice.


Use of Advair

Use Advair exactly as prescribed as too much of it can lead to harmful side effects. If the person already has asthma or bronchospasm attack, use fast-acting inhalation medicine instead.

Adult supervision is always required when a child is using this drug.


Advair comes in two forms. One is Advair Diskus, which is a powder version of salmeterol and fluticasone. This comes with an inhaler device that is preloaded with blister packs of measured doses of this drug. Another one is the Advair HFA, which comes in a canister that is used with an actuator inhaler device.


When using Advair HFA, use it at the same time each day and only use the inhaler device that comes with the package. Shake the inhaler for about 5 seconds before each spray, then after every use, rinse your mouth with water and do not swallow. 


Do not change the dosage unless the doctor directed it. And if using oral steroid drugs, do not abruptly stop the medication and continue with your doctor’s instructions. If using a peak flow meter, inform your doctor if your numbers are lower than usual.


If you are under this treatment, your vision and bone mineral density may need to be checked regularly.  


Once the asthma is under control, you may be asked to stop this chronic bronchitis medication, but do not stop unless upon your doctor’s advice.


This drug should be stored at room temperature and away from sunlight, moisture, and heat.


Side Effects

Advair may cause side effects that can either be the common ones or the more serious ones.

Some of its common side effects include:

  • Bone pain
  • Dizziness
  • Headache
  • Muscle pain
  • Throat irritation
  • A hoarse or strained voice
  • Nausea
  • Vomiting
  • Thrush including fungal infection in the throat or mouth
  • Upper respiratory infections like sinus infections or the common colds

Side effects may differ depending on the type of Advair device being used as well as the patient’s condition while using Advair.


Serious side effects of this medicine may include:

  • Pneumonia for those with COPD
  • Severe allergic reaction to the drug’s components
  • Reduced function of the adrenal gland
  • Paradoxical bronchospasm
  • Eye problems like cataracts and glaucoma
  • A decrease in bone density that can result in osteoporosis
  • Increased risk for serious infections including chickenpox and measles

Side Effects in children

A lot of the side effects are similar in children and adults. Children who are 4 to 11 years old and are using Advair Diskus are said to have more ear, nose, and throat irritations and infections as compared to adults and children 12 years old and up.


The use of inhaled corticosteroids like fluticasone propionate is said to slow down a child’s growth, so to reduce this risk, only the lowest dosage of this drug should be given to children. 


Indication and Dosage

Advair HFA is administered twice a day with two inhalations, then rinsing the mouth with water after every use to prevent the development of infection.  

Should symptoms of asthma arise between doses, take an inhaled short-acting beta 2- agonist for quick relief.


For 12 years old and up, the dosage recommended is twice per day of 2 inhalations at a 12-hour interval. Dosage may vary as it is based on the patient’s condition, previous asthma therapy, including ICS dosage, and the current control of asthma symptoms.

The maximum dosage allowed for this drug is two inhalations of Advair HFA 230/21 two times a day.


After the administration of Advair HFA, improvement in asthma control may happen around 30 minutes from the start of the treatment up to a week or more. If there is no improvement after two weeks, dosage strength may be increased, and therapy may be reevaluated. Additional treatment options may also be implemented.


Before using Advair HFA, you need to prepare it first by discharging four sprays toward the air and far from the face. Shake well for 5 seconds before each use. For unused inhalers of around four weeks or more, you would again need to prepare the inhaler by discharging two sprays toward the air and far from the face.


Drug Interaction

This medication can work well with other drugs like short-acting beta 2- agonists, methylxanthines, and intranasal corticosteroids. These medicines are used for those with asthma and do not cause adverse effects with Advair HFA.

The individual components Fluticasone propionate and salmeterol are substrates of CYP3A4 inhibitors such as:

  • Ritonavir
  • Clarithromycin
  • Itraconazole
  • Atazanavir
  • Indinavir
  • Nefazodone
  • Nelfinavir
  • Saquinavir
  • Ketoconazole
  • Telithromycin

Strong use of these inhibitors with Advair HFA is not advised due to an increased systemic corticosteroid, and the patient may have an increased risk for a cardiovascular adverse reaction.

This drug may also cause interactions with the following:

  • Monoamine oxidase inhibitor drugs 
  • tricyclic antidepressants or TCAs
  • Beta-blockers
  • Potassium-sparing diuretics

Warnings and Precautions

Prior to taking Advair, consult with your health care provider first and inform him or her about your medical history as this medicine may not be appropriate for you.

Do not take this drug if you have these conditions:

  • Allergic reaction to the drug or its components
  • harsh allergic reaction to milk protein
  • asthma or COPD that is escalating quickly
  • Serious infections
  • Heart problems
  • Seizure disorders
  • Certain hormone disorders
  • Pregnant
  • Breastfeeding

Overdose and Contraindications

There has been no known overdosage for humans while using Advair HFA. In case an overdose occurs, treatment would include discontinuation of the drug along with the replacement of an appropriate symptomatic and/ or supportive therapy.  

A cardioselective beta-receptor blocker may be considered as well, but since it can cause bronchospasm, cardiac monitoring is necessary.


Fluticasone Propionate

For an overdose of this component, hypercorticism symptoms may occur.



Overdosage of this ingredient is related to the excess in the stimulation of the beta-adrenergic receptors or having any of its symptoms such as:

  • Seizures
  • Hypertension
  • Tachycardia with the heart rate going up to 200 beats per minute
  • Angina
  • Hypotension
  • Arrhythmias
  • anxiety
  • migraine
  • spasm
  • Muscle cramps
  • Dry mouth
  • shaking
  • queasiness
  • vertigo
  • exhaustion
  • uneasiness
  • Insomnia
  • Hyperglycemia
  • Hypokalemia
  • Metabolic acidosis

Clinical Pharmacology

The two active components of Advair Diskus and Advair HFA are fluticasone propionate and salmeterol. Fluticasone propionate is a type of corticosteroid whose function is to improve COPD symptoms and asthma by decreasing inflammation. Salmeterol, on the other hand, is a long-acting beta 2- agonist (LABA) that works to improve asthma and symptoms of COPD by relaxing bronchial smooth muscle.


Pharmacokinetics and Metabolism

Following the inhalation of this drug, the peak concentration for fluticasone propionate is around 0.33 to 1.5 hours and 5 to 10 minutes for salmeterol.  

The terminal half-life for both drugs is around 5.5 hours. Fluticasone propionate is excreted through the fecal route, while salmeterol is excreted through urine.


Medication Guide

Upon purchasing Advair, the expiration date will be added on the label of the bottle, which is usually 12 months from the date it was dispensed.  

Advair Diskus needs to be disposed of when it says “0” or a month after opening the foil pouch.    

Advair HFA needs to be disposed of when it says “000”.


How to store

Both Advair Diskus and HFA must be kept at room temperature that is no greater than 25°C.

These products must be kept in their packaging and must not be exposed to the light. Advair HFA must be away from high temperatures as it tends to burst when it becomes so hot.

Don’t store this drug in wet or damp areas like in a bathroom.


Proper Disposal

Advair products that are not being used anymore must be disposed of properly to avoid untoward accidents like being inhaled by kids or pets unintentionally.

Proper disposal may be inquired through the pharmacist or FDA website.