Advair diskus dosage, forms, and strengths

Advair Diskus is a brand-name inhaled drug containing two active ingredients: fluticasone propionate and salmeterol. Combined, these drugs treat asthma in children and adults and chronic obstructive pulmonary disease (COPD) in adults. Fluticasone is an inhaled corticosteroid that reduces inflammation, a key part of COPD and asthma attacks. Salmeterol is a long-acting beta-2 agonist (LABA), a type of bronchodilator that relaxes the muscles in the airways, helping to prevent and minimize asthma symptoms. Advair Diskus is not used as a rescue inhaler but is instead a twice-daily maintenance treatment to reduce the incidence and severity of these attacks.

Advair Diskus forms and strengths

Advair Diskus is a powder inhaler with 60 oral inhalations, which is enough medicine for 30 days of twice-daily dosing. An institutional pack intended as a free sample or for use in clinical settings has 14 actuations or seven days of twice-daily dosing. 

• Advair Diskus powder inhaler: 100 micrograms (mcg) fluticasone propionate/50 mcg salmeterol, 250/50 mcg, 500/50 mcg

The packaging or package insert gives two salmeterol doses. In large type, the package identifies the salmeterol dose as the equivalent dose of salmeterol alone (50 micrograms). However, the actual drug in the powder is salmeterol xinafoate. The package will list its dose as 72.5 mcg, but it’s equal to 50 mcg of just plain salmeterol.

Advair is also available as an inhalation aerosol canister for a metered inhaler. Dose strengths are lower.

Advair Diskus dosage for adults

Advair Diskus is taken as a single inhalation (actuation) once in the morning and once at night for both asthma and COPD.

Advair Diskus dosage for asthma

For adults and children 12 years of age or older, the standard dosage is one puff twice a day, taken twelve hours apart. Dose amounts will depend on the severity of the asthma and the person’s response to the medicine. Starting doses will vary depending on the clinician’s assessment of the severity of the condition.

• Standard Advair Diskus dosage for asthma: 100/50 mcg OR 250/50 mcg OR 500/50 mcg taken twice per day 12 hours apart

• Maximum Advair Diskus dosage for asthma: 500/50 mcg taken twice per day, 12 hours apart

Advair Diskus dosage for COPD

COPD is the blanket term for two chronic and progressive lung conditions that cause breathing problems: chronic bronchitis and emphysema. There is no cure, but the symptoms can be controlled by a combination of medical treatments, including inhaled corticosteroids, inhaled short-acting and long-acting bronchodilators, and oral medications and injections of xanthines (like theophylline), corticosteroids, PDE-4 inhibitors, and mucolytics, drugs that break up mucus in the lungs. Advair Diskus combines two of these drug types. As with asthma, doses are taken twice per day to open airways and prevent COPD exacerbations. 

• Standard Advair Diskus dosage for COPD: 250/50 mcg taken twice per day, 12 hours apart

• Maximum Advair Diskus dosage for COPD: 250/50 mcg taken twice per day, 12 hours apart

Advair Diskus dosage for children

The FDA has approved the use of Advair Diskus in children as young as four years old to control asthma symptoms. Doses are not determined by body weight. Children take their doses twice per day, the same as adults. Healthcare providers will probably use the lowest possible dose in children younger than 12.

• Standard Advair Diskus pediatric dosage for children ages 4–11 years old: 100/50 mcg taken twice per day 12 hours apart

• Maximum Advair Diskus pediatric dosage for children ages 12 and older: Same as adult dosage

Advair Diskus dosage restrictions

No dosage restrictions or reductions are required for people with hepatic impairment (liver disease), renal impairment (kidney dysfunction), or advanced age. However, the FDA does caution healthcare professionals to carefully monitor for side effects in people with liver problems.

People who have allergic reactions to milk proteins should not use Advair Diskus.

Advair Diskus dosage for pets

Veterinarians routinely use inhaled medicines to treat dogs and cats with lung conditions that cause airway obstruction, such as chronic bronchitis. They can prescribe many human inhalants, including Advair. However, inhalation powders such as Advair Diskus are not practical for administering doses to an animal. Instead, veterinarians use other dosage forms, such as aerosol inhalers (with spacers) or nebulizers. If a veterinarian prescribes Advair, the prescription will be for Advair HFA. 

How to take Advair Diskus

Taking Advair Diskus is different from using a metered inhaler. The medicine inside is not an aerosol but little packets of powder. You don’t puff the powder into your lungs, you suck it in. Each time a dose is taken, you must pull a lever to puncture the powder blister. That means that you have a few steps to take every time you take a dose. 

A healthcare professional will probably demonstrate the use of the inhaler when you’re first prescribed the drug. If you need a refresher, the American Lung Association has a step-by-step video tutorial on using a Diskus dry powder inhaler.

Here’s a summary:

• Each Advair Diskus comes with an Instructions for Use package insert. Read this completely the first time you start the medicine.

WHEN YOU FIRST OPEN THE INHALER

• It’s very important to write the date that you start using the inhaler and the use-by date (30 days from the start date).

USING THE INHALER

• Open the inhaler by grabbing the inhaler in one hand and, with the thumb of the other hand in the thumb grip, twist the thumb grip counter-clockwise until the mouthpiece shows.

• Slide the lever away from the mouthpiece as far as you can. The inhaler should make a clicking noise when complete. For the first time, the counter will read “1.” For later doses, the counter will advance one number.

• The dose is now ready to be taken.

• Put the mouthpiece between your lips.

• Breathe in quickly through the mouth.

• Remove the inhaler from your mouth.

• Hold your breath for 10 seconds.

• Breathe out slowly. 

CLOSING THE INHALER

• Using the thumb grip, slide it clockwise to cover up the mouthpiece.

• Rinse your mouth with water and spit out the water.

• To prevent a yeast infection, consider brushing your teeth or gargling with mouthwash or salt water after an Advair dose to rinse any fluticasone from the tissues in your mouth.

SOME RULES FOR USING ADVAIR DISKUS

• Never use a spacer device with Advair Diskus.

• Never take a second dose until it’s time for the next dose.

• Never take a missed dose. Skip any forgotten dose and take the next dose as scheduled.

• Never take apart the inhaler.

• Never wash the inhaler.

AFTER YOU’RE DONE

• Store Advair Diskus at room temperature, protected from heat or sunlight, and out of the reach of children.

• Throw the inhaler away 30 days after it was opened or when the counter reaches 0, whichever comes first.

Advair Diskus dosage FAQs

How long does it take Advair Diskus to work?

Advair Diskus is not intended for the immediate relief of asthma or COPD symptoms such as breathing problems. However, asthma control can improve within 30 minutes of taking the first dose. This is primarily due to the effects of fluticasone. Maximum effects on lung function are typically reached after a week of treatment. 

What happens if I miss a dose of Advair Diskus?

If an Advair dose is missed, skip the missed dose. Take the next dose as scheduled. Do not take extra doses to make up for a missed dose. 

How long can you take Advair Diskus?

Advair Diskus is intended for long-term use over months and years of continual dosing. However, long-term use of inhaled corticosteroids increases the risk of yeast infections of the mouth and throat (thrush) as well as glaucoma, cataracts, skin problems, acne, and menstrual changes. There’s also an increased risk of pneumonia in people with COPD. Doctors will have to monitor for these problems during treatment.

How do I stop taking Advair Diskus?

When taken at the recommended dosage, Advair Diskus usually doesn’t cause withdrawal problems when it’s stopped. If not taken correctly, it may cause steroid withdrawal problems because of adrenal gland issues. If there’s any evidence that the adrenal gland is affected by the medication, the doctor will use a gradually tapering dose to stop Advair treatment. Another concern is asthma and COPD effects. When Advair is stopped without a substitute treatment, asthma or COPD symptoms may get noticeably worse. 

What is the maximum dosage for Advair Diskus?

The maximum Advair Diskus dosage for asthma is 500/50 mcg, taken twice per day. For COPD, the maximum dosage is 250/50 mcg twice per day.

Can you overdose on Advair Diskus?

Do not exceed the recommended doses. Taking too much Advair Diskus risks having too much of the drug enter the bloodstream. Symptoms of an Advair Diskus overdose are rarely reported, but a large enough overdose could cause chest pain, rapid heartbeats, and shortness of breath.

What interacts with Advair Diskus?

Among Advair Diskus drug interactions, healthcare providers are most concerned about drugs that slow down the body’s breakdown of both fluticasone and salmeterol. Although Advair largely concentrates in the lung tissues, some fluticasone and salmeterol is absorbed into the bloodstream. If the breakdown of these drugs is blocked, there’s a greater risk of adverse effects. There are several drugs in this category, but the FDA calls out two for special concern: the antiviral drug ritonavir and the antifungal drug ketoconazole.

For the same reason, other types of drugs may also cause problems, such as monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, beta blockers (a type of blood pressure drug), loop diuretics (“water pills”), and thiazide diuretics. None of these are prohibited, but people taking these drugs with Advair will be monitored for possible problems.

What happens when you mix Advair Diskus and alcohol?

There are no reported interactions between Advair Diskus and alcohol. However, some of the side effects of Advair Diskus, such as dizziness or headache, could be worsened by drinking alcohol.

Is it safe to take Advair Diskus during pregnancy?

Advair Diskus is used cautiously during pregnancy. There’s no evidence that Advair Diskus causes birth defects. Healthcare professionals also use Advair Diskus in women who are breastfeeding. When the drug is inhaled using recommended doses, only small amounts of the two active ingredients are present in breast milk. 

What are the side effects of Advair Diskus?

The most common side effects of Advair Diskus are upper respiratory tract infections, sore throat, hoarseness, throat irritation, headache, and muscle cramps. Possible serious side effects include worsening of asthma, bronchospasm, chest pain, irregular heartbeats, high blood pressure, low potassium, and severe allergic reactions.

Sources

• Advair Diskus fluticasone propionate and salmeterol powder prescribing information, NIH National Library of Medicine

• Asthma treatments and medications, SingleCare

• Chronic obstructive pulmonary disease, StatPearls

• COPD treatments and medications, SingleCare