Fixed-dose combination: long-acting beta-2 agonist (LABA) plus inhaled corticosteroid (ICS)
ATC code: R03AK06 (Salmeterol and fluticasone)
Salmeterol selectively stimulates bronchial beta-2 adrenoceptors with a 12-hour duration – relaxes smooth muscle and dilates bronchi. Fluticasone suppresses mucosal inflammation through glucocorticoid receptors. The LABA + ICS combination outperforms doubling the ICS dose and reduces exacerbations. Never use LABA as monotherapy in asthma – risk of fatal exacerbations (SMART 2006).
First line
Asthma at step 3 and above – patients not controlled on low-to-medium ICS monotherapy. Per GINA 2024, fixed ICS-LABA is the backbone of steps 3-5 controller therapy. Salmeterol/fluticasone dose: 50/100, 50/250, 50/500 µg twice daily (Accuhaler/Diskus) or 25/50, 25/125, 25/250 µg as 2 inhalations twice daily (HFA inhaler). Reassess at 4-12 weeks; if stable for 3 months, step down to lower dose or drop LABA while keeping ICS.
Second line
COPD with frequent exacerbations (≥2/year or ≥1 with hospitalization) and eosinophils ≥300 cells/µL. Per 2024, ICS-LABA is added to LAMA or used as part of triple therapy LAMA+LABA+ICS. Dose: 50/500 µg twice daily. Before starting, discuss increased pneumonia risk (NNH ~14 per year). Reassess at 12 months.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Use when clearly needed. Asthma control outweighs theoretical risk. In women of reproductive age, budesonide + formoterol is preferred (more pregnancy data).
Compatible. Hale L2. Systemic absorption of inhaled ICS and LABA is minimal.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Salmeterol + Fluticasone is evaluated for the following indications with varying evidence strength: Asthma (evidence tier A), Chronic obstructive pulmonary disease (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Salmeterol + Fluticasone (≥ 1 in 100): Oral candidiasis, Hoarseness, Tremor, Palpitations, Headache, Throat irritation. See the Safety section for uncommon and serious reactions.
FDA category C. Use when clearly needed. Asthma control outweighs theoretical risk. In women of reproductive age, budesonide + formoterol is preferred (more pregnancy data).
Compatible. Hale L2. Systemic absorption of inhaled ICS and LABA is minimal.
Salmeterol + Fluticasone is contraindicated in: Hypersensitivity to components; History of paradoxical bronchospasm with LABA; Active tuberculosis without antitubercular therapy; LABA monotherapy in asthma (ICS component required). Full list in the Safety section.