The other brands listed are trademarks of their respective owners and are not trademarks of
GlaxoSmithKline. The makers of these brands are not affiliated with and do not endorse
2012, GlaxoSmithKline. All rights reserved.
PHARMACIST—DETACH HERE AND GIVE MEDICATION GUIDE TO PATIENT
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MEDICATION GUIDE ADVAIR® HFA [ad vair] 45/21 Inhalation Aerosol (fluticasone propionate 45 mcg and salmeterol 21 mcg) ADVAIR® HFA 115/21 Inhalation Aerosol (fluticasone propionate 115 mcg and salmeterol 21 mcg) ADVAIR® HFA 230/21 Inhalation Aerosol (fluticasone propionate 230 mcg and salmeterol 21 mcg)
Read the Medication Guide that comes with ADVAIR HFA Inhalation Aerosol before
you start using it and each time you get a refill. There may be new information.
This Medication Guide does not take the place of talking to your healthcare provider
about your medical condition or treatment.
What is the most important information I should know about ADVAIR HFA? ADVAIR HFA can cause serious side effects, including:
1. People with asthma who take long-acting beta2-adrenergic agonist (LABA) medicines, such as salmeterol (one of the medicines in ADVAIR HFA), have an increased risk of death from asthma problems. It is not
known whether fluticasone propionate, the other medicine in ADVAIR HFA,
reduces the risk of death from asthma problems seen with salmeterol.
Call your healthcare provider if breathing problems worsen over time while using ADVAIR HFA. You may need different treatment.
Get emergency medical care if:
breathing problems worsen quickly and
you use your rescue inhaler medicine, but it does not relieve your
2. ADVAIR HFA should be used only if your healthcare provider decides that your
asthma is not well controlled with a long-term asthma control medicine, such as
3. When your asthma is well controlled, your healthcare provider may tell you to
stop taking ADVAIR HFA. Your healthcare provider will decide if you can stop
ADVAIR HFA without loss of asthma control. Your healthcare provider may
prescribe a different long-term asthma control medicine for you, such as an
4. Children and adolescents who take LABA medicines may have an increased risk
of being hospitalized for asthma problems.
What is ADVAIR HFA?
ADVAIR HFA combines an inhaled corticosteroid medicine, fluticasone propionate
(the same medicine found in FLOVENT®), and a LABA medicine, salmeterol (the
Inhaled corticosteroids help to decrease inflammation in the lungs.
Inflammation in the lungs can lead to asthma symptoms.
LABA medicines are used in people with asthma and chronic obstructive
pulmonary disease (COPD). LABA medicines help the muscles around the
airways in your lungs stay relaxed to prevent symptoms, such as wheezing
and shortness of breath. These symptoms can happen when the muscles
around the airways tighten. This makes it hard to breathe. In severe cases,
wheezing can stop your breathing and cause death if not treated right away.
ADVAIR HFA is used to control symptoms of asthma and to prevent symptoms
such as wheezing in adults and adolescents aged 12 years and older.
ADVAIR HFA should not be used as a rescue inhaler.
ADVAIR HFA contains salmeterol (the same medicine found in SEREVENT). LABA
medicines, such as salmeterol, increase the risk of death from asthma problems.
ADVAIR HFA is not for adults and adolescents with asthma who are well controlled
with an asthma control medicine, such as a low to medium dose of an inhaled
Who should not use ADVAIR HFA?
to treat sudden, severe symptoms of asthma and
if you are allergic to any of the ingredients in ADVAIR HFA. See the end of this
Medication Guide for a list of ingredients in ADVAIR HFA.
What should I tell my healthcare provider before using ADVAIR HFA? Tell your healthcare provider about all of your health conditions, including
have heart problems
have high blood pressure
have thyroid problems
have liver problems
have an immune system problem
have eye problems such as increased pressure in the eye (glaucoma) or cataracts
are pregnant or planning to become pregnant. It is not known if ADVAIR
are breastfeeding. It is not known if ADVAIR HFA passes into your milk and if
are allergic to ADVAIR HFA or any other medicines
are exposed to chickenpox or measles
Tell your healthcare provider about all the medicines you take including prescription
and non-prescription medicines, vitamins, and herbal supplements. ADVAIR HFA
and certain other medicines may interact with each other. This may cause serious
side effects. Especially, tell your healthcare provider if you take ritonavir. The anti
HIV medicines NORVIR® (ritonavir capsules) Soft Gelatin, NORVIR (ritonavir oral
solution), and KALETRA® (lopinavir/ritonavir) Tablets contain ritonavir.
Know the medicines you take. Keep a list and show it to your healthcare provider
and pharmacist each time you get a new medicine.
How do I use ADVAIR HFA? See the step-by-step instructions for using ADVAIR HFA at the end of this Medication Guide. Do not use ADVAIR HFA unless your healthcare provider has
taught you and you understand everything. Ask your healthcare provider or
Use ADVAIR HFA exactly as prescribed. Do not use ADVAIR HFA more often than prescribed. ADVAIR HFA comes in 3 strengths. Your healthcare provider
has prescribed the one that is best for your condition.
The usual dosage of ADVAIR HFA is 2 inhalations 2 times each day (morning and
evening). The 2 doses should be about 12 hours apart. Rinse your mouth with
If you take more ADVAIR HFA than your doctor has prescribed, get medical help
right away if you have any unusual symptom, such as worsening shortness of
breath, chest pain, increased heart rate, or shakiness.
If you miss a dose of ADVAIR HFA, just skip that dose. Take your next dose at
your usual time. Do not take 2 doses at one time.
While you are using ADVAIR HFA 2 times each day, do not use other medicines that contain a LABA for any reason. Ask your healthcare provider
or pharmacist if any of your other medicines are LABA medicines.
Do not stop using ADVAIR HFA or other asthma medicines unless told to do so
by your healthcare provider because your symptoms might get worse. Your
healthcare provider will change your medicines as needed.
ADVAIR HFA does not relieve sudden symptoms. Always have a rescue inhaler
medicine with you to treat sudden symptoms. If you do not have a short-acting
bronchodilator rescue inhaler, call your healthcare provider to have one
Call your healthcare provider or get medical care right away if:
your breathing problems worsen with ADVAIR HFA
you need to use your rescue inhaler medicine more often than usual
your rescue inhaler medicine does not work as well for you at relieving
you need to use 4 or more inhalations of your rescue inhaler medicine for 2
you use 1 whole canister of your rescue inhaler medicine in 8 weeks’ time
your peak flow meter results decrease. Your healthcare provider will tell you
your asthma symptoms do not improve after using ADVAIR HFA regularly for
What are the possible side effects with ADVAIR HFA? ADVAIR HFA can cause serious side effects, including:
See “What is the most important information I should know about ADVAIR HFA?”
serious allergic reactions. Call your healthcare provider or get emergency
medical care if you get any of the following symptoms of a serious allergic
swelling of the face, mouth, and tongue
sudden breathing problems immediately after inhaling your medicine
effects on heart
effects on nervous system
reduced adrenal function (may result in loss of energy)
changes in blood (sugar, potassium, certain types of white blood cells)
weakened immune system and a higher chance of infections
lower bone mineral density. This may be a problem for people who already
have a higher chance of low bone density (osteoporosis).
eye problems including glaucoma and cataracts. You should have regular
slowed growth in children. A child’s growth should be checked often.
pneumonia. ADVAIR HFA contains the same medicine found in ADVAIR
DISKUS®. ADVAIR DISKUS is used to treat people with asthma and people with
chronic obstructive pulmonary disease (COPD). People with COPD have a higher
chance of getting pneumonia. ADVAIR DISKUS may increase the chance of
getting pneumonia. ADVAIR HFA has not been studied in people with COPD. Call
your healthcare provider if you notice any of the following symptoms:
increase in mucus (sputum) production
Common side effects of ADVAIR HFA include:
Tell your healthcare provider about any side effect that bothers you or that does
These are not all the side effects with ADVAIR HFA. Ask your healthcare provider or
Call your doctor for medical advice about side effects. You may report side effects
How do I store ADVAIR HFA?
Store ADVAIR HFA at room temperature between 59F to 86F (15C to 30C),
Contents Under Pressure: Do not puncture. Do not use or store near heat or
open flame. Exposure to temperatures above 120°F may cause bursting.
Do not throw into fire or an incinerator.
Keep ADVAIR HFA and all medicines out of the reach of children.
General Information about ADVAIR HFA
Medicines are sometimes prescribed for purposes not mentioned in a Medication
Guide. Do not use ADVAIR HFA for a condition for which it was not prescribed. Do
not give your ADVAIR HFA to other people, even if they have the same condition
This Medication Guide summarizes the most important information about ADVAIR
HFA. If you would like more information, talk with your healthcare provider or
pharmacist. You can ask your healthcare provider or pharmacist for information
about ADVAIR HFA that was written for healthcare professionals. You can also
contact the company that makes ADVAIR HFA (toll free) at 1-888-825-5249 or at
What are the ingredients in ADVAIR HFA?
Active ingredients: fluticasone propionate, salmeterol xinafoate
Inactive ingredient: propellant HFA-134a
Instructions for using your ADVAIR HFA The parts of your ADVAIR HFA
There are 2 main parts to your ADVAIR HFA
1572 inhaler—the metal canister that holds the medicine 1573 and the purple plastic actuator that sprays the 1574 medicine from the canister (see Figure 1).
The canister has a counter to show how many
1576 sprays of medicine you have left. The number 1577 shows through a window in the back of the
1578 actuator. The counter starts at 124, or at 064 if
1579 you have a sample or institutional canister. The 1580 number will count down by 1 each time you spray 1581 the inhaler. The counter will stop counting at 000.
Never try to change the numbers or take the counter off the metal canister. The counter cannot be reset, and it is permanently attached to the
The mouthpiece of the actuator is covered by a cap. The strap on the cap keeps
Do not use the actuator with a canister of medicine from any other inhaler. Do not use an ADVAIR HFA canister with an actuator from any other inhaler. Using your ADVAIR HFA
The inhaler should be at room temperature before you use it.
Take your ADVAIR HFA inhaler out of the moisture-protective pouch just before
you use it for the first time. Safely throw away the foil pouch and the drying
Priming your ADVAIR HFA Before you use ADVAIR HFA for the first time, you must prime the inhaler so that you will get the right amount of medicine when you use it.
To prime the inhaler, take the cap off the mouthpiece and shake the inhaler well for
5 seconds. Then spray the inhaler 1 time into the air away from your face. Avoid spraying in eyes. Shake and spray the inhaler like this 3 more times to finish
priming it. The counter should now read 120, or 060 if you have a sample or
You must prime your inhaler again if you have not used it in more than 4 weeks
or if you drop it. Take the cap off the mouthpiece, shake the inhaler well for 5
seconds. Then spray it into the air away from your face. Shake and spray the
inhaler like this 1 more time to finish priming it.
Read the following 7 steps before using ADVAIR HFA and follow them at each
use. If you have any questions, ask your doctor or pharmacist.
1611 1. Take the cap off the mouthpiece of the 1612 actuator (see Figure 2).
Look inside the mouthpiece for foreign objects,
Make sure the canister fits firmly in the actuator.
Shake the inhaler well for 5 seconds.
1617 2. Hold the inhaler with the mouthpiece down (see
Breathe out through your mouth and push as
much air from your lungs as you can. Put the
mouthpiece in your mouth and close your lips
1625 3. Push the top of the canister all the way 1626 down while you breathe in deeply and slowly through your mouth (see Figure 3).
Right after the spray comes out, take your finger
off the canister. After you have breathed in all
the way, take the inhaler out of your mouth and
1632 4. Hold your breath as long as you can, up to
5. Wait about 30 seconds and shake the inhaler well for 5 seconds. Repeat
6. After you finish taking this medicine, rinse your mouth with water. Spit out the
7. Put the cap back on the mouthpiece after every time you use the inhaler. Make
Cleaning your ADVAIR HFA
Clean your inhaler at least 1 time each week after your evening dose. It is
important to keep the canister and plastic actuator clean so the medicine will not
1646 1. Take the cap off the mouthpiece. The strap on 1647
the cap will stay attached to the actuator. Do not
take the canister out of the plastic actuator.
1649 2. Use a dry cotton swab to clean the small circular 1650
opening where the medicine sprays out of the
canister. Carefully twist the swab in a circular
motion to take off any medicine (see Figure 4).
1653 3. Wipe the inside of the mouthpiece with a clean
tissue dampened with water. Let the actuator
1656 4. Put the cap back on the mouthpiece after the 1657
Replacing your ADVAIR HFA
When the counter reads 020, you should refill your prescription or ask your
doctor if you need another prescription for ADVAIR HFA.
When the counter reads 000, throw the inhaler away. You should not keep
using the inhaler when the counter reads 000 because you will not receive the
Do not use the inhaler after the expiration date, which is on the packaging it This Medication Guide has been approved by the U.S. Food and Drug Administration.
ADVAIR, ADVAIR DISKUS, FLOVENT, and SEREVENT are registered trademarks of
GlaxoSmithKline. The other brands listed are trademarks of their respective owners
and are not trademarks of GlaxoSmithKline. The makers of these brands are not
affiliated with and do not endorse GlaxoSmithKline or its products.
2012, GlaxoSmithKline. All rights reserved.
Charles A. LeFebvre* and Martin W. Siemer**Each year, it seems that new cases and statutes of relevance to the ElderLaw practitioner arrive in force. The year this article was written, 2008, is nodifferent. There are cases of significance, statutory amendments (though veryfew for the year and none that will be discussed here), and general updates ofinterest. Now, almost three years after the pa
Worming horses and -by Nick Bowen BVetMed, CertEP, MRCVS, Chalgrave Equine Clinic near Dunstable. an update Equitape ) twice yearly in April (Strongid P or Pyratape P) or with praziquantel (Equimax or management is equally Macrocyclic Lactones Pryrimidines Benzimidazoles better to prevent infection than Equest or Panacur Equine Guard. Currently, the only