The usual dose for asthma in adolescents over 12 years of age and in adults is two puffs twice daily of either the 125mcg or the 250 mcg inhaler.

Advair® contains two different medications, salmeterol and fluticasone that act in two different ways to help you breathe better. Salmeterol is a long-acting bronchodilator. It relaxes the muscles in the walls of the small air passages in the lungs. This helps to open the airways and makes it easier for air to get in and out of the lungs. Fluticasone is a potent corticosteroid that possesses strong local anti-inflammatory activity. It reduces swelling and irritation in the walls of the small air passages in the lungs to ease breathing problems. Fluticasone also helps prevent asthma attacks.

Along with its needed effects, Advair® may cause some unwanted or undesirable effects. The severity and duration of these effects are dependent on many factors including duration of therapy, dose, and individual response. Occasionally, some people feel a little shaky or have a headache or notice that their heart is beating faster than usual. These effects usually wear off with continued treatment. Tell your doctor about unwanted effects, but do not stop treatment unless told to do so.
Common:

• hoarseness
• throat irritation
• thrush of the mouth and throat

Less common:

• palpitations (awareness of heart beat)
• cough

Rare:

• irregular heart rhythms
• pain in joints
• muscle cramps

Many of these unwanted effects, especially the most common ones, may disappear with continued use. Check with the doctor or pharmacist if any of them continue or become bothersome.

• Poor control of symptoms with Advair® can often be caused by improper use of the delivery device. Be sure to follow the directions given to you by your pharmacist and read the patient instructions that are provided with the medication.
• Optimal relief of symptoms may require 2 to 7 days of continuous therapy.
• If you are not responding to your usual dose, or your symptoms get worse, contact your doctor. Never increase the dose or frequency of the dose without being instructed to do so by your doctor.
• Do not take any other respiratory medications without your doctor's approval.
• Treatment with Advair® should never be stopped without first consulting your doctor. Discontinuation requires a gradual tapering of the dose and/or frequency or you may experience a flare-up of your condition.
• People who have been treated with long term oral corticosteroids (e.g. prednisone) and are being switched to Advair® should start the Advair® before stopping the oral corticosteroid. The oral corticosteroid should then be gradually withdrawn.
• The fluticasone in Advair® may make people more susceptible to respiratory infections and may mask the symptoms of an existing infection. If you suspect that you may have a respiratory tract infection, contact your physician.
• This immune system suppression also makes people more susceptible to getting thrush of the mouth and throat. Thrush is a fungal infection that usually presents as milky-white curds on the surface of the skin of the mouth and throat. These curds are easily wiped off and when removed leave a red, raw, painful surface. If you suspect that you might have thrush, see your physician. To best prevent getting thrush, it is wise to rinse your mouth out with water after using Advair®.
• Drug Interactions: Be sure to tell your doctor and pharmacist about any prescription or over-the- counter medications you are taking in order to avoid any potentially dangerous interactions.The following drugs may interact with Advair®:
  • short-acting beta-agonists (e.g. salbutamol)
  • MAO (monoamine oxidase) inhibitors (e.g. phenelzine, tranylcypromine)
  • tricyclic antidepressants (e.g. amitriptyline, imipramine)
  • methylxanthines (e.g. theophylline)
  • some beta-blockers (e.g. propranolol)
  • ritonavir (e.g. Norvir®)

Use is not recommended in the following situations:

• allergy to any component of Advair®
• patients with allergic reactions to lactose or milk
• cardiac arrhythmia associated with tachycardia (irregular heartbeat associated with rapid heart rate)
• people with untreated fungal, bacterial or tuberculosis infections

Caution is recommended in the following situations:

• hypothyroidism
• diabetes
• cirrhosis
• glaucoma
• cardiovascular disorders
• cardiac arrhythmia (irregular heartbeat)

Use in pregnancy: Advair® is generally considered safe in pregnancy but consult your doctor or pharmacist before use.
Use while breast-feeding: Advair® is generally considered safe in breast-feeding but consult your doctor or pharmacist before use.
As with all long-acting beta2-agonists and beta2-agonist/corticosteroid combinations, Advair® carries a warning that long-acting beta2-agonists have been associated with asthma death. These warnings are based on a U.S. study using salmeterol.