The Wellness Collective

What to Know About Fluticasone/Salmeterol Inhalers

Mariah Powers
February 13, 2026

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

The fluticasone and salmeterol dry inhaler is a prescription-only drug combining fluticasone, an inhaled corticosteroid, and salmeterol, a long-acting beta-2 agonist.

The medication comes in the form of a dry powder administered to patients via an inhaler device, normally prescribed to manage asthma or chronic obstructive pulmonary disorder (COPD).

how does a Fluticasone and Salmeterol inhaler work?

The fluticasone and salmeterol inhaler consists of two components, each of which plays a key role in the medication’s mechanisms:

Fluticasone Propionate: This is an inhaled synthetic corticosteroid that helps reduce inflammation in the airway and strengthen the lungs to make them less sensitive to allergens, cold air, exercise, and other triggers.
Samleterol: This long-acting beta-agonist is a bronchodilator that relaxes the muscles around the bronchial tubes and alleviates tension and swelling in these areas.

By combining these components, the fluticasone and salmeterol inhaler both reduces inflammation and helps maintain an open airway. This dual-action protection has made the inhaler a cornerstone of asthma and COPD management.

drug facts

Common Brands	Advair Diskus, Wixela Inhub, AirDuo RespiClick
Drug Class	Combination inhaled corticosteroid (ICS), long-acting beta-2 agonist (LABA)
Generic Status	Generic version of Advair Diskus
Availability	Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs.

Most providers follow a standardized dosage when prescribing a fluticasone and salmeterol inhaler, though the medication’s strength – specifically, the amount of fluticasone in the dose – depends on the patient’s severity of symptoms.

Standard Frequency: Standard guidelines suggest one inhalation two times per day, with each session spaced about 12 hours apart.
Medication Strength: Using the Diskus format, common concentrations include 100 micrograms of fluticasone to 50 micrograms of salmeterol (100/50 mcg), 250/50 mcg, and 500/50 mcg.
Administration: It is advised to use the inhaler at the same time each day to maintain consistent fluticasone and salmeterol in your lungs at all times.

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

The fluticasone and salmeterol combination medication is FDA-approved for maintenance treatment of COPD and long-term maintenance treatment of asthma. The generic Wixela earned FDA approval in 2019, and Advair Diskus received the same approval the following year.

common off-label uses

You may see fluticasone and salmeterol prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

Common off-label uses for fluticasone and salmeterol currently found in clinical practice and research include:

Post-Infectious Cough: Providers may prescribe a brief fluticasone and salmeterol course for patients with hyperactive airways following a severe viral infection.
Exercise-Induced Bronchospasm (EIB): Fluticasone and salmeterol combination medication is not considered a first-line treatment for EIB, but doctors may prescribe it to athletes who need daily maintenance for their asthma.

side effects

Many patients use fluticasone and salmeterol with minimal – if any – issues, but side effects can occur as the body adjusts to the new medication. Common side effects include:

Common Side Effects

Sore or hoarse throat, persistent dry cough, and other upper respiratory sensations
Mild, transient headache
Nausea or vomiting
Mild muscle or bone pain
Throat irritation or a “scratchy” sensation in the mouth

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur. Serious side effects of taking fluticasone and salmeterol combination medication can include:

Candidiasis: Also known as oral thrush, this fungal infection causes white patches in the mouth and throat.
Pneumonia: Patients with COPD are at higher risk of developing a lung infection like pneumonia while using an inhaled corticosteroid.
Cardiovascular Strain: By acting as a bronchodilator, the salmeterol can increase blood pressure and cause a rapid or irregular heartbeat.
Paradoxical Bronchospasm: In rare cases, fluticasone and salmeterol causes the airway to tighten immediately after inhalation.
Adrenal Suppression: Long-term use of this medication and other drugs with high-dose steroids can affect how the body produces cortisol.
Ocular Changes: Prolonged use of fluticasone and salmeterol elevates the patient’s risk of glaucoma and cataracts.

Call your doctor immediately if you experience any concerning or prolonged symptoms.

Starting at $99.99

Fluticasone Propionate/Salmeterol Inhaler

Fluticasone propionate and salmeterol are a combination of an inhaled corticosteroid (ICS) and long-acting beta₂-adrenergic agonist (LABA) used as maintenance treatment for asthma.

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pharmacist tips

Rinse and Spit Every Time: After you’ve completed your inhaling session, it is advised to rinse out your mouth with clean drinking water and spit into a sink. This removes lingering powder and residue left behind by the medication, reducing the likelihood of developing thrush.
Wait to Exhale: After inhaling the medication, it is recommended to turn away from the device before exhaling. Breathing onto the inhaler can introduce moisture and cause the dry powder to stick inside the device.
Keep an Eye on the Counter: Diskus has a built-in counter to keep track of the remaining doses. If the number turns red, this means five or fewer doses are remaining and it’s time for a refill.
Spot Clean Only: It is not recommended to ever clean the inhaler with water. Wiping the device’s surfaces with a dry tissue or cloth should suffice.
Don’t Shake the Diskus: If you use the Advair Diskus Inhaler, it is not recommended to shake before using like you would with a standard “puff” asthma inhaler. This can disperse the medication incorrectly within the device.

drug interactions

Since the fluticasone and salmeterol combination medication contains a steroid and bronchodilator, it can interact with a wide range of other drug types. Notable interactions for fluticasone and salmeterol include:
Beta Blockers: Primarily used to treat high blood pressure and heart conditions, beta blockers can counteract the effects of salmeterol and cause the airway to become narrow.
Antifungals and Antiretrovirals: Some antifungal medications, including ketoconazole, and antiretrovirals like ritonavir can increase the level of fluticasone in your blood. If you take these drugs with a fluticasone and salmeterol inhaler, it can exacerbate the steroid’s potential side effects.
Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants: These antidepressant medications may enhance the effects of salmeterol and lead to heart palpitations.
Diuretics: Using a fluticasone and salmeterol inhaler while taking water pill diuretics can cause potassium levels to decrease.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

What is the difference between fluticasone-salmeterol Diskus and HFA?

Hydrofluoroalkane (HFA) is an aerosol spray “puffer” medication that uses a propellant to deliver the medication. This differs from the Diskus, which consists of a dry powder inhaler that requires a forceful inhalation to force the medication into the lungs.

Is fluticasone-salmeterol a rescue inhaler?

No, fluticasone-salmeterol is a controlled or maintenance inhaler. It is designed to manage daily symptoms, and does not work fast enough to prevent a sudden asthma attack.

Why do I need to rinse my mouth after using this inhaler?

Rinsing your mouth with water after inhaling fluticasone-salmeterol is recommended for flushing out lingering powder and residue. If powder and residue are not rinsed out, this can lead to yeast growth and oral thrush.

How long does it take for fluticasone-salmeterol to improve breathing?

Patients may begin to notice the effects of fluticasone-salmeterol within 30 to 60 minutes of their inhalation session. However, the medication may need up to two weeks to take full effect.

Can I use this inhaler for a sudden asthma attack?

No, it is not advised to use the fluticasone-salmeterol inhaler during a sudden asthma attack because the device does not work quickly enough. It is strongly recommended for people with asthma to keep a rescue albuterol inhaler instead.

Is Wixela Inhub the same thing as Advair Diskus?

Yes, Wixela Inhub is the generic version of the brand-name Advair Diskus. Both contain the same active ingredients and use the same type of inhaler device.

Does fluticasone-salmeterol contain steroids?

Yes, fluticasone is in the inhaled corticosteroid drug class of medications used to reduce inflammation.

Can I use a spacer with the Diskus inhaler?

No, spacers – or holding chambers – are only designed for use with HFA aerosol inhalers. The Diskus and other dry powder inhalers require users to inhale deeply directly from the device’s mouthpiece.

What should I do if I accidentally breathe out into the device?

Breathing out into the fluticasone-salmeterol inhaler can introduce moisture to the device and cause the dry powder medication to clump or stick to the side walls. If this happens, it is recommended to consult your pharmacist or simply empty the inhaler and load a new dose.

Does this medication cause weight gain?

Since fluticasone-salmeterol and other inhaled steroids target the lungs, and not the entire body, significant weight gain is not associated with taking this medication. That said, systemic absorption may occur with high-dose treatments.

Can fluticasone-salmeterol cause thrush (yeast infection in the mouth)?

Yes, oral thrush is a known side effect of fluticasone-salmeterol. Thrush is a fungal infection that appears as white patches in the mouth and throat. Thoroughly rinsing and spitting after inhaling the medication should help prevent oral thrush.

Is it safe to stop taking this inhaler if my asthma or COPD feels better?

It is not advised to stop fluticasone-salmeterol treatment without first consulting your doctor – even if your symptoms subside. This medication is meant to control asthma and COPD, so not taking it can cause inflammation and asthma attacks to return.

Does this medication affect my voice or cause hoarseness?

Yes, some people who take fluticasone-salmeterol experience a hoarse voice. Thorough rinsing and spitting after inhaling the powder can help mitigate this issue.

Can I take fluticasone-salmeterol while pregnant?

Each pregnant patient should discuss options with their provider, who can make recommendations based on unique medical history. However, providers generally agree that controlling and maintaining asthma while pregnant is vital to both maternal and fetal health.

How do I know when the Diskus is empty?

Diskus inhalers feature an indicator window near the top. When the counter reaches 5, the number turns red as a warning to replenish your supply soon. A “0” indicates the inhaler is completely empty.

Does salmeterol increase the risk of asthma-related complications?

LABAs like salmeterol can increase the risk of asthma-related complications without the presence of an inhaled corticosteroid like fluticasone. Combination devices like the Diskus help ensure users get the treatment they need without an added risk of asthma-related complications.

Can I take over-the-counter cold medicines while using this inhaler?

Yes, most over-the-counter cold medicines are safe to take while using the fluticasone-salmeterol inhaler. However, some decongestants increase heart rate and blood pressure, and this can compound salmeterol’s effects. Talk to your doctor or pharmacist before mixing fluticasone-salmeterol and cold medicine.

Does fluticasone-salmeterol raise blood pressure or heart rate?

For some patients, fluticasone-salmeterol can temporarily increase heart rate and blood pressure. It is advised to speak with your doctor if this occurs.

What are the long-term side effects of inhaled corticosteroids?

Long-term fluticasone-salmeterol use in high doses can lead to complications like reduced bone density, increased eye pressure, and slowed growth in children. Providers monitor these and other potential long-term side effects during checkup appointments.

Should I wash the Diskus device with water?

No, you should never wash the Diskus device with water. Exposure to water and moisture can ruin the dry powder and cause you to waste doses.

compare medications

Compared: Albuterol, Xopenex, Fluticasone, or Symbicort?

Here’s how albuterol compares to other common respiratory inhalers.

Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)
- Type – “Rescue” Inhaler (Short-Acting Beta-Agonist, SABA).
- Use – Taken “as-needed” to provide rapid, short-term relief from sudden symptoms (wheezing, shortness of breath). It works by relaxing airway muscles.

Levalbuterol (Xopenex)
- Type – “Rescue” Inhaler (SABA).
- Use – This is a direct alternative to albuterol. It works in the exact same way but contains only one isomer of the drug. It is sometimes prescribed for patients who are very sensitive to albuterol’s side effects (like shakiness).

Inhaled Corticosteroids (Flovent/Fluticasone, Pulmicort/Budesonide)
- Type – “Controller” Inhaler.
- Use – This is a different class of medication. It does not provide rescue. It’s taken every day (even when you feel well) to reduce the underlying inflammation in your lungs and prevent symptoms from happening.

Combination Inhalers (Advair, Symbicort, Dulera)
- Type – “Controller” Inhaler.
- Use – This is also a daily controller medication. It combines an inflammation-reducing steroid (ICS) with a Long-Acting Beta-Agonist (LABA) that keeps airways open for 12-24 hours. It is not used for sudden rescue.

Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.

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