By clicking the “I Agree” button below, you certify under penalty of perjury that the following statements are true and correct and understand that a medical provider will rely on the truthfulness of your statements when determining whether a prescription is warranted and appropriate.

I agree that I:

• am 18 years or older
• have not had a hypersensitivity reaction to fluticasone, salmeterol, or any component of the formulation
• have not had a severe hypersensitivity reaction to milk proteins or lactose
• will not use as the primary treatment of status asthmaticus or other acute episodes of asthma or chronic obstructive pulmonary disease (COPD)
• will not start fluticasone/salmeterol in significantly worsening or acutely deteriorating COPD
• have already been using fluticasone/salmeterol oral inhalation as prescribed by a pulmonologist or an authorized healthcare provider
• am not pregnant or breastfeeding
• do not have moderate or severe hepatic impairment
• will use the medication as prescribed for the appropriate treatment and duration
• understand fluticasone/salmeterol oral inhalation is used for asthma maintenance and not to treat an asthma attack
• understand inhaled fluticasone/salmeterol products such as Advair Diskus or Wixela Inhub may contain lactose; very rare anaphylactic reactions have been reported in patients with severe milk protein allergy
• will not take nor intend to take the following medications concurrently with fluticasone/salmeterol oral inhalation: long-acting beta-2 agonists, nonselective beta-blockers, cobicistat, topical cocaine, desmopressin, fexinidazole, systemic fusidic acid, kratom, linezolid, loxapine, methacholine, monoamine oxidase inhibitors, nirmatrelvir and ritonavir, tipranavir, or tricyclic antidepressants. I understand this list is not all-inclusive.
• Will not nor intend to take strong CYP3A4 inhibitors with fluticasone/salmeterol oral inhalation such as clarithromycin, erythromycin, diltiazem, amiodarone, itraconazole, verapamil, ritonavir, ketoconazole, or cobicistat. I understand this list is not all-inclusive.
• Understand I can find more information regarding drug-drug interactions at https://www.drugs.com/drug_interactions.html
• Understand to discontinue fluticasone/salmeterol oral inhalation if paradoxical bronchospasm occurs
• Understand prolonged use of corticosteroids, such as the fluticasone contained in fluticasone/salmeterol, may increase incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines
• Understand to avoid use of fluticasone/salmeterol oral inhalation, if possible, in patients with ocular herpes, tuberculosis, or viral, fungal, or bacterial or parasitic systemic infections
• Understand local oropharyngeal Candida infections have been reported with the use of fluticasone/salmeterol oral inhalation
• Understand long-term use of inhaled corticosteroids such as fluticasone in fluticasone/salmeterol have been associated with decreases in bone mineral density
• Understand fluticasone/salmeterol is to be used with caution in cardiovascular disease as salmeterol may cause elevation in blood pressure, heart rate, increase risk of arrhythmia, or cause ECG changes
• Understand fluticasone/salmeterol is to be used with caution in diabetes as salmeterol may increase serum glucose and aggravate preexisting diabetes and ketoacidosis
• Understand fluticasone/salmeterol should be used with caution in patients with cataracts and/or glaucoma; prolonged fluticasone use has been associated with increased intraocular pressure, open-angle glaucoma, and cataracts
• Understand fluticasone/salmeterol should be used with caution in seizure disorders as salmeterol may result in CNS stimulation/excitation
• Understand inhaled corticosteroids such as the fluticasone in fluticasone/salmeterol have been associated with increased risk of pneumonia
• Understand fluticasone, contained in fluticasone/salmeterol, may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.
• Understand withdrawal and discontinuation of a corticosteroid such fluticasone in fluticasone/salmeterol should be done slowly and carefully
• understand this is not a comprehensive list of precautions, risks, side effects, or details about taking this medication
• understand that only major drug interactions are listed and have not been reviewed against the other medications, supplements, or herbal products I may be taking unless also filled by TelyRx