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ICS/LABA Combination Pregnancy: Compatible — continued use preferred over poor asthma control in pregnancy

Fluticasone-Salmeterol

Brand names: Seretide, AirFluSal

Adult dose

Dose: Seretide 125/25 mcg or 250/25 mcg: 1–2 puffs BD. Accuhaler 250/50 or 500/50: 1 puff BD
Route: Inhaled
Frequency: Twice daily
Max: Fluticasone 1000 mcg/day + salmeterol 100 mcg/day
For persistent asthma and COPD (Gold 3/4). Use lowest effective ICS dose. Not for acute bronchospasm.

Paediatric dose

Route: Inhaled MDI with spacer
Frequency: BD
Max: Fluticasone 100 mcg BD in children ≥4 years
Seretide 50/25 mcg in children ≥4 years; always use spacer device in children

Dose adjustments

Renal

No dose adjustment required

Hepatic

Caution in severe hepatic impairment — increased systemic fluticasone exposure

Clinical pearls

  • Always prescribe ICS/LABA together — LABA monotherapy in asthma increases mortality risk
  • Rinse mouth and gargle after each use to prevent oral candidiasis
  • SMART therapy (single inhaler maintenance and reliever) is preferred in asthma guidelines — use budesonide-formoterol instead
  • Seretide cannot be used as SMART therapy — salmeterol is not suitable for reliever use

Contraindications

  • Use as monotherapy in asthma (LABA without ICS)
  • Hypersensitivity to lactose or milk proteins (Accuhaler)

Side effects

  • Oral candidiasis (rinse mouth after use)
  • Hoarseness
  • Dysphonia
  • Paradoxical bronchospasm (rare)
  • HPA axis suppression with high doses
  • Tachycardia (salmeterol)

Interactions

  • Beta-blockers — may antagonise salmeterol bronchodilation
  • QT-prolonging drugs — salmeterol increases QT risk
  • Strong CYP3A4 inhibitors (ketoconazole) — increase fluticasone exposure

Monitoring

  • Peak flow/spirometry
  • Signs of oral candidiasis
  • Adrenal function if high doses long-term
  • Growth in children (high-dose ICS)

Reference: BNFc; BNF; GINA Guidelines 2024; NICE NG80. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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