The combination of salmeterol and fluticasone propionate can be used for initial maintenance therapy in patients with persistent asthma (daily occurrence of symptoms or dailyuse of funds to stop seizures), if there are indications for the appointment of GCS and when determining their approximate dosage.
The more frequent use of short-acting bronchodilators to relieve symptoms indicates a worsening of disease control, and in such situations the patient should consult a doctor.
The sudden and increasing deterioration in the control of bronchial asthma poses a potential threat to life, and in such situations, the patient should also consult a doctor. It is possible that the doctor will prescribe a higher dose of GCS. If the dose of Seretide® Multidisk does not provide adequate control over the disease, the patient should also consult a doctor.
Patients with asthma can not abruptly stop treatment with Seretide® Multidisk because of the risk of developing an exacerbation, the dose of the drug should be reduced gradually under the supervision of a doctor.
In patients with COPD, the withdrawal of the drug may be accompanied by symptoms of decompensation and requires the supervision of a physician.
In clinical studies, data have been obtained on the increase in the incidence of pneumonia in patients with COPD receiving Seretide® Multidisk (see below).see "Side effects"). Doctors should be aware of the possibility of developing pneumonia in COPD, as the clinical picture of pneumonia and exacerbations of COPD are often similar. Any inhaled GCS can cause systemic effects, especially with prolonged use in high doses; it should be noted, however, that the likelihood of such symptoms is much lower than when treated with oral GCS. Possible systemic effects include Cushing's syndrome, cushingoid features, suppression of adrenal function, growth retardation in children and adolescents, reduction of bone mineral density, cataract and glaucoma. Therefore, in the treatment of bronchial asthma, it is important to reduce the dose to the lowest dose, which provides effective control of symptoms.
In emergency and planned situations, which can cause stress, it is always necessary to remember the possibility of suppressing the adrenal glands and to be ready for application of GCS. When carrying out resuscitation measures or surgical interventions, it is required to determine the degree of adrenal insufficiency.
It is recommended to regularly measure the growth of children who receive long-term inhaled glucocorticosteroids.
Because of the possibility of adrenal suppression, patients transferred from oral corticosteroids to inhalation of fluticasone propionate therapy should be treated with extreme caution and regular monitoring of their function of the adrenal cortex. When transferring patients from taking systemic GCS to inhalation therapy, allergic reactions (for example, allergic rhinitis, eczema), which were suppressed by systemic GCS, may appear. In such situations it is recommended to carry out symptomatic treatment with antihistamines and / or topical preparations, incl. GCS for topical application.
After initiation of treatment with inhaled fluticasone propionate, systemic GCS should be discontinued gradually, and such patients should carry a special patient card containing an indication of the possible need for additional administration of SCS in stressful situations.
In patients with exacerbation of bronchial asthma, hypoxia, it is necessary to monitor the concentration of K + ions in the plasma.
There are very rare reports of an increase in blood glucose levels, and this should be remembered by prescribing a combination of salmeterol and fluticasone propionate to patients with diabetes mellitus.
During the post-marketing period, reports were received of a clinically significant drug interaction between fluticasone propionate and ritonavir leading to systemic effects of GCS, including Cushing's syndrome and suppression of adrenal function. Therefore, it is advisable to avoid the simultaneous use of fluticasone propionate and ritonavir, unless the potential benefit to the patient exceeds the risk associated with systemic effects of GCS (see section "Interaction with other drugs").
A clinical study of the safety of salmeterol added to ongoing asthma therapy compared with placebo showed that the incidence of lethal outcomes due to bronchial asthma was higher in the salmeterol group. In patients of African American origin, presumably, the risk of serious adverse events from the respiratory system or lethal outcome is higher with salmeterol compared with placebo than in other patients. The importance of pharmacogenetic factors or other causes is unknown. The effect associated with the use of GCS in this study has not been studied.Like other inhaled drugs, the drug Seretide® Multidisk can cause a paradoxical bronchospasm, manifested by the increase of dyspnea immediately after use. In this case, a short-acting inhaled bronchodilator should be immediately applied, the Seretide® Multidisk should be discontinued and alternative therapy should be started, if necessary.
There are reports of side effects associated with the pharmacological action of betach antagonists, such as a subjective feeling of the heartbeat. However, these phenomena are of a short-term nature, and their severity decreases with regular therapy.