Advair is one of the most prescribed controller inhalers in the US, and one of the most expensive. Outside the US, the same GSK product is sold as Seretide, and Cipla in India makes its own version called Seroflo. All three pair fluticasone propionate, an inhaled steroid, with salmeterol, a long-acting bronchodilator. This guide matches up their strengths and devices and explains the rules that keep this combination safe.
Advair, Seretide and Seroflo at a glance
| Seroflo | Seretide | Advair | |
|---|---|---|---|
| Maker | Cipla, India | GSK (outside the US) | GSK (US) |
| Aerosol inhaler | Seroflo Inhaler 50, 125, 250 | Seretide Evohaler | Advair HFA |
| Dry-powder device | Seroflo Rotacaps and Multihaler 100, 250, 500 | Seretide Accuhaler | Advair Diskus |
| Doses per day | Twice daily | Twice daily | Twice daily |
Matching the strengths
The number in each product name refers to the fluticasone content, while the salmeterol dose stays fixed. That makes matching easier than it first looks:
- Dry powder: Advair Diskus 100/50, 250/50 and 500/50 mcg line up with Seretide Accuhaler and with Seroflo Rotacaps or Multihaler 100, 250 and 500, each delivering 50 mcg of salmeterol per inhalation. The dose is one inhalation twice a day.
- Aerosol: each puff of Seroflo Inhaler 50, 125 or 250 contains 25 mcg of salmeterol, like Seretide Evohaler. US Advair HFA labels the amount leaving the mouthpiece instead (45/21, 115/21 and 230/21 mcg), which corresponds to the same products. The dose is two puffs twice a day.
Two puffs of the aerosol and one inhalation of the powder give the same total salmeterol (50 mcg), which is why both devices are taken twice daily and never more often.
What each ingredient does
Fluticasone propionate is a potent inhaled steroid. Used every day, it lowers airway inflammation, cuts the number of asthma attacks and reduces COPD flare-ups. Salmeterol relaxes the airway muscles for about 12 hours. It takes longer to start working than albuterol or formoterol, roughly 10 to 20 minutes, so a fluticasone/salmeterol inhaler is never a rescue inhaler. Keep a fast-acting reliever such as albuterol for sudden symptoms; our Asthalin vs Ventolin guide compares two common options.
Generic Advair in the US
The FDA approved the first generic of Advair Diskus, Wixela Inhub, in 2019, and other generic and authorized generic versions have followed. They are still not cheap for everyone, especially without insurance. Seretide is GSK’s original made for other markets, while Seroflo is manufactured and licensed in India.
All of our fluticasone/salmeterol inhalers are compared with strengths and prices on our generic Advair page.
Which device should you choose?
Seroflo Inhaler is a pressurized aerosol that needs you to press and breathe in at the same moment. A spacer solves timing problems and puts more medicine into the lungs and less in the throat. It suits children, older adults and anyone with a weak breath.
Seroflo Rotacaps are single powder capsules used in a Rotahaler, and the Seroflo Multihaler is a pre-loaded powder device similar to the Diskus. Both are breath-activated, so they need a quick, deep inhalation but no coordination.
The Seretide Accuhaler is GSK’s own powder device, the non-US twin of Advair Diskus.
Dosing rules that matter
- Take it twice a day, about 12 hours apart, even when you feel well.
- Do not take extra doses for symptoms. More salmeterol does not work faster and increases side effects.
- Never use salmeterol, or any long-acting bronchodilator, for asthma without an inhaled steroid. In combination inhalers like these, the steroid is built in.
- Do not combine it with another long-acting bronchodilator such as formoterol, which is found in Foracort and Symbicort.
- For COPD, the US-approved Advair Diskus dose is 250/50 twice daily.
- Rinse your mouth with water and spit after each dose.
Side effects
Common effects include hoarseness, throat irritation, oral thrush, headache and, less often, tremor, palpitations or muscle cramps. People with COPD who use inhaled steroids have a higher risk of pneumonia, so report fever, chills, more mucus or worse breathlessness. High doses used for many years can affect bone density, the eyes (cataracts, glaucoma) and growth in children; your doctor will aim for the lowest dose that keeps you well.
Ritonavir and cobicistat, used in HIV treatment, can raise fluticasone levels enough to cause Cushing’s syndrome and adrenal suppression, a well-documented interaction. Ketoconazole and itraconazole have a similar effect. Tell your doctor about every medicine you take.
When asthma is not under control
If you still need your reliever more than twice a week, wake at night with symptoms or have had a flare needing steroid tablets, your treatment needs review. The answer may be better technique, a higher strength or a different combination. Bring your inhaler to appointments so the nurse can watch you use it. Browse the full asthma range to see other preventer options.
Frequently asked questions
Is Seretide the same as Advair?
Yes, in substance. Seretide is the name GSK uses outside the US for the same fluticasone/salmeterol product.
Can Seroflo replace Advair?
It contains the same ingredients in matching strengths, but it is a different manufacturer’s product. Agree the switch and the device with your doctor.
How soon will I feel better?
Breathing often improves in the first week, but the full preventive effect builds over several weeks of twice-daily use.
Can children use these inhalers?
Advair Diskus 100/50 is approved in the US from age 4. Children usually use the lowest strength, often with a spacer for aerosol inhalers.
This article gives general information and does not replace advice from your doctor. If your reliever is not helping or your lips or fingernails turn blue or gray, call 911.
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Browse all Generic Advair (Fluticasone/Salmeterol) products →
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