Generic Advair (Fluticasone/Salmeterol)

What is generic Advair?

Generic Advair is an inhaler with the same two medicines as Advair: fluticasone propionate, an inhaled corticosteroid that calms airway inflammation, and salmeterol, a long-acting bronchodilator that keeps the airways open for about 12 hours. The first FDA-approved US generic was Mylan's Wixela Inhub, a copy of Advair Diskus approved on January 30, 2019 (FDA list of 2019 first generics).

Cipla's Seroflo range and the Seretide Accuhaler sold by GSK's Indian company contain the same active ingredients and are made and licensed in India. Brand-name Advair can cost several hundred dollars a month in the US without insurance; see our Seroflo vs Advair comparison.

Is Seroflo or Seretide the same as Advair?

All three use the same ingredients twice a day; the maker, device and strength labeling differ. Seretide is GSK's name for Advair outside the US, and the Accuhaler is the device sold in the US as the Diskus.

Which strength matches Advair Diskus or Advair HFA?

US labels put fluticasone first, so Advair Diskus 250/50 means 250 mcg of fluticasone with 50 mcg of salmeterol. Seretide puts salmeterol first (50/250), and Seroflo names only the fluticasone amount. Advair HFA is labeled by the dose leaving the mouthpiece, but its label on DailyMed shows the valve meters 50/25, 125/25 or 250/25 mcg per puff, matching Seroflo inhaler strengths.

These are close counterparts, not identical doses from identical devices; ask your doctor to confirm the strength before switching.

Which fluticasone/salmeterol products are available here?

Prices can change. Shipping to the USA is a flat $30, free on orders of $199 or more; product pages state delivery in about 6–15 days, and customs can add delays.

How do you choose a strength and device?

• Asthma from age 12: the Advair Diskus label gives one inhalation twice daily, up to 500/50 twice daily. The aerosol dose is two puffs twice daily, up to two puffs of 230/21 twice daily.
• Children: the US powder form is approved from age 4, at 100/50 twice daily for ages 4 to 11; the aerosol from age 12.
• COPD: 250/50 twice daily is the only approved COPD dose, matching Seroflo Rotacaps 250 or Seretide 50/250. Advair HFA is labeled for asthma only. See other COPD medicines.
• Aerosol inhaler: closest to Advair HFA. You time a slow breath with the press; ask whether a spacer would help.
• Rotacaps: one capsule per dose, loaded into a device such as the Rotahaler.
• Multihaler or Accuhaler: pre-filled doses, with no capsules to load.

Why is salmeterol never a rescue inhaler?

Salmeterol is built for steady 12-hour control, not fast relief. The US labels state that fluticasone/salmeterol is not indicated for relief of acute bronchospasm, and MedlinePlus says not to use it during an asthma or COPD attack. Keep a fast-acting albuterol (salbutamol) inhaler such as Asthalin Inhaler with you for sudden symptoms.

Asthma guidelines let some budesonide/formoterol inhalers double as a reliever under a doctor's written plan (see Foracort vs Symbicort); salmeterol combinations cannot. Never use salmeterol alone for asthma either: the label links a long-acting bronchodilator taken without an inhaled steroid to a higher risk of asthma-related death. If you need your rescue inhaler more often, see your doctor.

How do you use fluticasone/salmeterol?

Take one inhalation from a powder device, or two puffs from the aerosol, twice a day about 12 hours apart. Improvement can start within 30 minutes, but full benefit may take a week or longer, so keep using it even when you feel well.

1. Aerosol: shake for about 5 seconds before each puff, and prime a new inhaler as the leaflet directs. Powder: load a capsule or open the device.
2. Breathe out fully, away from the mouthpiece; never breathe out into a powder device.
3. Aerosol: press the canister as you start a slow, deep breath. Powder: breathe in quickly and deeply.
4. Hold your breath for about 10 seconds, or as long as is comfortable.
5. Rinse your mouth with water and spit it out after each dose to lower the risk of oral thrush.

Keep an Accuhaler dry and never wash it. Do not use another long-acting bronchodilator, such as formoterol, alongside this medicine.

What are the side effects?

For asthma, common side effects on the US label include upper respiratory infections, sore throat, hoarseness, oral thrush, bronchitis, cough, headache, and nausea and vomiting. For COPD, they include pneumonia, viral respiratory infections and muscle or bone pain. Salmeterol can affect heart rate and blood pressure in some people. With long-term use, doctors watch for adrenal suppression, thinning bones, glaucoma, cataracts and slower growth in children.

Get urgent help if breathing worsens right after a dose, if your face, lips or throat swell, or if you have chest pain or an irregular heartbeat.

Who should not use it?

• Anyone having an asthma attack or COPD flare that needs urgent treatment.
• People with a severe milk protein allergy: Advair Diskus contains lactose with milk proteins, so ask your pharmacist whether a powder product contains lactose.
• Tell your doctor about heart problems, high blood pressure, seizures, an overactive thyroid, diabetes, liver problems, osteoporosis, eye problems, tuberculosis or other infections, recent contact with chickenpox or measles, and pregnancy or breastfeeding.

The label does not recommend strong CYP3A4 inhibitors such as ritonavir with this medicine, because they raise steroid levels. Beta-blockers can block salmeterol and may tighten the airways, and MAO inhibitors, tricyclic antidepressants and some diuretics also need caution.

Frequently asked questions

What is the generic name for Advair?

Fluticasone propionate and salmeterol. The first US generic of Advair Diskus, Wixela Inhub, was approved by the FDA in January 2019.

Is Wixela Inhub the same as Advair Diskus?

It is an FDA-approved generic of Advair Diskus in the same three strengths, supplied in its own Inhub device; ask your pharmacist to show you how to use it.

Can I switch from Advair to Seroflo or Seretide?

Only with your doctor's agreement. Use the strength table above as a starting point and have your technique checked.

How long does one pack last?

At the usual twice-daily dose, a 120-puff Seroflo inhaler or a 60-dose Multihaler or Accuhaler lasts 30 days, and 30 Rotacaps last 15 days.

This article gives general information and does not replace advice from your doctor or pharmacist. Fluticasone/salmeterol is a prescription medicine; do not start, stop or change an inhaler without medical advice.