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8 Interactions found for:

Ventolin HFA and Advair Diskus
Interactions Summary
  • 4 Major
  • 2 Moderate
  • 2 Minor
  • Ventolin HFA
  • Advair Diskus

Drug Interactions

Moderate
Ventolin Hfa + Advair Diskus

The following applies to the ingredients: Albuterol (found in Ventolin Hfa) and Salmeterol (found in Advair Diskus)

Using albuterol together with salmeterol may increase cardiovascular side effects such as elevations in heart rate and blood pressure or irregular heart rhythm. Talk to your doctor if you have any questions or concerns, particularly if you have a history of high blood pressure, arrhythmia, or heart disease. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Minor
Ventolin Hfa + Advair Diskus

The following applies to the ingredients: Albuterol (found in Ventolin Hfa) and Fluticasone (found in Advair Diskus)

Professional Content

Although they are often combined in clinical practice, the concomitant use of beta-2 adrenergic agonists and corticosteroids may result in additive hypokalemic effects. Since beta-2 agonists can sometimes cause QT interval prolongation, the development of hypokalemia may potentiate the risk of ventricular arrhythmias including torsade de pointes. However, clinical data are limited, and the potential significance is unknown. Patients who are receiving systemic or nebulized formulations of beta-2 agonists, high dosages of inhaled beta-2 agonists, or systemic corticosteroid therapy may be at a greater risk of developing hypokalemia.

References

  1. "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):

Drug and Food Interactions

Moderate
Ventolin Hfa + Food

The following applies to the ingredients: Albuterol (found in Ventolin Hfa)

Professional Content

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):

Drug and Pregnancy Interactions

The following applies to the ingredients: Albuterol (found in Ventolin Hfa)

Professional Content

The manufacturer makes no recommendation regarding use during pregnancy.

AU TGA pregnancy category: A
US FDA pregnancy category: Not assigned

Comments:
-There are no randomized clinical studies of albuterol use during pregnancy, but available information on pregnancy exposure by inhalation do not consistently show miscarriage or major birth defects.
-This drug is known to cross the placental barrier, as evidenced by increases in fetal heart rate.
-Beta-agonists, including this drug, may potentially interfere with uterine contractility.
-In women with poorly or moderately controlled asthma, there is an increased risk of preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate. Pregnant women should be closely monitored and the dose adjusted as necessary to maintain optimal control.
-In some countries, intravenous injection presentations of this drug have been approved for delay pre-term labor (tocolytic agent) and should not be used in the management of uncomplicated premature labor.

Epidemiological studies and postmarketing case reports following inhaled administration of this drug do not consistently demonstrate a risk of major birth defects or miscarriage. In animal reproduction studies, subcutaneous administration to pregnant mice evidence of cleft palate at less than and up to 9 times the maximum recommended human daily inhalation dose (MRHDID). A study in pregnant rats demonstrated that drug-related material was transferred from the maternal circulation to the fetus. There are no controlled data in human pregnancy.
During worldwide marketing experience, various congenital anomalies, including cleft palate and limb defects, have been reported in the offspring of patients being treated with this drug. Some of the mothers were taking multiple medications during their pregnancies. A relationship between the use of this drug and congenital anomalies has not been established. Profuse uterine bleeding following spontaneous abortion has been reported after the use of this drug. Special care is required in pregnant diabetic women. The background birth defect and miscarriage risk for the indicated population is not known. In the US general population, the estimated major birth defect risk is 2 to 4% and the miscarriage risk is 15 to 20%.


A pregnancy exposure registry monitors outcomes after exposure to asthma medications during pregnancy. For more information, contact the Mothers To Baby Pregnancy Studies conducted by the Organization of Teratology Information Specialists at http://mothertobaby.org/pregnancystudies/.


AU TGA pregnancy category A: Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. Lunell NO, Joelsson I, Bjorkman U, Lamb P, Persson B "The use of salbutamol in obstetrics." Acta Obstet Gynecol Scand 55 (1976): 333-6
  2. Davies AE, Robertson MJ "Pulmonary oedema after the administration of intravenous salbutamol and ergometrine. Case report." Br J Obstet Gynaecol 87 (1980): 539-41
  3. Watson NA, Morgan B "Pulmonary oedema and salbutamol in preterm labour. Case report and literature review." Br J Obstet Gynaecol 96 (1989): 1445-8
  4. Lind T, Godfrey KA, Gerrard J, Bryson MR "Continuous salbutamol infusion over 17 weeks to pre-empt premature labour." Lancet 2 (1980): 1165-6
  5. Tan SN "Peri-partum pulmonary oedema." Anaesth Intensive Care 19 (1991): 111-3
  6. Hawker F "Five cases of pulmonary oedema associated with beta 2-sympathomimetic treatment of premature labour." Anaesth Intensive Care 12 (1984): 159-62
  7. Martin AJ "Severe unwanted effects associated with betasympathomimetics when used in the treatment of premature labour: causes, incidence and preventative measures." Br J Clin Pract 35 (1981): 325-9
  8. "Product Information. Proventil (albuterol)." Schering Corporation PROD (2002):
  9. "Product Information. Ventolin (albuterol)." Glaxo Wellcome PROD (2002):
  10. Rayburn WF, Atkinson BD, Gilbert K, Turnbull GL "Short-term effects of inhaled albuterol on maternal and fetal circulations." Am J Obstet Gynecol 171 (1994): 770-3
  11. Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
  12. Dombrowski MP "Pharmacologic therapy of asthma during pregnancy." Obstet Gynecol Clin North Am 24 (1997): 559
  13. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  14. Cerner Multum, Inc. "Australian Product Information." O 0
  15. "Product Information. Albuterol Extended Release (albuterol)." Dava Pharmaceuticals Inc (2022):
  16. "Product Information. Albuterol Sulfate (albuterol)." Vista Pharm Inc (2022):
  17. "Product Information. Albuterol (albuterol)." Physicians Total Care (2022):

The following applies to the ingredients: Fluticasone (found in Advair Diskus)

Professional Content

Use is not recommended unless the benefit outweighs the risk to the fetus

AU TGA pregnancy category: B3
US FDA pregnancy category: Not assigned

Comments:
-Pregnant women with asthma should be closely monitored to maintain optimal asthma control.
-Hypoadrenalism may occur in neonates exposed to glucocorticosteroids in utero; carefully observe neonates for signs and symptoms of hypoadrenalism.
-There is insufficient data on use in pregnancy.

Animal studies have shown teratogenicity typical of corticosteroids (decreased fetal body weight and/or skeletal variations) with subcutaneously administered doses of this drug. Rats dosed via inhalation have shown decreased fetal body weight, but teratogenicity was not observed. Epidemiologic data of other inhaled corticosteroids have not demonstrated these effects in animals to occur in humans. Women with poorly or moderately controlled asthma have shown an increased risk of pre-eclampsia, and there has been an increased incidence of prematurity, low birth weight, and small for gestational age events observed in their babies. There are no adequate and well controlled studies in pregnant women. Fluticasone was detected in neonatal cord blood after drug inhalation by the parent.

AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. "Product Information. Flovent Diskus (fluticasone)." GlaxoSmithKline (2016):
  4. "Product Information. Flovent HFA (fluticasone)." GlaxoSmithKline (2016):
  5. "Product Information. Arnuity Ellipta (fluticasone)." GlaxoSmithKline (2016):

The following applies to the ingredients: Salmeterol (found in Advair Diskus)

Professional Content

The manufacturer makes no recommendation regarding use during pregnancy.

AU TGA pregnancy category: B3
US FDA pregnancy category: Not assigned

Comments:
-Available data from studies and case reports have not found a drug-associated increase in major birth defects, miscarriage, or adverse fetal or maternal outcomes.
-There are clinical considerations for asthma during pregnancy; poorly or moderately controlled asthma is associated with pre-eclampsia, prematurity, low birth weight, and small for gestational age infants.
-Severe asthma is associated with maternal mortality, fetal mortality, or both.
-Closely monitor pregnant patients and adjust medications to optimize asthma control.
-Beta-agonists, including this drug, may potentially interfere with uterine contractility due to a relaxant effect on uterine smooth muscle; use this drug during labor only if benefits clearly outweigh the risks.

Animal studies of oral doses approximately 50 times the maximum recommended human daily inhalation dose (MRHDID) caused teratogenicity characteristic of beta-adrenoreceptor stimulation, including precocious eyelid openings, cleft palate, sternebral fusion, limb and paw flexures, and delayed ossification of frontal cranial bones; no such effects occurred at oral doses 20 times the MRHDID. Doses 973 times the MRHDID was fetotoxic and decreased fertility in survivors. This drug crossed the placenta following oral administration to rodents. Published data in humans do not definitively establish absence of risk, but have not established an association with major birth defects, miscarriage, or adverse fetal or maternal outcomes. The background birth defect and miscarriage risk for the indicated population is not known. In the US general population, the estimated major birth defect risk is 2 to 4% and the miscarriage risk is 15 to 20%.


AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Product Information. Serevent (salmeterol)." Glaxo Wellcome PROD
  2. Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
  3. Briggs GG, Freeman RK, Yaffe SJ.. "Drugs in Pregnancy and Lactation." Baltimore, MD: Williams & Wilkins (1998):
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  5. Cerner Multum, Inc. "Australian Product Information." O 0

The following applies to the ingredients: Fluticasone-Salmeterol (found in Advair Diskus)

Professional Content

This drug should not be used during pregnancy unless the benefit outweighs the risk to the fetus.

AU TGA pregnancy category: B3
US FDA pregnancy category: Not assigned.

Risk Summary:
-There are no randomized clinical studies of this combination drug or individual monoproducts in pregnant women.
-Disease-Associated Maternal and/or Embryofetal Risk: In women with poorly or moderately controlled asthma, there is an increased risk of several perinatal adverse outcomes such as pre-eclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate. Pregnant women with asthma should be closely monitored and medication adjusted as necessary to maintain optimal asthma control.

Comments:
-Patients should contact their physician if pregnancy occurs while taking this drug.
-If needed, the lowest effective dose of this drug should be used.
-Closely monitor pregnant patients and adjust medications to optimize asthma control.
-There are no human studies of the effects of this drug on labor and delivery.
-Beta-agonists may interfere with uterine contractility.

Corticosteroids and beta2-agonists have been shown to be teratogenic in laboratory animals when administered systemically at relatively low dosage levels. In mouse reproduction assays, fluticasone propionate by the subcutaneous route at a dose approximately 3/5 the maximum recommended human daily inhalation dose (MRHDID) combined with oral salmeterol at a dose approximately 410 times the MRHDID produced cleft palate, fetal death, increased implantation loss, and delayed ossification. These observations are characteristic of glucocorticoids. No developmental toxicity was observed at combination doses of fluticasone propionate subcutaneously up to approximately 1/6 the MRHDID and doses of salmeterol up to approximately 55 times the MRHDID. In rats, combining fluticasone propionate subcutaneously at a dose equivalent to the MRHDID and a dose of salmeterol at approximately 810 times the MRHDID produced decreased fetal weight, umbilical hernia, delayed ossification, and changes in the occipital bone. These effects were not seen when combining fluticasone propionate subcutaneously at a dose less than the MRHDID and an oral dose of salmeterol at approximately 80 times the MRHDID. There are no controlled data in human pregnancy.

Fluticasone Propionate and Salmeterol:
The combination of subcutaneous administration of fluticasone propionate and oral administration of salmeterol during the period of organogenesis, in rats and mice were generally consistent with the individual monoproducts and there was no exacerbation of expected fetal effects. Omphalocele, increased embryofetal deaths, decreased body weight, and skeletal variations were observed in rat fetuses in the presence of maternal toxicity when combining fluticasone propionate at a dose approximately equivalent to the MRHDID and salmeterol at a dose approximately 970 times the MRHDID. Cleft palate, fetal death, increased implantation loss, and delayed ossification were observed in mouse fetuses when combining fluticasone propionate at a dose approximately 0.7 times the MRHDID and salmeterol at a dose approximately 490 times the MRHDID.

Salmeterol xinafoate crossed the placenta following oral administration to mice and rats.

Fluticasone propionate crossed the placenta following subcutaneous administration to mice and rats and oral administration to rabbits. It was not associated with decreases in pup body weight, and had no effects on developmental landmarks, learning, memory, reflexes, or fertility at doses up to 0.5 times the MRHDID.

Data Human Data:
Fluticasone Propionate: Following inhaled administration, fluticasone propionate was detected in the neonatal cord blood after delivery.

AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
  2. Dombrowski MP "Pharmacologic therapy of asthma during pregnancy." Obstet Gynecol Clin North Am 24 (1997): 559
  3. "Product Information. Advair Diskus (fluticasone-salmeterol)." Glaxo Wellcome PROD (2001):
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  5. Cerner Multum, Inc. "Australian Product Information." O 0

Drug and Breastfeeding Interactions

The following applies to the ingredients: Albuterol (found in Ventolin Hfa)

Professional Content

The manufacturer makes no recommendation regarding use during lactation.

Excreted into human milk: Unknown
Excreted into animal milk: Data not available

Comments:
-There is no information regarding this drug on the presence in human milk, the effects on a breastfed infant, or effects on milk production.
-Consider the developmental and health benefits of breastfeeding along with the mother's clinical need for this medication as well as any potential adverse effects from this drug or the underlying maternal condition.

References

  1. "Product Information. Proventil (albuterol)." Schering Corporation PROD (2002):
  2. "Product Information. Ventolin (albuterol)." Glaxo Wellcome PROD (2002):
  3. Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  5. Cerner Multum, Inc. "Australian Product Information." O 0
  6. "Product Information. Albuterol Extended Release (albuterol)." Dava Pharmaceuticals Inc (2022):
  7. "Product Information. Albuterol Sulfate (albuterol)." Vista Pharm Inc (2022):
  8. "Product Information. Albuterol (albuterol)." Physicians Total Care (2022):

The following applies to the ingredients: Fluticasone-Salmeterol (found in Advair Diskus)

Professional Content

A decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother and any potential adverse effects on the breastfed child.

Excreted into human milk: Unknown (fluticasone-salmeterol)
Excreted into animal milk: Yes (fluticasone-salmeterol)

Comments: The effects in the nursing infant are unknown.

Fluticasone-salmeterol:
After inhaled therapeutic doses, plasma levels are low and therefore concentrations in human breast milk are likely to be correspondingly low.

Salmeterol:
Oral administration of salmeterol in lactating rats at 10,000 mcg/kg/day (approximately 973 times the MRHDID for adults) resulted in measurable levels in milk.

Fluticasone:
Subcutaneous administration of 10 mcg/kg/day to lactating rats of tritiated fluticasone propionate resulted in measurable radioactivity in the milk.

There are no controlled data on the use of this drug by nursing mothers.

References

  1. Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
  2. "Product Information. Advair Diskus (fluticasone-salmeterol)." Glaxo Wellcome PROD (2001):
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  4. Cerner Multum, Inc. "Australian Product Information." O 0

The following applies to the ingredients: Fluticasone (found in Advair Diskus)

Professional Content

Benefit should outweigh risk

Excreted into human milk: Unknown
Excreted into animal milk: Yes

Comment: Inhaled corticosteroids are generally considered acceptable to use during breastfeeding as the amount, if excreted into breastmilk, would probably be too small to affect a breastfed infant.

Measurable milk levels were seen after subcutaneous administration of 10 mcg/kg/day of titrated fluticasone propionate to lactating rats.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  4. "Product Information. Flovent Diskus (fluticasone)." GlaxoSmithKline (2016):
  5. "Product Information. Flovent HFA (fluticasone)." GlaxoSmithKline (2016):
  6. "Product Information. Arnuity Ellipta (fluticasone)." GlaxoSmithKline (2016):

The following applies to the ingredients: Salmeterol (found in Advair Diskus)

Professional Content

The manufacturer makes no recommendation regarding use during lactation.

Excreted into human milk: Unknown
Excreted into animal milk: Yes

Comments:
-There is no information regarding this drug on the presence in human milk, the effects on a breastfed infant, or effects on milk production.
-Drug concentrations in human plasma after inhalation are low; concentrations in breast milk are expected to be low.
-Consider the developmental and health benefits of breastfeeding along with the mother's clinical need for this medication as well as any potential adverse effects from this drug or the underlying maternal condition.

Animal studies of oral doses of 10,000 mg/kg/day salmeterol showed measurable levels in the milk.

References

  1. "Product Information. Serevent (salmeterol)." Glaxo Wellcome PROD
  2. Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
  3. Briggs GG, Freeman RK, Yaffe SJ.. "Drugs in Pregnancy and Lactation." Baltimore, MD: Williams & Wilkins (1998):
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  5. Cerner Multum, Inc. "Australian Product Information." O 0

Therapeutic Duplication Warnings

The following applies to: Ventolin Hfa (albuterol), Advair Diskus (fluticasone/salmeterol)

Professional Content

The recommended maximum number of medicines in the 'inhaled smooth muscle relaxants' category to be taken concurrently is usually one. Your list includes two medicines.

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Switch to: Professional Interactions

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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