Fluticasone and Vilanterol (Inhalation)

Overview

When patients are diagnosed with respiratory conditions, they normally exhibit symptoms, such as, shortness of breath, wheezing and/or chest tightness. While some patients may experience these symptoms at all times, others may suffer from acute attacks and short-lived symptoms.

Although asthma and chronic obstructive pulmonary disease (COPD) are distinct conditions, they are both characterized by inflammation. In patients with COPD, inflammation may be relatively minor to begin with but tends to worsen over time. As chronic inflammation becomes more consistent, the patient's symptoms also tend to worsen.

Similar to COPD, asthma involves inflammation in the airways and lungs as well. Causing both long-term symptoms and acute attacks, the inflammation involved in asthma prevents patients from breathing normally. As inflammation increases, the airways allow less air through them, thus causing an inability to inhale and exhale effectively.

Whilst both conditions are associated with inflammation, the cause of inflammation in cases of COPD and asthma differs. In cases of COPD, the main inflammatory cells are neutrophils, CD8+ T-lymphocytes and macrophages. In asthmatic patients, however, inflammatory mediators are released by lymphocytes, phagocytes, mast cells and eosinophils. Despite these key differences, asthma and COPD can be treated with the same medications in some instances.

Fluticasone and Vilanterol, for example, can be used as a combination medicine to manage both asthma and COPD. As a corticosteroid, Fluticasone needs to be used on a long-term basis but, when it is used consistently, it can provide significant relief from symptoms associated with asthma and COPD. By preventing cells in the lungs and airways from releasing inflammatory mediators, Fluticasone reduces the amount of inflammation. As a result, the symptoms caused by this chronic inflammation are also reduced.

When patients are affected by chronic inflammation in the lungs and airways, the bronchial tubes effectively decrease in size. Whilst inflammation is taking place, there is less room for air to pass through these tubes and this causes a number of symptoms, such as difficulty breathing, cough, wheezing and shortness of breath.

As a bronchodilator, Vilanterol reverses this and ensures that the bronchial tubes remain open. When used successfully, this type of medication can have a significant impact on patient's symptoms. Many patients with COPD and/or asthma regularly report difficulty in breathing and may sometimes feel as if they're choking. By increasing the capacity of the bronchial tubes and ensuring that the patient's airways remain open, Vilanterol helps to relieve some of the most distressing symptoms of COPD and asthma.

Although Fluticasone and Vilanterol can be successful in managing asthma and COPD, it is not a cure for either condition. Patients will generally need to use the medication on a long-term basis in order to minimize their symptoms. In addition to this, Fluticasone and Vilanterol should not be used to manage acute attacks of asthma or breathlessness. Whilst Fluticasone and Vilanterol can help to reduce the frequency of acute asthma attacks, it will not provide relief once an attack has started. Patients with asthma should, therefore, be prescribed additional medication for this purpose.

When treating patients with COPD and/or asthma, physicians generally use a variety of medicines and therapeutic interventions. Whilst Fluticasone and Vilanterol is not likely to be used in isolation when treating patients, it can be extremely effective in improving the patient's lung function and managing certain respiratory symptoms.

Conditions Treated

  • Asthma
  • Chronic obstructive pulmonary disorder (COPD)

Type Of Medicine

  • Corticosteroid (Fluticasone)
  • Bronchodilator (Vilanterol)

Side Effects

When patients are prescribed medicine, they should be made of aware of the side-effects which could occur. In most cases, patients will only experience relatively mild side-effects when using Fluticasone and Vilanterol and these may not be particularly bothersome. If patients experience the following side-effects when using Fluticasone and Vilanterol, for example, they may not require medical intervention:

  • White, creamy curd-like patches in the throat or mouth
  • Muscle stiffness
  • Difficulty with moving
  • Pain when swallowing and/or eating

There are, however, additional side-effects which can occur when patients are using Fluticasone and Vilanterol. These typically require medical assessment and patients should seek medical help if they experience any of the following:

  • Body pain or aches
  • Difficulty breathing
  • Cough
  • Fever
  • Ear congestion
  • Chills
  • Headache
  • Sore throat
  • Loss of voice
  • Sneezing
  • Muscle aches
  • Runny or stuffy nose
  • Unusual weakness or tiredness
  • Swelling or bloating of the arms, face, lower legs, feet or hands
  • Blurred vision
  • Diarrhea
  • Chest pain
  • Muscle or joint pain
  • Dizziness
  • Lack of appetite
  • General feeling of illness or discomfort
  • Nausea or vomiting
  • Tenderness or pain around the eyes and/or in the cheekbones
  • Nervousness
  • Fast or slow heartbeat
  • Pounding in the ears
  • Tightness in the chest
  • Sweating
  • Difficulty sleeping
  • Tingling of the feet or hands
  • Difficulty breathing
  • Unusual weight loss or gain

In addition to this, patients should be aware of the symptoms which can occur if too much Fluticasone and Vilanterol is used or inhaled. If the following symptoms are displayed, an overdose may have occurred and the patient will need emergency medical treatment:

  • Stomach or abdominal pain
  • Pain in the jaw, back or arm
  • Confusion
  • Chest discomfort
  • Decreased urination
  • Chest heaviness or tightness
  • Convulsions
  • Lightheadedness, fainting or dizziness when getting up suddenly from a sitting or lying position
  • Irregular, fast, racing or pounding pulse or heartbeat
  • Drowsiness
  • General feeling of illness or discomfort
  • Fruit-like breath odor
  • Increased thirst or hunger
  • Lack of appetite
  • Increased urination
  • Muscle cramps
  • Tingling or numbness in the lips, hands or feet
  • Deep, rapid breathing
  • Unexplained weight loss
  • Shakiness in the arms, feet, legs, arms or hands
  • Restlessness
  • Stomach cramps

As the symptoms of an overdose are life-threatening, patients are advised to call 911 if they notice these side-effects occurring. Furthermore, patients should obtain medical assistance if they experience any side-effects which are not listed above.

Dosage

When patients are prescribed Fluticasone and Vilanterol, their doctor will advise them how much medication they will need to use. Most patients are instructed to take one inhalation of Fluticasone and Vilanterol per day, but this could vary depending on the patient's symptoms.

Before using the medicine, it's vital that patients are shown how to administer Fluticasone and Vilanterol properly. In most cases, patients can simply slide down the cover of the inhaler until they hear a clicking sound. They should then breathe out as fully as possible before placing the inhaler in their mouth. Following this, patients should take a deep breath in order to inhale the medicine. Patients should breathe through their mouth, rather than their nose, to ensure that the Fluticasone and Vilanterol reaches their airways.

Once the medicine has been administered, patients should remove the inhaler from their mouth and hold their breath for approximately three to four seconds. This ensures that the medicine settles in the airways and has the chance to take effect.

Following this, patients should wipe the inhaler's mouthpiece with a dry tissue and replace the cover. If patients choose to, they can rinse their mouth with water after using their inhaler. This can help to reduce some side-effects, such as throat irritation, hoarseness and infections. However, patients should only rinse their mouths after Fluticasone and Vilanterol has been administered and should not attempt to swallow the water.

Most Fluticasone and Vilanterol inhalers feature a counter which tells the patient how many doses of medicine are remaining. When patients notice they are running low, they should request another prescription from their physician. Fluticasone and Vilanterol is most effective when it is used consistently so patients should be sure not to run out of medicine.

If possible, patients should administer Fluticasone and Vilanterol at the same time every day and should keep using their medication until they are advised to stop. Similarly, patients should only administer the dose set out by their physician and should continue to use any other breathing medicines they have been prescribed unless they are advised otherwise.

If patients forget to administer a dose of Fluticasone and Vilanterol, they should do so as soon as they remember. However, if the patient's next dose of medicine is due soon, they should avoid the missed dose completely and continue using their medication as normal. Patients should not attempt to administer a double dose of Fluticasone and Vilanterol and patients should not use more than one puff of medicine per day unless they are given differing instructions by their doctor.

Although the above information is appropriate for standard treatment with Fluticasone and Vilanterol, patients should be given unique instructions by their physician. They should, therefore, follow the advice given to them by their doctor. If patients are unsure how to use an inhaler or how to administer Fluticasone and Vilanterol, they should seek advice from their physician or pharmacist.

Potential Drug Interactions:

As medicines can interact with one another, it may not be safe for patients to use Fluticasone and Vilanterol if they are taken certain other medications. The following medicines are not usually prescribed alongside Fluticasone and Vilanterol, for example:

  • Amifampridine
  • Posaconazole
  • Amisulpride
  • Pimozide
  • Bepridil
  • Mesoridazine
  • Cisapride
  • Sparfloxacin
  • Dronedarone
  • Saquinavir
  • Fluconazole
  • Terfenadine
  • Ketoconazole
  • Thioridazine
  • Nelfinavir
  • Ziprasidone
  • Piperaquine

Similarly, the following medications may not prescribed alongside Fluticasone and Vilanterol in some cases:

  • Amineptine
  • Dibenzepin
  • Amiodarone
  • Conivaptan
  • Amitriptyline
  • Cobicistat
  • Amitriptylinoxide
  • Delamanid
  • Amoxapine
  • Degarelix
  • Anagrelide
  • Clarithromycin
  • Aripiprazole
  • Dasabuvir
  • Atazanavir
  • Ceritinib
  • Bemiparin
  • Crizotinib
  • Boceprevir
  • Deslorelin
  • Bupropion
  • Desipramine
  • Buserelin
  • Dabrafenib
  • Butriptyline
  • Darunavir
  • Clomipramine
  • Lumacaftor
  • Donepezil
  • Ivabradine
  • Lofepramine
  • Iprindole
  • Efavirenz
  • Lopinavir
  • Dothiepin
  • Idelalisib
  • Doxepin
  • Itraconazole
  • Escitalopram
  • Levofloxacin
  • Gonadorelin
  • Metronidazole
  • Goserelin
  • Nadroparin
  • Histrelin
  • Leuprolide
  • Hydroxychloroquine
  • Ketoconazole
  • Hydroxyzine
  • Tacrolimus
  • Imipramine
  • Propizepine
  • Indinavir
  • Tianeptine
  • Melitracen
  • Saquinavir
  • Nafarelin
  • Telaprevir
  • Nefazodone
  • Protriptyline
  • Nelfinavir
  • Sulpiride
  • Nilotinib
  • Telithromycin
  • Nortriptyline
  • Quetiapine
  • Opipramol
  • Tipranavir
  • Panobinostat
  • Troleandomycin
  • Pasireotide
  • Trimipramine
  • Pimavanserin
  • Triptorelin
  • Pitolisant
  • Vinflunine
  • Sotalol
  • Pixantrone
  • Vemurafenib
  • Posaconazole
  • Voriconazole
  • Ritonavir
  • Zuclopenthixol

Although the above medicines could interact with Fluticasone and Vilanterol, doctors may still feel it's appropriate to prescribe Fluticasone and Vilanterol. If so, the patient's dose of medicine may be altered to prevent an interaction occurring. In addition to this, patients may be advised to take their medicines at different times as this could help to prevent them interacting.

Patients should also be aware that prescribed medicines can interact with some over-the-counter medicines, foods, supplements and/or vitamins. Due to this, patients will need to avoid the following substance when taking Fluticasone and Vilanterol:

  • Grapefruit, grapefruit juice and/or grapefruit derivatives

Similarly, patients should inform their doctor of any over-the-counter medicines, supplements or vitamins they're taking before they start using Fluticasone and Vilanterol. Patients should also seek medical advice before using any new over-the-counter medicines, supplements or vitamins once they have started using Fluticasone and Vilanterol.

Warnings

Before treatment with Fluticasone and Vilanterol commences, patients will need to discuss their symptoms and their medical history with their physician. There are some conditions which may affect the patient's use of Fluticasone and Vilanterol so it's vital that these are disclosed before the patient begins using the medication. These may include:

  • Liver disease
  • Tuberculosis
  • Measles
  • Chickenpox (including recent exposure to the virus)
  • Herpes simplex infection of the eye
  • Asthma attack
  • Infections
  • Trauma
  • Stress
  • Bacterial, viral, parasitic and/or fungal infections
  • Stress
  • Seizures
  • Diabetes
  • Cataracts
  • Glaucoma
  • High levels of ketones in the blood (Ketoacidosis)
  • Blood vessel or heart disease
  • Difficulty breathing (bronchospasm)
  • Bone problems (e.g. osteoporosis)
  • Allergy to milk protein
  • Heart rhythm problems
  • Overactive thyroid (Hyperthyroidism)
  • High blood pressure (Hypertension)
  • Low levels of potassium in the blood (Hypokalemia)

The use of Fluticasone and Vilanterol by younger patients is not recommended. As this medication may not be safe for pediatric patients, it is not usually prescribed to young people. In most cases, an alternative medicine is used to control respiratory disorders in pediatric patients, whilst Fluticasone and Vilanterol is prescribed to adult patients.

When using Fluticasone and Vilanterol, patients should notice an improvement in their symptoms within one week. If symptoms do not improve or if they get worse, patients should contact their physician for advice.

If patients notice that other medications aren't working as well when they're using Fluticasone and Vilanterol, they should contact their doctor immediately. If, for example, the patient's short-acting inhaler does not seem to be as effective or if they have to use it more often, they should obtain urgent assistance. Generally, patients should consult a doctor if they are using a short-acting inhaler four or more times, two days in a row or are using a whole canister of medication in under eight weeks.

If there is a significant decrease in the patient's peak flow reading while they are using Fluticasone and Vilanterol, their medication should be re-assessed by their physician.

When patients are using Fluticasone and Vilanterol, they should be monitored regularly and have on-going check-ups with their physician, particularly if they are using this medicine for a long period of time. This ensures that it is working as expected and that it is not having any harmful effects on the patient.

Patients should not use Fluticasone and Vilanterol during a COPD or asthma attack. Patients should be prescribed additional medicines, such as a short-acting inhaler, for this purpose.

Using Fluticasone and Vilanterol may weaken the patient's immune system and this could leave them more prone to illnesses and infections. Patients should notify their doctor if they have been exposed to particular illnesses, such as chickenpox and/or measles. In addition to this, patients should seek medical help quickly if they think they have contracted an illness or infection.

Taking Fluticasone and Vilanterol may increase the patient's risk of developing pneumonia. If patients exhibit the following symptoms, they should obtain medical assistance:

  • Chills
  • Increased sputum production
  • Fever
  • Change in sputum color
  • Increased breathing problems
  • Increased cough

When using Fluticasone and Vilanterol, patients may experience a fungal infection, known as thrush. This affects the throat and/or mouth. If patients notice white patches in their throat or mouth or experience pain when eating or swallowing, they should seek medical treatment.

Using Fluticasone and Vilanterol for a long period of time may increase the patient's risk of developing problems with their adrenal glands. If patients display the following symptoms, they should obtain medical help:

  • Unusual weakness or tiredness
  • Diarrhea
  • Vomiting
  • Rash on the skin
  • Nausea
  • Muscle weakness or pain
  • Fainting
  • Dizziness
  • Lightheadedness
  • Depression
  • Lack of appetite
  • Darkening of the skin

When patients are prescribed Fluticasone and Vilanterol, they may also be issued with a medical identification card. This alerts healthcare practitioners to the fact the patient is using Fluticasone and Vilanterol and that they may need additional medication in the event of a COPD attack, trauma, stress and/or asthma attack.

In some cases, Fluticasone and Vilanterol may cause patients to develop paradoxical bronchospasm. This results in the patients breathing getting worse and can be a life-threatening situation. If patients experience the following symptoms after using Fluticasone and Vilanterol, they should obtain immediate medical assistance:

  • Difficulty breathing
  • Shortness of breath
  • Coughing

When patients use Fluticasone and Vilanterol for long periods of time, their bone mineral density may be decreased. When this happens, patients may be at an increased risk of suffering from weak bones and/or osteoporosis. If patients are concerned about this potential complication, they should discuss the risks with their physician.

If patients experience changes in their vision or blurred vision when they are using Fluticasone and Vilanterol, they should seek urgent medical help. In some cases, they may be referred to an ophthalmologist for further treatment.

Fluticasone and Vilanterol can affect the patient's potassium levels and blood sugar levels. If patients have been diagnosed with heart disease and/or diabetes, they should discuss the use of this medicine with their doctor. Similarly, if the patient's urine or blood sugar tests and/or potassium tests are abnormal, they should seek medical advice.

When patients are using Fluticasone and Vilanterol, they should ensure that they inform healthcare practitioners whenever they are due to undergo medical tests and/or procedures. Fluticasone and Vilanterol may affect the results of some tests so it's important that the relevant practitioners are aware that the patient is using this medication.

As Fluticasone and Vilanterol could cause harm to an unborn fetus, it is not usually prescribed to patients who are pregnant. If a safer alternative is available, physicians are more likely to treat the patient without Fluticasone and Vilanterol. However, if no other option is available and the benefits of using Fluticasone and Vilanterol outweigh the possible risks, doctors may prescribe Fluticasone and Vilanterol. However, patients should be made aware of the risks and this medicine should not be prescribed to pregnant patients unless it is absolutely necessary.

If patients become pregnant or plan to become pregnant while using Fluticasone and Vilanterol, they should contact their physician for medical advice.

It is not known whether Fluticasone and Vilanterol can be transferred from a patient to an infant via breastfeeding and, if so, whether it will cause harm to the child. Due to this, patients are generally advised not to breastfeed while using Fluticasone and Vilanterol as it may put the infant at risk.

If patients have any allergies, they should notify their doctor before using Fluticasone and Vilanterol. If patients experience an allergic reaction whilst using Fluticasone and Vilanterol, they should obtain immediate medical assistance. An allergic reaction may cause the following symptoms:

  • Rash on the skin
  • Wheezing
  • Difficulty breathing
  • Hives
  • Difficulty swallowing
  • Itching
  • Swelling of the lips, throat, mouth, tongue, face and/or hands

Storage

Generally, patients should store Fluticasone and Vilanterol at room temperature and should keep their medicine away from moisture, heat and direct light. When keeping medicine at home, it's important that children and/or pets cannot gain access to it.

If patients are advised to stop using Fluticasone and Vilanterol or if it has been opened for a period of six weeks, they will need to dispose of the medicine. However, it is not safe to throw medications out with regular household waste.

Instead, patients should contact their physician's office or pharmacist in order to access a suitable method of disposal.

Summary

Both asthma and COPD can be extremely debilitating for patients and acute attacks of either condition can be life-threatening. Due to this, it's vital that the patient's symptoms are managed and that the frequency and intensity of attacks are reduced.

Although treatment with Fluticasone and Vilanterol will not successfully cure either asthma or COPD, it can provide long-term relief from symptoms. When used in conjunction with other medicines, it can successfully reduce symptoms, such as, coughing, wheezing, chest tightness and shortness of breath, and allow the patient to breathe more easily.

Whilst Fluticasone and Vilanterol is not usually a first-choice of treatment for asthmatic patients, it can work well for a significant number of patients. Due to this, the combination of Fluticasone and Vilanterol is widely used to manage respiratory disorders and is prescribed to a large number of patients on a regular basis.