Seretide Inhaler

What is Seretide?

Seretide is a prescription-only combination inhaler used for the long-term management of asthma and Chronic Obstructive Pulmonary Disease (COPD). It belongs to a class of medicines known as Long-Acting Beta-Agonist (LABA) and Inhaled Corticosteroid (ICS) combinations.

Active Ingredients: Salmeterol (as xinafoate) and Fluticasone Propionate.

Mechanism of Action

Think of Seretide as a two-pronged approach to managing your breathing:

1. Salmeterol (The Long-Acting Bronchodilator): This component acts like a long-lasting muscle relaxant for the airways. It attaches to receptors in the lung muscles, causing them to relax and open up. This makes it easier to breathe, and its effects last for at least 12 hours.
2. Fluticasone Propionate (The Anti-Inflammatory Steroid): This component acts like a firefighter for the lungs. It reduces and prevents the swelling and irritation (inflammation) inside the airways, which is a key underlying problem in asthma and COPD. By calming this inflammation, it makes the airways less sensitive to triggers.

Together, they work synergistically to provide better control over respiratory symptoms than either ingredient alone.

What is Seretide Used For?

Seretide is prescribed for the regular treatment of:

• Asthma: For patients where a preventer inhaler containing a steroid is needed to achieve control. It is not indicated for the initial treatment of asthma.
• Chronic Obstructive Pulmonary Disease (COPD): Specifically, the 50/500 microgram strength is used for patients with a history of repeated exacerbations (flare-ups) of their COPD. It helps reduce the number of these flare-ups.

Before Using Seretide

Before starting Seretide, discuss your full medical history with your doctor, especially if you have or have had:

• Heart disease, including an irregular or fast heartbeat.
• An overactive thyroid gland (hyperthyroidism).
• High blood pressure.
• Diabetes mellitus (Seretide may increase blood sugar levels).
• Low potassium levels in your blood (hypokalaemia).
• Tuberculosis (TB) now or in the past, or any other ongoing lung infection.

You should also inform your doctor immediately if you experience blurred vision or other visual disturbances while using Seretide.

Seretide Contraindications

Do not use Seretide if you are allergic (hypersensitive) to salmeterol, fluticasone propionate, or any of the other ingredients, including lactose (which contains milk proteins).

Special Population Considerations

• Elderly: No specific dose adjustment is required, but elderly patients may be more susceptible to side effects and should be monitored closely.
• Renal/Hepatic Impairment: There are no specific recommendations, but caution is advised.
• Pediatric: Seretide Accuhaler 50/100 is indicated for children aged 4 years and older. It is not recommended for children below 4 years of age.

Seretide and Other Medicines

Always tell your doctor or pharmacist about all other medicines you are taking, including prescription, over-the-counter, and herbal medicines. Key interactions include:

• β-blockers (e.g., atenolol, propranolol): May antagonise the effect of salmeterol and cause bronchospasm.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir): Can significantly increase the blood levels of fluticasone and salmeterol, raising the risk of systemic side effects like Cushing's syndrome and cardiac effects. Your doctor may need to monitor you carefully.
• Other corticosteroids (oral or injectable): Increase the risk of systemic steroid side effects, including adrenal suppression.
• Diuretics ('water tablets'): Can lower potassium levels, an effect that may be enhanced by beta-agonists like salmeterol.
• Other bronchodilators (e.g., salbutamol) and xanthines (e.g., theophylline): May increase the risk of heart-related side effects.

Pregnancy & Breastfeeding

Pregnancy: You should only use Seretide during pregnancy if your doctor determines that the benefit outweighs the potential risk. Discuss this with your doctor.

Breastfeeding: It is unknown if the ingredients in Seretide pass into breast milk. A risk-benefit assessment by your doctor is necessary. Do not use Seretide while breastfeeding without medical advice.

Driving & Machine Operation

Seretide is not likely to affect your ability to drive or use machines. However, as with any medicine, be aware of how you react to it. If you experience dizziness, shakiness, or visual disturbances, do not drive or operate machinery until you feel well again.

Seretide Ingredients

• Active Ingredients: Salmeterol xinafoate, Fluticasone propionate.
• Excipient: Lactose monohydrate (which contains small amounts of milk proteins).

Allergen Warning: The lactose in Seretide contains milk proteins. If you are allergic to milk proteins, you should not use this medicine. The amount of lactose is very small and does not normally cause problems in people who are lactose intolerant.

How to Use Seretide

Use Seretide exactly as prescribed by your doctor. It is for regular, daily use to prevent symptoms, not for immediate relief.

Seretide Dosage Guidelines

Your doctor may adjust your dose based on your response. Do not change your dose without consulting your doctor.

Administration Instructions for Accuhaler

1. Open: Hold the outer case. Put your thumb on the thumbgrip and push it away from you until you hear a click.
2. Load: Slide the lever away from you until it clicks. This loads the dose. Do not play with the lever.
3. Breathe Out: Turn your head away from the inhaler and breathe out fully. Do not breathe into the mouthpiece.
4. Inhale: Place the mouthpiece between your lips. Breathe in steadily and deeply through your mouth. Remove the inhaler and hold your breath for about 10 seconds.
5. Breathe Out: Breathe out slowly away from the inhaler.
6. Close: Slide the thumbgrip back towards you to close it.
7. Rinse: Rinse your mouth with water and spit it out, and/or brush your teeth after each dose to prevent oral thrush and hoarseness.

Missed Dose Management

If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Do not take a double dose to make up for a forgotten one. Just continue with your regular dosing schedule.

Overdose Information

Accidentally taking more than the prescribed dose may cause:

• Fast heartbeat
• Shakiness (tremor)
• Headache
• Muscle weakness
• Dizziness

If this happens, talk to your doctor or pharmacist. Using high doses for a long time can suppress the adrenal gland's ability to produce natural steroid hormones. If you suspect a serious overdose, seek immediate medical attention.

Seretide Side Effects

Like all medicines, Seretide can cause side effects, although not everybody gets them. Your doctor will prescribe the lowest effective dose to minimise this risk.

Serious Side Effects - Seek Immediate Medical Help

• Allergic Reactions (Uncommon): Sudden wheezing, breathing difficulties, swelling of face/tongue/throat, itching, rash, fainting. Stop using Seretide and get help immediately.
• Paradoxical Bronchospasm (Rare): Breathing difficulties or wheezing that get worse immediately after use. Stop and use your reliever inhaler.
• Adrenal Insufficiency (Rare with high long-term doses): Symptoms include tiredness, stomach pain, nausea/vomiting, weight loss, headache, low blood pressure. This can be life-threatening under stress (e.g., surgery, infection).
• Pneumonia (Common in COPD patients): Watch for fever, chills, increased mucus, change in mucus colour, increased cough/breathing difficulties.

Other Side Effects (by Frequency)

• Very Common (>1 in 10): Headache.
• Common (1 in 10 to 1 in 100):
  • Oral thrush (sore, creamy patches in mouth), hoarse voice, throat irritation. Rinsing your mouth after use helps prevent this.
  • Aching, swollen joints, muscle pain, muscle cramps.
  • In COPD patients: Bruising, fractures, sinus inflammation, low blood potassium.
• Uncommon (1 in 100 to 1 in 1000):
  • Increased blood sugar (important for diabetics).
  • Cataract.
  • Fast heartbeat (tachycardia), feeling shaky, palpitations, chest pain.
  • Feeling worried, disturbed sleep, allergic skin rash.
• Rare (<1 in 1000):
  • Systemic steroid effects (with high doses): Slowing of growth in children, thinning of bones (osteoporosis), glaucoma, weight gain, Cushing's syndrome.
  • Behavioural changes (especially in children).
  • Irregular heartbeat (arrhythmias).
  • Fungal infection in the oesophagus.
• Frequency Not Known: Depression, aggression (mainly in children), blurred vision.

Reporting Side Effects: If you get any side effects, talk to your doctor or pharmacist. You can also report them directly via the UK Yellow Card Scheme.

How to Store Seretide

• Keep out of the sight and reach of children.
• Do not use after the expiry date printed on the pack.
• Store below 30°C.
• Do not throw away medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use.

Seretide Pack Information

The Seretide Accuhaler is a plastic device containing a foil strip of blisters. Each blister contains one pre-dispensed dose of powder.

Available Pack Sizes: 1 x 28 inhalations, or 1, 2, 3, or 10 x 60 inhalations. Not all pack sizes may be marketed.

The device has a dose counter that counts down to zero. When it shows 0, the inhaler is empty.

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