Drug Information

This drug combines two primary active ingredients: salmeterol and fluticasone.

Salmeterol is a member of the drug family known as long-acting, beta-adrenergic bronchodilators (also called beta-agonists). It is inhaled by mouth, into the lungs, to treat asthma and prevent bronchospasm. Salmeterol is also used to prevent exercise-induced bronchospasm.

Fluticasone is a type of corticosteroid that is inhaled by mouth to treat and prevent asthma, as well as other inflammatory conditions of the lungs that restrict breathing. Oral corticosteroids are inhaled into the nose to treat and prevent symptoms of hay fever and other allergies, and some may be used to prevent recurrence of nasal polyps after surgical removal.

Some of the information in this article pertains to inhaled corticosteroids in general, not fluticasone specifically. The interactions reported here may not apply to all the Also Indexed As terms. Talk to your doctor or pharmacist if you are taking any of these drugs.

Common brand names:

Advair Diskus, Advair HFA

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Calcium

    Therapeutic amounts of intravenous salbutamol (albuterol) in four healthy people were associated with decreased plasma levels of calcium, magnesium, phosphate, and potassium.1 Decreased potassium levels have been reported with intramuscular and subcutaneous albuterol administration.2 How frequently this effect occurs is not known; whether these changes are preventable through diet or supplementation is also unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • DHEA

    A group of women with asthma who had been taking inhaled beclomethasone were shown to have low levels of DHEA compared to women with asthma who were not taking beclomethasone.11 The authors speculated that this effect may partially explain how corticosteroids can cause osteoporosis. However, more research is needed to confirm these suspicions and to evaluate whether supplemental DHEA is beneficial to patients taking inhaled corticosteroids.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Magnesium

    Therapeutic amounts of intravenous salbutamol (albuterol) in four healthy people were associated with decreased plasma levels of calcium, magnesium, phosphate, and potassium.13 Decreased potassium levels have been reported with oral,14 intramuscular, and subcutaneous albuterol administration.15 How frequently this effect occurs is not known; whether these changes are preventable through diet or supplementation is also unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Phosphate

    Therapeutic amounts of intravenous salbutamol (albuterol) in four healthy people were associated with decreased plasma levels of calcium, magnesium, phosphate, and potassium.25 Decreased potassium levels have been reported with intramuscular and subcutaneous albuterol administration.26 How frequently this effect occurs is not known; whether these changes are preventable through diet or supplementation is also unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Potassium

    Therapeutic amounts of intravenous salbutamol (albuterol) in four healthy people were associated with decreased plasma levels of calcium, magnesium, phosphate, and potassium.33 Decreased potassium levels have been reported with oral,34 intramuscular, and subcutaneous albuterol administration.35 How frequently this effect occurs is not known; whether these changes are preventable through diet or supplementation is also unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • none

Support Medicine

  • Aloe

    In animal research, applying aloe (Aloe vera) gel topically along with a topical corticosteroid enhanced the hormone’s anti-inflammatory activity in the skin.45 No human research has investigated this effect.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Coleus

    A test tube study demonstrated that the bronchodilating effects of salbutamol, another beta-adrenergic bronchodilator drug, were significantly increased by the addition of forskolin, the active component of the herb Coleus forskohlii.47 The results of this preliminary research suggest that the combination of forskolin and beta-agonists might provide an alternative to raising the doses of the beta-agonist drugs as they lose effectiveness. Until more is known, coleus should not be combined with salmeterol without the supervision of a doctor.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Zinc and Biotin

    Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.49 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • none

Explanation Required 

  • Digitalis

    Digitalis (Digitalis lanata, Digitalis purpurea) refers to a family of plants (commonly called foxglove) that contain digitalis glycosides, chemicals with actions and toxicities similar to the prescription drug digoxin.

    In a small study of salbutamol (albuterol) in people receiving digoxin, albuterol was associated with decreased serum digoxin levels.51 No interactions between albuterol and digitalis have been reported. Until more is known, albuterol and digitalis-containing products should be used only under the direct supervision of a doctor trained in their use.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

1. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

2. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

3. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

4. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

5. Smith BJ, Phillips PJ, Pannall PR. Effect of orally administered beclomethasone dipropionate on calcium absorption from the gut in normal subjects. Thorax 1993;48:890-3.

6. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

7. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

8. Smith BJ, Phillips PJ, Pannall PR. Effect of orally administered beclomethasone dipropionate on calcium absorption from the gut in normal subjects. Thorax 1993;48:890-3.

9. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

10. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

11. Smith BJ, Buxton JR, Dickeson J, Heller RF. Does beclomethasone dipropionate suppress dehydroepiandrosterone sulphate in postmenopausal women? Austral NZ J Med 1994;24:396-401.

12. Smith BJ, Buxton JR, Dickeson J, Heller RF. Does beclomethasone dipropionate suppress dehydroepiandrosterone sulphate in postmenopausal women? Austral NZ J Med 1994;24:396-401.

13. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

14. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

15. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

16. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

17. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

18. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

19. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

20. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

21. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

22. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

23. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

24. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

25. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

26. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

27. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

28. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

29. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

30. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

31. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

32. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

33. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

34. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

35. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

36. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

37. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

38. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

39. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

40. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

41. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

42. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol. Br J Clin Pharmacol 1980;9:483-91.

43. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

44. Spector SL. Adverse reactions associated with parenteral beta agonists: serum potassium changes. N Engl Reg Allergy Proc 1987;8:317-22.

45. Davis RH, Parker WL, Murdoch DP. Aloe vera as a biologically active vehicle for hydrocortisone acetate. J Am Podiatric Med Assoc 1991;81:1-9.

46. Davis RH, Parker WL, Murdoch DP. Aloe vera as a biologically active vehicle for hydrocortisone acetate. J Am Podiatric Med Assoc 1991;81:1-9.

47. Yousif MH, Thulesius O. Forskolin reverses tachyphylaxis to the bronchodilator effects of salbutamol: an in-vitro study on isolated guinea-pig trachea. J Pharm Pharmacol 1999;51:181-6.

48. Yousif MH, Thulesius O. Forskolin reverses tachyphylaxis to the bronchodilator effects of salbutamol: an in-vitro study on isolated guinea-pig trachea. J Pharm Pharmacol 1999;51:181-6.

49. Camacho FM, Garcia-Hernandez MJ. Zinc aspartate, biotin, and clobetasol propionate in the treatment of alopecia areata in childhood. Pediatr Dermatol 1999;16:336-8 [letter].

50. Camacho FM, Garcia-Hernandez MJ. Zinc aspartate, biotin, and clobetasol propionate in the treatment of alopecia areata in childhood. Pediatr Dermatol 1999;16:336-8 [letter].

51. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

52. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

53. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.

54. Edner M, Jogestrand T. Oral salbutamol decreases serum digoxin concentration. Eur J Clin Pharmacol 1990;38:195-7.