Seretide

Seretide is a combination inhaler from GlaxoSmithKline that contains the inhaled corticosteroid fluticasone and the long-acting bronchodilator salmeterol.

Unlike Foster and Symbicort, Seretide contains salmeterol, which acts more slowly and is therefore not suitable as an as-needed medication. Seretide is used exclusively as regular maintenance therapy.

Available as a Diskus (powder inhaler) and as a metered-dose inhaler.

Seretide works through two mechanisms:

Fluticasone (corticosteroid):

• Strong anti-inflammatory effect
• Low systemic availability
• Reduces bronchial hyperresponsiveness

Salmeterol (LABA):

• Long-lasting bronchodilation (12 hours)
• Onset of action: 10-20 minutes (slower than formoterol)
• High beta-2 selectivity
• Not suitable for acute treatment

Important difference: Salmeterol does not act quickly enough for acute therapy – so always keep salbutamol on hand as a rescue inhaler as well!

Seretide is suitable for:

• Asthma patients who are not adequately controlled with a corticosteroid alone
• As maintenance therapy for moderate to severe asthma
• COPD with repeated exacerbations

Not suitable:

• As the sole as-needed medication
• For MART therapy
• For mild, only occasional asthma

Important: Always have a fast-acting reliever (e.g., salbutamol) available as well!

Seretide Diskus (powder):

• 100/50 µg (fluticasone/salmeterol)
• 250/50 µg
• 500/50 µg

Seretide metered-dose inhaler:

• 50/25 µg
• 125/25 µg
• 250/25 µg

Dosage for asthma:

• Diskus: 1 inhalation 2x daily
• Metered-dose inhaler: 2 puffs 2x daily
• Strength depending on severity

For COPD:

• Seretide Diskus 500/50: 1 inhalation 2x daily

Seretide Diskus: 1. Hold the Diskus in one hand, thumb on the thumb grip 2. Open the Diskus until it clicks 3. Slide the lever back until it clicks (dose is ready) 4. Breathe out deeply (not into the Diskus!) 5. Close your lips tightly around the mouthpiece 6. Breathe in steadily and deeply 7. Hold your breath for 10 seconds 8. Close the Diskus 9. Rinse your mouth

Metered-dose inhaler:

• Like other sprays, coordinating the puff with breathing in
• If you have problems: use a spacer

Use regularly! Seretide must be taken every day – even when you have no symptoms. This is the only way to build up the full protective effect.

Do not use in case of:

• Hypersensitivity to the active ingredients
• Diskus: severe milk allergy (contains lactose)

Use with caution in case of:

• Pulmonary tuberculosis
• Respiratory tract infections
• Severe cardiovascular diseases
• Diabetes mellitus
• Hypokalemia
• Thyroid disorders
• Glaucoma, cataracts

Pregnancy and breastfeeding: Only if clearly indicated. Asthma should also be well controlled during pregnancy.

Common (1-10%):

• Oral thrush
• Hoarseness
• Headache
• Muscle cramps
• Joint pain

Uncommon:

• Tremor
• Palpitations
• Skin rash

Rare:

• Systemic corticosteroid effects at high doses
• Paradoxical bronchospasm
• Angioedema

With long-term use (high doses):

• Adrenal suppression possible
• Bone loss (osteoporosis)
• Cataracts, glaucoma

Prevention: Rinse your mouth after inhalation. Regular eye examinations during long-term therapy.

Interactions:

• Beta blockers – can cancel out the effect of salmeterol
• CYP3A4 inhibitors (ritonavir, ketoconazole) – increased fluticasone levels
• QT-prolonging medications
• MAO inhibitors

Note: Ritonavir can lead to considerable systemic corticosteroid exposure – avoid this combination!