Drug Interactions between Advair Diskus and posaconazole

Posaconazole may significantly increase the absorption of fluticasone into the blood stream. You may be more likely to experience side effects such as swelling, weight gain, high blood pressure, high blood glucose, muscle weakness, depression, acne, thinning skin, stretch marks, easy bruising, bone density loss, cataracts, menstrual irregularities, excessive growth of facial or body hair, and abnormal distribution of body fat, especially in the face, neck, back, and waist. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Other side effects that may occur include decreased ability to fight infections, increased risk of developing infections, and inadequate response to stress such as infection, surgery, trauma, or a severe asthma attack. Children may experience a reduced growth rate due to excessive effects of fluticasone. 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.

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GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the systemic levels and pharmacologic effects of salmeterol, which is primarily metabolized by the isoenzyme. Because salmeterol prolongs the QT interval in a dose-dependent manner, high systemic levels of salmeterol may increase the risk of ventricular arrhythmias such as ventricular tachycardia, ventricular fibrillation, and torsade de pointes. In a placebo-controlled, crossover drug interaction study consisting of 20 healthy subjects, coadministration of salmeterol (50 mcg twice daily) and the potent CYP450 3A4 inhibitor ketoconazole (400 mg once daily) for 7 days resulted in a 16-fold increase in plasma salmeterol exposure (AUC) mainly due to increased bioavailability of the swallowed portion of the dose. Peak plasma salmeterol concentrations (Cmax) were increased by 1.4-fold, and three out of 20 subjects (15%) were withdrawn from the combination due to salmeterol-mediated systemic effects (two with QTc prolongation and one with palpitations and sinus tachycardia). Coadministration of salmeterol and ketoconazole did not result in a clinically significant effect on mean heart rate, blood potassium, or blood glucose. Although there was no statistical effect on the mean QTc, the combination was associated with more frequent increases in QTc duration than salmeterol and placebo.

MANAGEMENT: Concomitant use of salmeterol with potent CYP450 3A4 inhibitors is not recommended. Some authorities recommend avoiding concomitant use of salmeterol during and for 2 weeks after treatment with itraconazole. Other authorities consider concomitant use of salmeterol and atazanavir-cobicistat to be contraindicated.

Information for this minor interaction is available on the professional version.