Consumer medicine information

SalplusF 250/25 Metered dose inhaler

Fluticasone propionate + Salmeterol

BRAND INFORMATION

Brand name

SalplusF Inhaler

Active ingredient

Fluticasone propionate + Salmeterol

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using SalplusF 250/25 Metered dose inhaler.

What is in this leaflet


Please read this leaflet carefully before you start using SalplusF Inhaler.
This leaflet answers some common questions about SalplusF Inhaler. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.
All medicines have risks and benefits. Your doctor has weighed the risks of you taking SalplusF Inhaler against the benefits they expect it will have for you.
If you have any concerns about taking this medicine, ask your doctor or pharmacist.
Keep this leaflet with the medicine.
You may need to read it again.

What SalplusF Inhaler is used for


SalplusF Inhaler is available as a Metered Dose Inhaler (MDI).

  • SalplusF Inhaler 125/25 (125 microgram fluticasone propionate and 25 microgram salmeterol), or
  • SalplusF Inhaler 250/25 (250 microgram fluticasone propionate and 25 microgram salmeterol).

SalplusF Inhaler is used to help with asthma and chronic obstructive pulmonary disease (COPD) in people who need regular treatment.
Asthma is a condition affecting the lungs. Symptoms of asthma include shortness of breath, wheezing, chest tightness and cough. Two main causes of asthma symptoms are bronchoconstriction (tightening of the muscle surrounding the airways) and inflammation (swelling and irritation of the airways).
Chronic obstructive pulmonary disease (COPD) is a long-term condition affecting the lungs, resulting from chronic bronchitis or emphysema. Symptoms of COPD include shortness of breath, cough, chest discomfort and coughing up phlegm. The COPD symptoms are mainly due to bronchoconstriction (tightening of the muscle surrounding the airways) and inflammation (swelling and irritation of the airways).
SalplusF Inhaler contains two medicines, fluticasone propionate and salmeterol (as xinafoate).
Fluticasone propionate belongs to a group of medicines known as corticosteroids, frequently called 'steroids'. They are not 'anabolic steroids' which are the steroids sometimes misused by athletes.
Corticosteroids have an anti-inflammatory action. They reduce the swelling and irritation in the walls of the small air passages in the lungs and so help you to breathe more easily. Corticosteroids are used to treat asthma and COPD.
Salmeterol (as xinafoate) is a bronchodilator. A bronchodilator keeps the breathing tubes in your lungs open and relieves the symptoms of asthma and other chest conditions. The effects of salmeterol (as xinafoate) last for up to twelve hours.
When taken together regularly fluticasone propionate and salmeterol help to control your breathing difficulties.
DO NOT use this medicine to treat a sudden attack of breathlessness as it will not help you. You will need a different type of medicine, e.g. Ventolin (salbutamol), which you must not confuse with SalplusF Inhaler.
Ask your doctor if you have any questions about why this medicine has been prescribed for you.
Your doctor may have prescribed it for another reason.
This medicine is not addictive.
This medicine is available only with a doctor's prescription.

Before you use SalplusF Inhaler

When you must not take it


Do not take SalplusF Inhaler if you have an allergy to:
  • any medicine containing fluticasone propionate
  • any medicine containing salmeterol (as xinafoate)
  • any of the ingredients listed at the end of this leaflet.

Some of the symptoms of an allergic reaction may include:
  • wheezing or difficulty breathing
  • swelling of the face, eyelids, lips/mouth, tongue or throat
  • chest pain or tightness
  • hay fever or lumpy rash ("hives")
  • fainting

Do not take this medicine after the expiry date (EXP) printed on the pack or if the packaging is torn or shows signs of tampering.
If you use it after the expiry date has passed, it may not work as well.
If it has expired or is damaged, return it to your pharmacist for disposal.
If you are not sure whether you should start taking this medicine, talk to your doctor.

Before you start to take it


Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.
Tell your doctor if you have or have had any of the following medical conditions:
  • thrush in your mouth
  • tuberculosis
  • diabetes
  • a thyroid condition
  • high blood pressure or a heart problem
  • low blood potassium levels

Tell your doctor if you are taking other steroid medicines by mouth or inhalation.
Tell your doctor if you are pregnant or plan to become pregnant or are breast-feeding.
Your doctor can discuss with you the risks and benefits involved.
If you have not told your doctor about any of the above, tell him/her before you start taking SalplusF Inhaler.

Taking other medicines


Tell your doctor or pharmacist if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.
Some medicines and SalplusF Inhaler may interfere with each other. These include:
  • Beta-blockers used to treat high blood pressure (hypertension)
  • Ketoconazole used to treat fungal infection
  • Ritonavir used to treat HIV infection.

These medicines may be affected by SalplusF Inhaler or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines.
Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking this medicine.
If you are taking these medicines, consult your doctor or pharmacist who will advise on what you should do.

How to take SalplusF Inhaler


Follow all directions given to you by your doctor or pharmacist carefully.
They may differ from the information contained in this leaflet.
If you do not understand the instructions on the box, ask your doctor or pharmacist for help.

How much to take


It is very important that you use the medicine regularly every day. Do not stop treatment even if you feel better unless told to do so by your doctor.
Do not change your dose unless told to by your doctor.
If you are breathless or wheezing more often than normal, tell your doctor.
SalplusF Inhaler is not for use in patients aged under 12 years. A lower strength fluticasone and salmeterol (50/25 microgram) inhalation can be available from other brand/s.
ASTHMA
Adults and adolescents 12 years and older:
Your doctor will prescribe 1 of 2 different strengths of SalplusF Inhaler for you, depending on the severity of your condition:
• SalplusF Inhaler 125/25 (125 microgram fluticasone propionate and 25 microgram salmeterol), or
• SalplusF Inhaler 250/25 (250 microgram fluticasone propionate and 25 microgram salmeterol).
The usual dose is two puffs from your inhaler twice a day.
SalplusF Inhaler is only available in two strengths (fluticasone propionate and salmeterol 125/25 microgram and 250/25 microgram). It is not available in a lower strength product containing salmeterol 25 microgram and fluticasone propionate 50 microgram. Therefore, when it is appropriate to titrate down to a dose of inhaled corticosteroid below 125 micrograms, a change to an alternative fixed-dose combination of salmeterol and fluticasone propionate containing a lower dose of the inhaled corticosteroid is required.
COPD
Adults:
Your doctor will prescribe 1 of 2 different strengths of SalplusF Inhaler for you:
• SalplusF Inhaler 125/25 (125 microgram fluticasone propionate and 25 microgram salmeterol), or
• SalplusF Inhaler 250/25 (250 microgram fluticasone propionate and 25 microgram salmeterol).
The usual dose is two puffs from your inhaler twice a day.

How to take it


The medicine in SalplusF Inhaler should be inhaled into your lungs.
SalplusF Inhaler must only be breathed in through the mouth.
The full instructions for using SalplusF Inhaler is given on a leaflet inside the pack.
If you have any difficulties or do not understand the instructions, ask your doctor or pharmacist.
If you find it difficult to use your SalplusF Inhaler, talk to your doctor or pharmacist. It may be better for you to use something called a spacer device. Your doctor or pharmacist will explain what this is and how to use it.
If you change the make of spacer you use this may alter the amount of drug delivered to the lungs. You should let your doctor know if your asthma symptoms worsen.
If your SalplusF Inhaler is new and you have not used it before, shake it well, point the mouthpiece away from you and press the canister to release four puffs into the air. The dose indicator will show the number "120" indication the number of puffs in the inhaler.
If your SalplusF Inhaler has not been used for one week or more, you should release two puffs into the air before use.
As you use the inhaler the dose indicator will typically rotate during every five to seven puffs towards next decreasing number. The dose indicator will show the approximate no of puffs remaining in the inhaler.
In some cases dropping the inhaler may cause the indicator to count down.
Cleaning: Your Inhaler should be cleaned at least once a week as follows:
1. Remove the mouthpiece cover.
2. Do not remove the canister from the plastic casing.
3. Wipe the inside and outside of the mouthpiece and the plastic casing with a dry cloth or tissue.
4. Replace the mouthpiece cover.
DO NOT PUT THE METAL CANISTER INTO WATER.
Use your medicine as your doctor has told you. If you are not sure ask your doctor or pharmacist.

When to take it


Your doctor has chosen this medicine to suit you and your condition. SalplusF Inhaler is used to help with asthma and COPD in people who need regular treatment.
It is very important that you use your SalplusF Inhaler every day, twice a day. This will help you to keep free of symptoms throughout the day and night.
Take your medicine at about the same time each day.
Taking it at the same time each day will have the best effect. It will also help you remember when to take it.
It does not matter if you take this medicine before or after food.

How long to take it


Continue taking your medicine for as long as your doctor tells you.
This medicine helps to control your condition, but does not cure it. It is important to keep taking your medicine even if you feel well.

If you forget to take it


If it is almost time for your next dose, skip the dose you missed and use your next dose when you are meant to. Otherwise, use it as soon as you remember, then go back to using it as you would normally.
Do not use a double dose to make up for the dose that you missed.
If you become wheezy or feel tight in the chest before the next dose is due, use a 'reliever puffer' in the usual way. You should get relief from your 'reliever puffer' within a few minutes.
If you are not sure what to do, ask your doctor or pharmacist.
If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)


Immediately telephone your doctor or the Poisons Information Centre (in Australia telephone 13 11 26) for advice, or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much SalplusF Inhaler.
Do this even if there are no signs of discomfort or poisoning.
You may need urgent medical attention.
Keep telephone numbers for these places handy. Symptoms of an overdose may include:
• rapid heart beat
• increased rate of breathing
• significant muscle tremor
• headache
• increased blood pressure
• increased blood sugar (glucose) levels
If you are not sure what to do, contact your doctor or pharmacist.

While you are using SalplusF Inhaler

Things you must do


If you are about to be started on any new medicine, remind your doctor and pharmacist that you are taking SalplusF Inhaler.
Tell any other doctors, dentists, and pharmacists who treat you that you are taking this medicine.
If you are going to have surgery, tell the surgeon or anaesthetist that you are taking this medicine.
It may affect other medicines used during surgery.
It is important that all doctors treating you are aware that you are on inhaled steroids. If your body is stressed by, for example, severe infection, surgical operation, an accident etc, you may need steroid tablets or injections for a time.
If you become pregnant while taking this medicine, or are trying to become pregnant, tell your doctor immediately.
If you are about to have any blood tests, tell your doctor that you are taking this medicine.
It may interfere with the results of some tests.
Contact your doctor if you experience a change in your vision.
Keep all of your doctor's appointments so that your progress can be checked.
Tell your doctor if, for any reason, you have not used your medicine exactly as prescribed.
Otherwise, your doctor may think that it was not effective and change your treatment unnecessarily.

Things you must not do


Do not take SalplusF Inhaler to treat any other complaints unless your doctor tells you to.
Do not give your medicine to anyone else, even if they have the same condition as you, or their symptoms seem similar to yours.
Do not stop taking your medicine or change the dosage without checking with your doctor.
If you stop taking it suddenly, your condition may worsen or you may have unwanted side effects. If possible, your doctor will gradually reduce the amount you take each day before stopping the medicine completely.

Things to be careful of


This medicine is not expected to affect your ability to drive a car or operate machinery. It is prudent to be careful driving or operating machinery until you know how SalplusF Inhaler affects you.

Side effects


Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking SalplusF Inhaler, even if you do not think the problems are connected with the medicine or are not listed in this leaflet.
If your breathing or wheezing gets worse straight after using your SalplusF Inhaler, stop using it immediately and tell your doctor as soon as possible.
This medicine helps most people with asthma and COPD. Most people using this medicine find that it causes no problem, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.
Do not be alarmed by the following lists of side effects. You may not experience any of them.
Ask your doctor or pharmacist to answer any questions you may have.
Common Side Effects

  • soreness in the mouth, throat, or tongue
  • hoarseness
  • headache
  • muscle cramps
  • pains in joints
  • increase in heart rate

Pneumonia (lung infection) has been reported commonly in patients with COPD.
Uncommon Side Effects
  • skin rash
  • shortness of breath
  • sweating, trembling, feeling nervous or anxious
  • bruising
  • eye problems (e.g. cataract, glaucoma)
  • sleep disturbances

Rare Side Effects
  • swelling of the face, lips, mouth, tongue or throat
  • irregular heartbeat
  • behavioural changes, including unusual activity and irritability (mainly in children)
  • rounded face
  • slowing of growth in children and adolescents
  • soreness in the oesophagus

The above list includes serious side effects that may require medical attention.
If any of the following happen, tell your doctor immediately or go to Accident and Emergency at your nearest hospital, as you may be having an allergic reaction:
  • wheezing or difficulty breathing
  • swelling of the face, eyelids, lips/mouth, tongue or throat
  • chest pain or tightness
  • hay fever or lumpy rash ("hives")
  • fainting

The above list includes very serious side effects. You may need urgent medical attention or hospitalisation.
Some side effects, for example changes in blood sugar (glucose) level, blood pressure or loss of bone density can only be found when your doctor does tests from time to time to check your progress.
Taking high doses of steroids for a long time could affect the adrenal glands, which make the body's own steroid. Your doctor may do tests to check how the adrenal glands are working.
Your doctor will be able to answer any questions you may have.
If you have any side effects, tell your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

After using SalplusF Inhaler

Rinse mouth after use


Some people find that their mouth, throat or tongue becomes sore or that their voice becomes hoarse after inhaling this medicine. It may be helpful to rinse your mouth with water and spit it out after using your SalplusF Inhaler. Tell your doctor but do not stop treatment unless told to do so.

Storage


Keep your SalplusF Inhaler in a dry place where the temperature stays below 25°C, away from direct heat or sunlight.
Do not store inhaler in a cold place as it may not work as well.
Do not store SalplusF Inhaler or any other medicine in the bathroom or near a sink. Do not leave it on a window sill or in the car.
Heat and dampness can destroy some medicines.
If your SalplusF Inhaler becomes very cold, it may not work properly. Keep your Inhaler away from frost.
WARNING: The SalplusF Inhaler metal can is pressurised. Do not burn it or puncture it, even when it is empty.
Keep it where children cannot reach it.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal


If your doctor tells you to stop taking this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.

Product description

What it looks like


SalplusF Inhaler is available with a dose indicator. The MDI comprises a suspension of fluticasone propionate and salmeterol in a CFC-free propellant.
SalplusF 125/25 are a rigid, aluminium, container fitted with a metered dose valve, containing a white homogeneous suspension, fitted to a plastic actuator with a white coloured body and pink coloured cap, with a dose indicator.
SalplusF 250/25 are a rigid, aluminium, container fitted with a metered dose valve, containing a white homogeneous suspension, fitted to a plastic actuator with a white coloured body and rubin red coloured cap, with a dose indicator.
Each canister contains 120 doses of the medicine.
Each dose contains 125 or 250 micrograms of the active ingredient fluticasone propionate.
Each dose also contains 25 micrograms of active ingredient salmeterol. The amount depends on which strength of SalplusF Inhaler you have been given.
The canister has a indicator attached to show how many puffs of medicine you have left. The number of puffs left will show through a window in the back of the plastic casing. As you use the inhaler the dose indicator will typically rotate during every five to seven puffs towards next decreasing number. The dose indicator will show the approximate no of puffs remaining in the inhaler.
You should consider getting a replacement when the indicator shows the number 020.
Do not use your SalplusF Inhaler if the indicator shows 000. When the indicator shows 000 you must dispose of your SalplusF Inhaler.
Never try to alter the numbers on the indicator or detach the indicator from the metal canister. The indicator cannot be reset and is permanently attached to the canister.

Ingredients


SalplusF Inhaler contains the active ingredients:
  • fluticasone propionate
  • salmeterol (as xinafoate)

Your SalplusF Inhaler also contains HFA-134a, a CFC-Free propellant.

Supplier


SalplusF Inhaler is supplied in Australia by:
Cipla Australia Pty Ltd
Level 1, 132-136 Albert Road
South Melbourne, VIC 3205.
This leaflet was prepared on 19 August 2019.

BRAND INFORMATION

Brand name

SalplusF Inhaler

Active ingredient

Fluticasone propionate + Salmeterol

Schedule

S4

 

1 Name of Medicine

Fluticasone propionate/ salmeterol (as xinafoate).

2 Qualitative and Quantitative Composition

Each single actuation of fluticasone propionate/ salmeterol pressurised metered dose inhalation contains, 125 micrograms or 250 micrograms of fluticasone propionate (delivered from the valve) and 25 micrograms of salmeterol (as salmeterol xinafoate).
Fluticasone propionate is a white or almost white powder. It is practically insoluble in water, sparingly soluble in methylene chloride, slightly soluble in ethanol (96 per cent).
Salmeterol (as xinafoate) is a white or almost white powder. Practically insoluble in water, soluble in methanol, slightly soluble in anhydrous ethanol.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

SalplusF 125/25 are a rigid, aluminium, container fitted with a metered dose valve, containing a white homogeneous suspension, fitted to a plastic actuator with a white coloured body and pink coloured cap, with a dose indicator.
SalplusF 250/25 are a rigid, aluminium, container fitted with a metered dose valve, containing a white homogeneous suspension, fitted to a plastic actuator with a white coloured body and rubin red coloured cap, with a dose indicator.

4 Clinical Particulars

4.9 Overdose

For information on the management of overdose contact the Poison Information Centre on 131126 (Australia).
The available information on overdose with fluticasone propionate/salmeterol, fluticasone and/or salmeterol is given below:
It is not recommended that patients receive higher than approved doses of fluticasone propionate/salmeterol. It is important to review therapy regularly and titrate down to the lowest dose at which effective control of disease is maintained (see Section 4.2 Dose and Method of Administration).
Symptoms and signs. The expected symptoms and signs of salmeterol overdosage are those typical of excessive beta-2-adrenergic stimulation, including tremor, headache, tachycardia, increases in systolic blood pressure, hypokalaemia and raised blood glucose levels.
Acute inhalation of fluticasone propionate doses in excess of those approved may lead to temporary suppression of the hypothalamic-pituitary-adrenal axis. This does not usually require emergency action as normal adrenal function typically recovers within a few days.
If higher than approved doses of fluticasone propionate/salmeterol are continued over prolonged periods, significant adrenocortical suppression is possible. There have been very rare reports of acute adrenal crisis, mainly occurring in children exposed to higher than approved doses over prolonged periods (several months or years). Presenting symptoms are typically vague and may include anorexia, abdominal pain, weight loss, tiredness, headache, nausea, vomiting, decreased levels of consciousness, hypoglycaemia and seizures. Situations which could potentially trigger acute adrenal crisis include exposure to trauma, surgery, infection or any rapid reduction in the dosage of the inhaled fluticasone propionate component. Additional systemic corticosteroid cover should be considered during periods of stress or elective surgery.
Treatment. There is no specific treatment for an overdose of salmeterol and fluticasone propionate. If overdose occurs, the patient should be treated supportively with appropriate monitoring necessary.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.3 Preclinical Safety Data

Fluticasone propionate and salmeterol xinafoate have been extensively evaluated in animal toxicity tests. Significant toxicities occurred only at doses in excess of those recommended for human use and were those expected for a potent beta-2-adrenoreceptor agonist and glucocorticosteroid.
Co-administration of fluticasone propionate and salmeterol resulted in some cardiovascular lesions not seen upon dosing with the individual drugs (mild atrial myocarditis and focal coronary arteritis in rats and papillary muscle necrosis in dogs). However, these high dose changes were not consistently observed across studies and are unlikely to be of clinical relevance.
Co-administration did not modify other class-related toxicities in animals.
Genotoxicity. Neither fluticasone propionate nor salmeterol xinafoate showed evidence of mutagenic potential when tested alone in a standard battery of genotoxicity assays. No studies examining the potential interaction of fluticasone propionate and salmeterol xinafoate to cause genetic toxicity when co-administered have been conducted.
The non-CFC propellant, norflurane (HFA134a), has been shown to have no toxic effect at very high vapour concentrations, far in excess of those likely to be experienced by patients, in a wide range of animal species exposed daily for periods of two years.
Carcinogenicity. No studies on the carcinogenic potential of the combined formulation of fluticasone propionate: salmeterol xinafoate have been conducted in animals. With fluticasone alone, no evidence of a tumorigenic effect was observed in either a 2 year study in rats receiving doses of fluticasone propionate up to 57 mg/kg/day by inhalation or in an 18 month study in mice receiving oral doses of fluticasone propionate up to 1 mg/kg/day. With salmeterol xinafoate alone, oral administration to mice at 0.2, 1.4 or 10 mg/kg/day for 18 months resulted in the development of smooth muscle tumours (leiomyomas and possibly leiomyosarcomas) in the uterus. In rats, combined oral / inhalational administration for 24 months at total dose levels of 0.2, 0.7 and 2.6 mg/kg/day resulted in leiomyomas in the suspensory ligament of the ovaries, as well as an increased incidence of benign pituitary tumours. The smooth muscle tumours in both species are thought to result from chronic stimulation of beta-adrenoceptors in these tissues, whereas the mechanism involved in the development of the pituitary tumours is unknown.

6 Pharmaceutical Particulars

6.7 Physicochemical Properties

Fluticasone propionate. Chemical name: The chemical name of fluticasone propionate is S-Fluoromethyl 6α, 9α-difluoro-11β-hydroxy-16α-methyl-3-oxo-17α-propionyloxy-androsta-1, 4-diene-17β-carbothioate.
Molecular formula: C25H31F3O5S.
Molecular weight: 500.6.
Description: Fluticasone propionate is a white to off-white powder. It is freely soluble in dimethyl sulfoxide and dimethylformamide, sparingly soluble in acetone, dichloromethane, ethyl acetate and chloroform, slightly soluble in methanol and 95% ethanol, and practically insoluble in water.
Chemical structure.
https://stagingapi.mims.com/au/public/v2/images/fullchemgif/CSFLUTPR.gif CAS number. 80474-14-2.
Salmeterol (as xinafoate). Chemical name: The chemical name of salmeterol xinafoate is (±)-4-Hydroxy- α1-[[[6-(4-phenylbutoxy)hexyl]amino]methyl]-m-xylene-α, α′diol 1-hydroxy-2-naphthoate (salt).
Molecular formula: C25H37NO4.C11H8O3.
Molecular weight: 603.8.
Description: Salmeterol xinafoate is a white to off-white crystalline powder. It is freely soluble in methanol, slightly soluble in ethanol, chloroform, and isopropanol, and sparingly soluble in water.
Chemical structure.
https://stagingapi.mims.com/au/public/v2/images/fullchemgif/CSSALXIN.gif CAS number. 94749-08-3.

7 Medicine Schedule (Poisons Standard)

Schedule 4 - Prescription Only Medicine.

Summary Table of Changes

https://stagingapi.mims.com/au/public/v2/images/fulltablegif/SLPLSFST.gif