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AirDuo RespiClick

Last reviewed on RxList: 3/19/2018
Drug Description

AIRDUO RESPICLICK
(fluticasone propionate and salmeterol) Inhalation Powder

DESCRIPTION

AIRDUO RESPICLICK 55/14 mcg, AIRDUO RESPICLICK 113/14 mcg and AIRDUO RESPICLICK 232/14 mcg are combinations of fluticasone propionate and salmeterol xinafoate.

One active component of AIRDUO RESPICLICK is fluticasone propionate, a corticosteroid having the chemical name S-(fluoromethyl) 6αα,9-difluoro-11ß,17-dihydroxy-16α-methyl-3oxoandrosta- 1,4-diene-17ß-carbothioate, 17-propionate, and the following chemical structure:

Fluticasone propionate - Structural Formula Illustration

Fluticasone propionate is a white powder with a molecular weight of 500.6, and the empirical formula is C25H31F3O5S. It is practically insoluble in water, freely soluble in dimethyl sulfoxide and dimethylformamide, and slightly soluble in methanol and 95% ethanol.

The other active component of AIRDUO RESPICLICK is salmeterol xinafoate, a beta2– adrenergic bronchodilator. Salmeterol xinafoate is the racemic form of the 1-hydroxy-2-naphthoic acid salt of salmeterol. It has the chemical name 4-hydroxy-α -[[[6-(4phenylbutoxy) hexyl]amino]methyl]-1,3-benzenedimethanol, 1-hydroxy-2naphthalenecarboxylate and the following chemical structure:

Salmeterol - Structural Formula Illustration

Salmeterol xinafoate is a white powder with a molecular weight of 603.8, and the empirical formula is C25H37NO4•C11H8O3. It is freely soluble in methanol; slightly soluble in ethanol, chloroform, and isopropanol; and sparingly soluble in water.

AIRDUO RESPICLICK is a white multidose dry powder inhaler (MDPI) for oral inhalation only. It contains a formulation blend of fluticasone propionate, salmeterol xinafoate, and lactose monohydrate (which may contain milk proteins). The opening of the mouthpiece cover meters 5.5 mg of the formulation from the device reservoir, which contains 55 mcg, 113 mcg, or 232 mcg of fluticasone propionate, and 14 mcg of salmeterol base, equivalent to 20.3 mcg of salmeterol xinafoate. Patient inhalation through the mouthpiece causes the deagglomeration and aerosolization of the drug particles as the formulation moves through the cyclone component of the device. This is followed by dispersion into the airstream.

Under standardized in vitro test conditions, the AIRDUO RESPICLICK inhaler delivers 49 mcg, 100 mcg, or 202 mcg of fluticasone propionate and 12.75 mcg of salmeterol base, equivalent to 18.5 mcg of salmeterol xinafoate, with lactose from the mouthpiece when tested at a flow rate of 85 L/min for 1.4 seconds.

The amount of drug delivered to the lung will depend on patient factors such as inspiratory flow profiles. In adult subjects (N=50, aged 18 to 45 years) with asthma, mean peak inspiratory flow (PIF) through the AIRDUO RESPICLICK inhaler was 108.28 L/min (range: 70.37 to 129.24 L/min). In adolescent subjects (N=50, aged 12 to 17 years) with asthma, mean peak inspiratory flow (PIF) through the AIRDUO RESPICLICK inhaler was 106.72 L/min (range: 73.64 to 125.51 L/min).

Indications & Dosage

INDICATIONS

AIRDUO RESPICLICK® is indicated for the treatment of asthma in patients aged 12 years and older. AIRDUO RESPICLICK® should be used for patients not adequately controlled on a long term asthma control medication such as an inhaled corticosteroid or whose disease warrants initiation of treatment with both an inhaled corticosteroid and long acting beta2 adrenergic agonist (LABA).

Important Limitation Of Use

AIRDUO RESPICLICK is NOT indicated for the relief of acute bronchospasm.

DOSAGE AND ADMINISTRATION

General

AIRDUO RESPICLICK should be administered as one inhalation twice daily by the orally inhaled route only. Advise the patient to rinse his/her mouth with water without swallowing after each dose.

Dosing

AIRDUO RESPICLICK should be administered as 1 inhalation twice daily (approximately 12 hours apart) by the orally inhaled route. AIRDUO RESPICLICK should be used at approximately the same time every day. Do not use AIRDUO RESPICLICK more than 2 times every 24 hours.

The starting dosage for AIRDUO RESPICLICK is based upon patients’ asthma severity. The usual recommended starting dose for patients not on inhaled corticosteroids is 55/14 mcg twice daily. For other patients, the starting dose should be based on previous asthma drug therapy and disease severity. For patients switching to AIRDUO RESPICLICK from another inhaled corticosteroid or combination product, select the low (55/14 mcg), medium (113/14 mcg) or high (232/14 mcg) dose strength of AIRDUO RESPICLICK based on the strength of the previous inhaled corticosteroid product or the strength of the inhaled corticosteroid from a combination product and disease severity. For patients who do not respond to AIRDUO RESPICLICK 55/14 mcg after 2 weeks of therapy, increasing the dose may provide additional asthma control.

If a dosage regimen of AIRDUO RESPICLICK fails to provide adequate control of asthma, the therapeutic regimen should be re-evaluated and additional therapeutic options (e.g., replacing the current strength of AIRDUO RESPICLICK with a higher strength, or adding additional controller therapies) should be considered.

The highest recommended dose of AIRDUO RESPICLICK is 232/14 mcg twice daily. More frequent administration or a greater number of inhalations (more than one inhalation twice daily) of the prescribed strength of AIRDUO RESPICLICK is not recommended as some patients are more likely to experience adverse effects with higher doses of salmeterol. Patients using AIRDUO RESPICLICK should not use additional LABA for any reason [see WARNINGS AND PRECAUTIONS].

If asthma symptoms arise in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief.

Improvement in asthma control following inhaled administration of AIRDUO RESPICLICK can occur within 15 minutes of beginning treatment, although maximum benefit may not be achieved for 1 week or longer after starting treatment. Individual patients will experience a variable time to onset and degree of symptom relief.

After asthma stability has been achieved, it is desirable to titrate to the lowest effective dosage to reduce the possibility of side effects.

For patients who do not respond adequately to the starting dose after 2 weeks of therapy, replacing the current strength of AIRDUO RESPICLICK with a higher strength may provide additional improvement in asthma control.

If a previously effective dosage regimen fails to provide adequate improvement in asthma control, the therapeutic regimen should be reevaluated and additional therapeutic options (e.g., replacing the current strength of AIRDUO RESPICLICK with a higher strength, adding additional controller therapies) should be considered.

AIRDUO RESPICLICK does not require priming. Do not use AIRDUO RESPICLICK with a spacer or volume holding chamber.

Cleaning
  • Keep the inhaler in a cool dry place. Never wash or put any part of the inhaler in water.
  • Routine maintenance is not required. If the mouthpiece needs cleaning, gently wipe the mouthpiece with a dry cloth or tissue as needed.
Dose Counter

The AIRDUO RESPICLICK inhaler has a dose counter. When the patient receives the inhaler, the number 60 will be displayed. The dose counter will count down each time the mouthpiece is opened and closed. The dose counter window displays the number of actuations (inhalations) left in the inhaler in units of two (e.g., 60, 58, 56, etc.). When the dose counter reaches 20, the color of the numbers will change to red to remind the patient to contact their pharmacist for a refill of medication or consult their physician for a prescription refill. When the dose counter reaches 0, the background will change to solid red and the color of the numbers will change to black.

HOW SUPPLIED

Dosage Forms And Strengths

Inhalation Powder. AIRDUO RESPICLICK is a multidose, inhalation-driven, dry powder inhaler for oral inhalation that meters 55 mcg, 113 mcg, or 232 mcg of fluticasone propionate with 14 mcg of salmeterol from the device reservoir and delivers 49 mcg, 100 mcg, or 202 mcg of fluticasone propionate with 12.75 mcg of salmeterol, respectively, from the mouthpiece per actuation. AIRDUO RESPICLICK is supplied as a white dry powder inhaler with a yellow cap in a sealed foil pouch with desiccant.

AIRDUO RESPICLICK is supplied in the following three strengths as a white dry-powder inhaler. Each inhaler has a yellow cap and is packaged individually in a foil pouch in a carton. Each inhaler contains 0.45g of the formulation and provides 60 actuations:

STRENGTH NDC CODE
AIRDUO RESPICLICK 55/14 mcg NDC 59310-805-06
AIRDUO RESPICLICK 113/14 mcg NDC 59310-812-06
AIRDUO RESPICLICK 232/14 mcg NDC 59310-822-06

Each AIRDUO RESPICLICK inhaler has a dose counter attached to the actuator. Patients should never try to alter the numbers for the dose counter. Discard the inhaler when the counter displays 0, 30 days after opening the foil pouch or after the expiration date on the product, whichever comes first. The labeled amount of medication in each actuation cannot be assured after the counter displays 0, even though the inhaler is not completely empty and will continue to operate [see PATIENT INFORMATION].

Storage And Handling

Store at room temperature (between 15° and 25°C; 59° and 77°F) in a dry place; excursions permitted from 59° F to 86° F (15°C to 30°C). Avoid exposure to extreme heat, cold, or humidity.

Keep out of reach of children.

AIRDUO RESPICLICK should be stored inside the unopened moisture-protective foil pouch and only removed from the pouch immediately before initial use. Discard AIRDUO RESPICLICK 30 days after opening the foil pouch or when the counter reads 0, whichever comes first. The inhaler is not reusable. Do not attempt to take the inhaler apart.

Manufactured by: Teva Pharmaceutical Industries, Ltd., Jerusalem, Israel; Revised: Dec 2017

Side Effects & Drug Interactions

SIDE EFFECTS

Use Of LABA May Result In The Following
  • Serious asthma-related events – hospitalizations, intubations, death [see WARNINGS AND PRECAUTIONS]
  • Cardiovascular and central nervous system effects [see WARNINGS AND PRECAUTIONS]
Systemic And Local Corticosteroid Use May Result In The Following

Clinical Trials Experience In Asthma

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The incidence of adverse reactions associated with AIRDUO RESPICLICK in Table 2 is based upon two placebo-controlled, 12-week, clinical studies (Study 1 and 2). A total of 1,364 adolescent and adult patients previously treated with inhaled corticosteroids were treated twice daily ARMONAIR RESPICLICK 55 mcg, 113 mcg, 232 mcg or AIRDUO RESPICLICK 55/14 mcg, 113/14 mcg, 232/14 mcg, or placebo. Sixty percent of patients were female and 80% of patients were white. The average duration of exposure was 82 to 84 days in the active treatment groups compared with 75 days in the placebo group.

Table 2: Adverse Reactions with ≥3% Incidence with AIRDUO RESPICLICK, and More Common than Placebo in Subjects with Asthma

Adverse Reaction ARMONAIR RESPICLICK
55 mcg
(n=129)
%
ARMONAIR RESPICLICK
113 mcg
(n=274)
%
ARMONAIR RESPICLICK
232 mcg
(n=146)
%
AIRDUO RESPICLICK
55/14 mcg
(n=128)
%
AIRDUO RESPICLICK
113/14 mcg
(n=269)
%
AIRDUO RESPICLICK
232/14 mcg
(n=145)
%
Placebo
(n=273)
%
Infections and infestations
Nasopharyngitis 5.4 5.8 4.8 8.6 4.8 6.9 4.4
Oral candidiasis* 3.1 2.9 4.8 1.6 2.2 3.4 0.7
Musculoskeletal and connective tissue disorders
Back pain 0 1.5 1.4 3.1 0.7 0 1.8
Nervous system disorders
Headache 1.6 7.3 4.8 5.5 4.8 2.8 4.4
Respiratory disorders
Cough 1.6 1.8 3.4 2.3 3.7 0.7 2.6
*Oral candidiasis includes oropharyngeal candidiasis, oral fungal infection, and oropharyngitis fungal

Other adverse reactions not previously listed (and occurring in <3% of patients and in three or more patients on AIRDUO RESPICLICK), whether considered drug-related or not by the investigators, that were reported more frequently by patients with asthma treated with AIRDUO RESPICLICK compared with patients treated with placebo include the following:

Sinusitis, oropharyngeal pain, pharyngitis, dizziness, influenza, rhinitis allergic, respiratory tract infection, rhinitis, nasal congestion, abdominal pain upper, myalgia, pain in extremity, dyspepsia, laceration, dermatitis contact, and palpitations.

Long Term Safety Study

This was a 26-week, open labeled study of 674 patients previously treated with inhaled corticosteroids who were treated twice daily with ARMONAIR RESPICLICK 113 mcg, 232 mcg, AIRDUO RESPICLICK 113/14 mcg, 232/14 mcg, fluticasone propionate inhalation aerosol 110 mcg and 220 mcg, and fluticasone propionate 250 mcg and salmeterol 50 mcg inhalation powder, and fluticasone propionate 500 mcg and salmeterol 50 mcg inhalation powder. The types of adverse reactions were similar to those reported above in placebo controlled studies.

Postmarketing Experience

In addition to adverse reactions reported from clinical trials, the following adverse reactions have been identified during post approval use of fluticasone propionate and/or salmeterol regardless of indication. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion due to either their seriousness, frequency of reporting, or causal connection to fluticasone propionate and/or salmeterol or a combination of these factors.

Cardiac Disorders: Arrhythmias (including atrial fibrillation, extrasystoles, supraventricular tachycardia), ventricular tachycardia.

Endocrine Disorders: Cushing’s syndrome, Cushingoid features, growth velocity reduction in children/adolescents, hypercorticism.

Eye Disorders: Glaucoma.

Gastrointestinal Disorders: Abdominal pain, dyspepsia, xerostomia.

Immune System Disorders: Immediate and delayed hypersensitivity reaction (including very rare anaphylactic reaction). Very rare anaphylactic reaction in patients with severe milk protein allergy.

Infections and Infestations: Esophageal candidiasis.

Metabolic and Nutrition Disorders: Hyperglycemia, weight gain.

Musculoskeletal, Connective Tissue, and Bone Disorders: Arthralgia, cramps, myositis, osteoporosis.

Nervous System Disorders: Paresthesia, restlessness.

Psychiatric Disorders: Agitation, aggression, depression. Behavioral changes, including hyperactivity and irritability, have been reported very rarely and primarily in children.

Reproductive System and Breast Disorders: Dysmenorrhea.

Respiratory, Thoracic, and Mediastinal Disorders: Chest congestion; chest tightness, dyspnea; facial and oropharyngeal edema, immediate bronchospasm; paradoxical bronchospasm; tracheitis; wheezing; reports of upper respiratory symptoms of laryngeal spasm, irritation, or swelling such as stridor or choking.

Skin and Subcutaneous Tissue Disorders: Ecchymoses, photodermatitis.

Vascular Disorders: Pallor.

DRUG INTERACTIONS

AIRDUO RESPICLICK has been used concomitantly with other drugs, including short-acting beta2-agonists, and intranasal corticosteroids, commonly used in patients with asthma without adverse drug reactions [see CLINICAL PHARMACOLOGY]. No formal drug interaction trials have been performed with AIRDUO RESPICLICK.

Inhibitors Of Cytochrome P450 3A4

Fluticasone propionate and salmeterol, the individual components of AIRDUO RESPICLICK, are substrates of CYP3A4. The use of strong CYP3A4 inhibitors (e.g., ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, ketoconazole, telithromycin) with AIRDUO RESPICLICK is not recommended because increased systemic corticosteroid and increased cardiovascular adverse effects may occur.

Ritonavir

Fluticasone Propionate

A drug interaction trial with fluticasone propionate aqueous nasal spray in healthy subjects has shown that ritonavir (a strong CYP3A4 inhibitor) can significantly increase plasma fluticasone propionate exposure, resulting in significantly reduced serum cortisol concentrations [see CLINICAL PHARMACOLOGY]. During postmarketing use, there have been reports of clinically significant drug interactions in patients receiving fluticasone propionate and ritonavir, resulting in systemic corticosteroid effects including Cushing’s syndrome and adrenal suppression.

Ketoconazole

Fluticasone Propionate

Coadministration of orally inhaled fluticasone propionate (1,000 mcg) and ketoconazole (200 mg once daily) resulted in a 1.9-fold increase in plasma fluticasone propionate exposure and a 45% decrease in plasma cortisol area under the curve (AUC) but had no effect on urinary excretion of cortisol.

Salmeterol

In a drug interaction trial in 20 healthy subjects, coadministration of inhaled salmeterol (50 mcg twice daily) and oral ketoconazole (400 mg once daily) for 7 days resulted in greater systemic exposure to salmeterol (AUC increased 16-fold and Cmax increased 1.4-fold). Three (3) subjects were withdrawn due to beta2-agonist side effects (2 with prolonged QTc and 1 with palpitations and sinus tachycardia). Although there was no statistical effect on the mean QTc, coadministration of salmeterol and ketoconazole was associated with more frequent increases in QTc duration compared with salmeterol and placebo administration [see CLINICAL PHARMACOLOGY].

Monoamine Oxidase Inhibitors And Tricyclic Antidepressants

AIRDUO RESPICLICK should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents, because the action of salmeterol, a component of AIRDUO RESPICLICK, on the vascular system may be potentiated by these agents.

Beta-Adrenergic Receptor Blocking Agents

Beta-blockers not only block the pulmonary effect of beta-agonists, such as salmeterol, a component of AIRDUO RESPICLICK, but may also produce severe bronchospasm in patients with asthma. Therefore, patients with asthma should not normally be treated with beta-blockers. However, under certain circumstances, there may be no acceptable alternatives to the use of beta-adrenergic blocking agents for these patients; cardioselective beta-blockers could be considered, although they should be administered with caution.

Non-Potassium-Sparing Diuretics

The ECG changes and/or hypokalemia that may result from the administration of non– potassium-sparing diuretics (such as loop or thiazide diuretics) can be acutely worsened by beta-agonists, such as salmeterol, a component of AIRDUO RESPICLICK, especially when the recommended dose of the beta-agonist is exceeded. Although the clinical significance of these effects is not known, caution is advised in the coadministration of AIRDUO RESPICLICK with non–potassium-sparing diuretics.

Warnings & Precautions

WARNINGS

Included as part of the PRECAUTIONS section.

PRECAUTIONS

Asthma-Related Death

LABA, such as salmeterol, one of the active ingredients in AIRDUO RESPICLICK, increase the risk of asthma-related death. Currently available data are inadequate to determine whether concurrent use of inhaled corticosteroids or other long-term asthma control drugs mitigates the increased risk of asthma-related death from LABA. Available data from controlled clinical trials suggest that LABA increase the risk of asthma-related hospitalization in pediatric and adolescent patients. Therefore, when treating patients with asthma, physicians should only prescribe AIRDUO RESPICLICK for patients not adequately controlled on a long-term asthma control medication, such as an inhaled corticosteroid, or whose disease severity clearly warrants initiation of treatment with both an inhaled corticosteroid and a LABA. Once asthma control is achieved and maintained, assess the patient at regular intervals and step down therapy (e.g., discontinue AIRDUO RESPICLICK) if possible without loss of asthma control and maintain the patient on a long-term asthma control medication, such as an inhaled corticosteroid. Do not use AIRDUO RESPICLICK for patients whose asthma is adequately controlled on low-or medium-dose inhaled corticosteroids.

A large placebo-controlled US trial that compared the safety of salmeterol with placebo, each added to usual asthma therapy, showed an increase in asthma-related deaths in subjects receiving salmeterol . The Salmeterol Multicenter Asthma Research Trial (SMART) was a randomized double-blind trial that enrolled LABA-naïve subjects with asthma to assess the safety of salmeterol 42 mcg twice daily over 28 weeks compared with placebo when added to usual asthma therapy. A planned interim analysis was conducted when approximately half of the intended number of subjects had been enrolled (N=26,355), which led to premature termination of the trial. The results of the interim analysis showed that subjects receiving salmeterol were at increased risk for fatal asthma events (see Table 1 and Figure 1). In the total population, a higher rate of asthma-related death occurred in subjects treated with salmeterol than those treated with placebo (0.10% versus 0.02%; relative risk: 4.37 [95% CI: 1.25, 15.34]).

Post-hoc subpopulation analyses were performed. In Caucasians, asthma-related death occurred at a higher rate in subjects treated with salmeterol than in subjects treated with placebo (0.07% versus 0.01%; relative risk: 5.82 [95% CI: 0.70, 48.37]). In African Americans also, asthma-related death occurred at a higher rate in subjects treated with salmeterol than those treated with placebo (0.31% versus 0.04%; relative risk: 7.26 [95% CI: 0.89, 58.94]). Although the relative risks of asthma-related death were similar in Caucasians and African Americans, the estimate of excess deaths in subjects treated with salmeterol was greater in African Americans because there was a higher overall rate of asthma-related death in African American subjects (see Table 1). Given the similar basic mechanisms of action of beta2-agonists, the findings seen in the SMART trial are considered a class effect.

Post-hoc analyses in pediatric subjects aged 12 to 18 years were also performed. Pediatric subjects accounted for approximately 12% of subjects in each treatment arm. Respiratory-related death or life-threatening experience occurred at a similar rate in the salmeterol group (0.12% [2/1,653]) and the placebo group (0.12% [2/1,622]; relative risk: 1.0 [95% CI: 0.1, 7.2]).

All-cause hospitalization, however, was increased in the salmeterol group (2% [35/1,653]) versus the placebo group ( < 1% [16/1,622]; relative risk: 2.1 [95% CI: 1.1, 3.7]).

The data from the SMART trial are not adequate to determine whether concurrent use of inhaled corticosteroids, such as fluticasone propionate, the other active ingredient in AIRDUO RESPICLICK, or other long-term asthma control therapy mitigates the risk of asthma-related death.

Table 1: Asthma-Related Deaths in the 28-Week Salmeterol Multicenter Asthma Research Trial (SMART)

  Salmeterol
n (%a)
Placebo
n (%a)
Relative Riskb (95% Confidence Interval) Excess Deaths Expressed per 10,000 Subjectsc (95% Confidence Interval)
Total Populationd
Salmeterol: n=13,176
Placebo: n=13,179
13
(0.10%)
3
(0.02%)
4.37
(1.25, 15.34)
8
(3, 13)
Caucasian
Salmeterol: n=9,281
Placebo: n=9,361
6
(0.07%)
1
(0.01%)
5.82
(0.70, 48.37)
6
(1, 10)
African American
Salmeterol: n=2,366
Placebo: n=2,319
7
(0.31%)
1
(0.04%)
7.26
(0.89, 58.94)
27
(8, 46)
a Life-table 28-week estimate, adjusted according to the subjects' actual lengths of exposure to trial treatment to account for early withdrawal of subjects from the trial.
b Relative risk is the ratio of the rate of asthma-related death in the salmeterol group and the rate in the placebo group. The relative risk indicates how many more times likely an asthma-related death occurred in the salmeterol group than in the placebo group in a 28-week treatment period.
c Estimate of the number of additional asthma-related deaths in subjects treated with salmeterol in SMART, assuming 10,000 subjects received salmeterol for a 28-week treatment period. Estimate calculated as the difference between the salmeterol and placebo groups in the rates of asthma-related death multiplied by 10,000.
d The Total Population includes the following ethnic origins listed on the case report form: Caucasian, African American, Hispanic, Asian, and “Other.” In addition, the Total Population includes those subjects whose ethnic origin was not reported. The results for Caucasian and African American subpopulations are shown above. No asthma-related deaths occurred in the Hispanic (salmeterol n=996, placebo n=999), Asian (salmeterol n=173, placebo n=149), or “Other” (salmeterol n=230, placebo n=224) subpopulations. One asthma-related death occurred in the placebo group in the subpopulation whose ethnic origin was not reported (salmeterol n=130, placebo n=127).

Figure 1: Cumulative Incidence of Asthma-Related Deaths in the 28-Week Salmeterol Multicenter Asthma Research Trial (SMART), by Duration of Treatment

Cumulative Incidence of Asthma-Related Deaths in the 28-Week Salmeterol Multicenter Asthma Research Trial -1 Illustration

A 16-week clinical trial performed in the United Kingdom, the Salmeterol Nationwide Surveillance (SNS) trial, showed results similar to the SMART trial. In the SNS trial, the rate of asthma-related death was numerically, though not statistically significantly, greater in subjects with asthma treated with salmeterol (42 mcg twice daily) than those treated with albuterol (180 mcg 4 times daily) added to usual asthma therapy.

Deterioration Of Disease And Acute Episodes

AIRDUO RESPICLICK should not be initiated in patients during rapidly deteriorating or potentially life-threatening episodes of asthma. AIRDUO RESPICLICK has not been studied in subjects with acutely deteriorating asthma. The initiation of AIRDUO RESPICLICK in this setting is not appropriate.

Serious acute respiratory events, including fatalities, have been reported when salmeterol, a component of AIRDUO RESPICLICK, has been initiated in patients with significantly worsening or acutely deteriorating asthma. In most cases, these have occurred in patients with severe asthma (e.g., patients with a history of corticosteroid dependence, low pulmonary function, intubation, mechanical ventilation, frequent hospitalizations, previous life-threatening acute asthma exacerbations) and in some patients with acutely deteriorating asthma (e.g., patients with significantly increasing symptoms; increasing need for inhaled, short-acting beta2-agonists; decreasing response to usual medications; increasing need for systemic corticosteroids; recent emergency room visits; deteriorating lung function). However, these events have occurred in a few patients with less severe asthma as well. It was not possible from these reports to determine whether salmeterol contributed to these events.

Increasing use of inhaled, short-acting beta2-agonists is a marker of deteriorating asthma. In this situation, the patient requires immediate reevaluation with reassessment of the treatment regimen, giving special consideration to the possible need for replacing the current strength of AIRDUO RESPICLICK with a higher strength, adding additional inhaled corticosteroid, or initiating systemic corticosteroids. Patients should not use more than 1 inhalation twice daily of AIRDUO RESPICLICK.

AIRDUO RESPICLICK should not be used for the relief of acute symptoms, i.e., as rescue therapy for the treatment of acute episodes of bronchospasm. An inhaled, short-acting beta2-agonist, not AIRDUO RESPICLICK, should be used to relieve acute symptoms such as shortness of breath. When prescribing AIRDUO RESPICLICK, the healthcare provider should also prescribe an inhaled, short-acting beta2-agonist (e.g., albuterol) for treatment of acute symptoms, despite regular twice-daily use of AIRDUO RESPICLICK.

When beginning treatment with AIRDUO RESPICLICK, patients who have been taking oral or inhaled, short-acting beta2-agonists on a regular basis (e.g., 4 times a day) should be instructed to discontinue the regular use of these drugs.

Excessive Use Of AIRDUO RESPICLICK And Use With Other Long-Acting Beta2-Agonists

AIRDUO RESPICLICK should not be used more often than recommended, at higher doses than recommended, or in conjunction with other medicines containing LABA, as an overdose may result. Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs. Patients using AIRDUO RESPICLICK should not use another medicine containing a LABA (e.g., salmeterol, formoterol fumarate, arformoterol tartrate, indacaterol) for any reason.

Local Effects Of Inhaled Corticosteroids

In clinical trials, the development of localized infections of the mouth and pharynx with Candida albicans has occurred in subjects treated with AIRDUO RESPICLICK. When such an infection develops, it should be treated with appropriate local or systemic (i.e., oral) antifungal therapy while treatment with AIRDUO RESPICLICK continues, but at times therapy with AIRDUO RESPICLICK may need to be interrupted. Advise the patient to rinse his/her mouth with water without swallowing following inhalation to help reduce the risk of oropharyngeal candidiasis.

Immunosuppression

Persons who are using drugs that suppress the immune system are more susceptible to infections than healthy individuals. Chickenpox and measles, for example, can have a more serious or even fatal course in susceptible adolescents or adults using corticosteroids. In such patients who have not had these diseases or who have not been properly immunized, particular care should be taken to avoid exposure. How the dose, route and duration of corticosteroid administration affect the risk of developing a disseminated infection is not known. The contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known. If a patient is exposed to chickenpox, prophylaxis with varicella-zoster immune globulin (VZIG) or pooled intravenous immunoglobulin (IVIG) may be indicated. If a patient is exposed to measles, prophylaxis with pooled intramuscular immunoglobulin (IG) may be indicated. (See the respective package inserts for complete VZIG and IG prescribing information.) If chickenpox develops, treatment with antiviral agents may be considered.

Inhaled corticosteroids should be used with caution, if at all, in patients with active or quiescent tuberculosis infections of the respiratory tract; systemic fungal, bacterial, viral, or parasitic infections; or ocular herpes simplex.

Transferring Patients From Systemic Corticosteroid Therapy

Particular care is needed for patients who are transferred from systemically active corticosteroids to inhaled corticosteroids because deaths due to adrenal insufficiency have occurred in patients with asthma during and after transfer from systemic corticosteroids to less systemically available inhaled corticosteroids. After withdrawal from systemic corticosteroids, a number of months are required for recovery of hypothalamic-pituitary-adrenal (HPA) function.

Patients who have been previously maintained on 20 mg or more of prednisone (or its equivalent) may be most susceptible, particularly when their systemic corticosteroids have been almost completely withdrawn. During this period of HPA suppression, patients may exhibit signs and symptoms of adrenal insufficiency when exposed to trauma, surgery, or infection (particularly gastroenteritis) or other conditions associated with severe electrolyte loss. Although AIRDUO RESPICLICK may improve control of asthma symptoms during these episodes, in recommended doses it supplies less than normal physiological amounts of corticosteroid systemically and does NOT provide the mineralocorticoid activity that is necessary for coping with these emergencies.

During periods of stress or a severe asthmatic attack, patients who have been withdrawn from systemic corticosteroids should be instructed to resume oral corticosteroids (in large doses) immediately and to contact their physician for further instruction. These patients should also be instructed to carry a medical identification warning card indicating that they may need supplementary systemic corticosteroids during periods of stress or a severe asthma attack.

Patients requiring systemic corticosteroids should be weaned slowly from systemic corticosteroid use after transferring to AIRDUO RESPICLICK. Lung function (mean forced expiratory volume in 1 second [FEV1] or morning peak expiratory flow [AM PEF]), beta-agonist use, and asthma symptoms should be carefully monitored during withdrawal of systemic corticosteroids. In addition to monitoring asthma signs and symptoms, patients should be observed for signs and symptoms of adrenal insufficiency, such as fatigue, lassitude, weakness, nausea and vomiting, and hypotension.

Transfer of patients from systemic corticosteroid therapy to AIRDUO RESPICLICK may unmask allergic conditions previously suppressed by the systemic corticosteroid therapy (e.g., rhinitis, conjunctivitis, eczema, arthritis, eosinophilic conditions).

During withdrawal from oral corticosteroids, some patients may experience symptoms of systemically active corticosteroid withdrawal (e.g., joint and/or muscular pain, lassitude, depression) despite maintenance or even improvement of respiratory function.

Hypercorticism And Adrenal Suppression

Fluticasone propionate, a component of AIRDUO RESPICLICK, will often help control asthma symptoms with less suppression of HPA function than therapeutically equivalent oral doses of prednisone. Since fluticasone propionate is absorbed into the circulation and can be systemically active at higher doses, the beneficial effects of AIRDUO RESPICLICK in minimizing HPA dysfunction may be expected only when recommended dosages are not exceeded and individual patients are titrated to the lowest effective dose. A relationship between plasma levels of fluticasone propionate and inhibitory effects on stimulated cortisol production has been shown after 4 weeks of treatment with fluticasone propionate inhalation aerosol. Since individual sensitivity to effects on cortisol production exists, physicians should consider this information when prescribing AIRDUO RESPICLICK.

Because of the possibility of significant systemic absorption of inhaled corticosteroids, patients treated with AIRDUO RESPICLICK should be observed carefully for any evidence of systemic corticosteroid effects. Particular care should be taken in observing patients postoperatively or during periods of stress for evidence of inadequate adrenal response.

It is possible that systemic corticosteroid effects such as hypercorticism and adrenal suppression (including adrenal crisis) may appear in a small number of patients who are sensitive to these effects. If such effects occur, AIRDUO RESPICLICK should be reduced slowly, consistent with accepted procedures for reducing systemic corticosteroids, and for management of asthma symptoms.

Drug Interactions With Strong Cytochrome P450 3A4 Inhibitors

The use of strong cytochrome P450 3A4 (CYP3A4) inhibitors (e.g., ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, ketoconazole, telithromycin) with AIRDUO RESPICLICK is not recommended because increased systemic corticosteroid and increased cardiovascular adverse effects may occur [see DRUG INTERACTIONS, CLINICAL PHARMACOLOGY].

Paradoxical Bronchospasm And Upper Airway Symptoms

As with other inhaled medicines, AIRDUO RESPICLICK can produce paradoxical bronchospasm, which may be life-threatening. If paradoxical bronchospasm occurs following dosing with inhaled fluticasone propionate/salmeterol medicines, it should be treated immediately with an inhaled, short-acting bronchodilator; inhaled fluticasone propionate/salmeterol medicines should be discontinued immediately; and alternative therapy should be instituted. Upper airway symptoms of laryngeal spasm, irritation, or swelling, such as stridor and choking, have been reported in patients receiving inhaled fluticasone propionate/salmeterol medicines.

Hypersensitivity Reactions, Including Anaphylaxis

Immediate hypersensitivity reactions (e.g., urticaria, angioedema, rash, bronchospasm, hypotension), including anaphylaxis, may occur after administration of AIRDUO RESPICLICK. There have been reports of anaphylactic reactions in patients with severe milk protein allergy after inhalation of other powder products containing lactose; therefore, patients with severe milk protein allergy should not use AIRDUO RESPICLICK [see CONTRAINDICATIONS].

Cardiovascular And Central Nervous System Effects

Excessive beta-adrenergic stimulation has been associated with seizures, angina, hypertension or hypotension, tachycardia with rates up to 200 beats/min, arrhythmias, nervousness, headache, tremor, palpitation, nausea, dizziness, fatigue, malaise, and insomnia [see OVERDOSAGE]. Therefore, AIRDUO RESPICLICK, like all products containing sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension.

Salmeterol, a component of AIRDUO RESPICLICK, can produce a clinically significant cardiovascular effect in some patients as measured by pulse rate, blood pressure, and/or symptoms. Although such effects are uncommon after administration of salmeterol at recommended doses, if they occur, the drug may need to be discontinued. In addition, beta-agonists have been reported to produce electrocardiogram (ECG) changes, such as flattening of the T wave, prolongation of the QTc interval, and ST segment depression. The clinical significance of these findings is unknown. Large doses of inhaled or oral salmeterol (12 to 20 times the recommended dose) have been associated with clinically significant prolongation of the QTc interval, which has the potential for producing ventricular arrhythmias. Fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs.

Reduction In Bone Mineral Density

Decreases in bone mineral density (BMD) have been observed with long-term administration of products containing inhaled corticosteroids. The clinical significance of small changes in BMD with regard to long-term consequences such as fracture is unknown. Patients with major risk factors for decreased bone mineral content, such as prolonged immobilization, family history of osteoporosis, or chronic use of drugs that can reduce bone mass (e.g., anticonvulsants, oral corticosteroids) should be monitored and treated with established standards of care.

Effect On Growth

Orally inhaled corticosteroids, including AIRDUO RESPICLICK, may cause a reduction in growth velocity when administered to pediatric patients. Monitor the growth of pediatric patients receiving AIRDUO RESPICLICK routinely (e.g., via stadiometry). To minimize the systemic effects of orally inhaled corticosteroids, including AIRDUO RESPICLICK, titrate each patient's dosage to the lowest dosage that effectively controls his/her symptoms [see DOSAGE AND ADMINISTRATION, Use in Specific Populations].

Glaucoma And Cataracts

Glaucoma, increased intraocular pressure, and cataracts have been reported in patients following the long-term administration of inhaled corticosteroids, including fluticasone propionate, a component of AIRDUO RESPICLICK. Therefore, close monitoring is warranted in patients with a change in vision or with a history of increased intraocular pressure, glaucoma, and/or cataracts.

Effects of treatment with other Fluticasone Propionate and Salmeterol Inhalation Powder 500/50, fluticasone propionate 500 mcg, salmeterol 50 mcg, or placebo on development of cataracts or glaucoma was evaluated in a subset of 658 subjects with COPD in the 3-year survival trial. Ophthalmic examinations were conducted at baseline and at 48, 108, and 158 weeks. Conclusions about cataracts cannot be drawn from this trial because the high incidence of cataracts at baseline (61% to 71%) resulted in an inadequate number of subjects treated with other Fluticasone Propionate and Salmeterol Inhalation Powder 500/50 who were eligible and available for evaluation of cataracts at the end of the trial (n = 53). The incidence of newly diagnosed glaucoma was 2% with other Fluticasone Propionate and Salmeterol Inhalation Powder 500/50, 5% with fluticasone propionate, 0% with salmeterol, and 2% with placebo.

Eosinophilic Conditions And Churg-Strauss Syndrome

In rare cases, patients on inhaled fluticasone propionate, a component of AIRDUO RESPICLICK, may present with systemic eosinophilic conditions. Some of these patients have clinical features of vasculitis consistent with Churg-Strauss syndrome, a condition that is often treated with systemic corticosteroid therapy. These events usually, but not always, have been associated with the reduction and/or withdrawal of oral corticosteroid therapy following the introduction of fluticasone propionate. Cases of serious eosinophilic conditions have also been reported with other inhaled corticosteroids in this clinical setting. Physicians should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients. A causal relationship between fluticasone propionate and these underlying conditions has not been established.

Coexisting Conditions

AIRDUO RESPICLICK, like all medicines containing sympathomimetic amines, should be used with caution in patients with convulsive disorders or thyrotoxicosis and in those who are unusually responsive to sympathomimetic amines. Doses of the related beta2-adrenoceptor agonist albuterol, when administered intravenously, have been reported to aggravate preexisting diabetes mellitus and ketoacidosis.

Hypokalemia And Hyperglycemia

Beta-adrenergic agonist medicines may produce significant hypokalemia in some patients, possibly through intracellular shunting, which has the potential to produce adverse cardiovascular effects [see CLINICAL PHARMACOLOGY]. The decrease in serum potassium is usually transient, not requiring supplementation. Clinically significant changes in blood glucose and/or serum potassium were seen infrequently during clinical trials with AIRDUO RESPICLICK at recommended doses.

Patient Counseling Information

Advise the patient to read the FDA-approved patient labeling (Medication Guide and Instructions for Use). Patients should be given the following information:

Asthma-Related Death

Inform patients with asthma that salmeterol, one of the active ingredients in AIRDUO RESPICLICK, increases the risk of asthma-related death and may increase the risk of asthma-related hospitalization in pediatric and adolescent patients. Also inform them that currently available data are inadequate to determine whether concurrent use of inhaled corticosteroids or other long-term asthma control drugs mitigates the increased risk of asthma-related death from LABA.

Not For Acute Symptoms

Inform patients that AIRDUO RESPICLICK is not meant to relieve acute asthma symptoms and extra doses should not be used for that purpose. Advise patients to treat acute asthma symptoms with an inhaled, short-acting beta2-agonist such as albuterol. Provide patients with such medication and instruct them in how it should be used.

Instruct patients to seek medical attention if they experience any of the following:

  • Decreasing effectiveness of inhaled, short-acting beta2-agonists
  • Need for more inhalations than usual of inhaled, short-acting beta2-agonists
  • Significant decrease in lung function as outlined by the physician

Tell patients they should not stop therapy with AIRDUO RESPICLICK without physician/provider guidance since symptoms may recur after discontinuation.

Do Not Use Additional Long-Acting Beta2-Agonists

Instruct patients not to use other LABA for asthma.

Local Effects

Inform patients that localized infections with Candida albicans occurred in the mouth and pharynx in some patients. If oropharyngeal candidiasis develops, treat it with appropriate local or systemic (i.e., oral) antifungal therapy while still continuing therapy with AIRDUO

RESPICLICK, but at times therapy with AIRDUO RESPICLICK may need to be temporarily interrupted under close medical supervision. Rinsing the mouth with water without swallowing after inhalation is advised to help reduce the risk of thrush.

Immunosuppression

Warn patients who are on immunosuppressant doses of corticosteroids to avoid exposure to chickenpox or measles and, if exposed, to consult their physicians without delay. Inform patients of potential worsening of existing tuberculosis, fungal, bacterial, viral, or parasitic infections; or ocular herpes simplex.

Hypercorticism And Adrenal Suppression

Advise patients that AIRDUO RESPICLICK may cause systemic corticosteroid effects of hypercorticism and adrenal suppression. Additionally, inform patients that deaths due to adrenal insufficiency have occurred during and after transfer from systemic corticosteroids. Patients should taper slowly from systemic corticosteroids if transferring to AIRDUO RESPICLICK.

Immediate Hypersensitivity Reactions

Advise patients that immediate hypersensitivity reactions (e.g., urticaria, angioedema, rash, bronchospasm, hypotension), including anaphylaxis, may occur after administration of AIRDUO RESPICLICK. Patients should discontinue AIRDUO RESPICLICK if such reactions occur and contact their healthcare provider or get emergency medical help. There have been reports of anaphylactic reactions in patients with severe milk protein allergy after inhalation of powder products containing lactose; therefore, patients with severe milk protein allergy should not take AIRDUO RESPICLICK.

Reduction In Bone Mineral Density

Advise patients who are at an increased risk for decreased BMD that the use of corticosteroids may pose an additional risk.

Reduced Growth Velocity

Inform patients that orally inhaled corticosteroids, including fluticasone propionate, may cause a reduction in growth velocity when administered to adolescent patients. Physicians should closely follow the growth of adolescents taking corticosteroids by any route.

Ocular Effects

Long-term use of inhaled corticosteroids may increase the risk of some eye problems (cataracts or glaucoma); consider regular eye examinations.

Risks Associated With Beta-Agonist Therapy

Inform patients of adverse effects associated with beta2-agonists, such as palpitations, chest pain, rapid heart rate, tremor, or nervousness.

Pregnancy

Inform patients who are pregnant or nursing that they should contact their physician about the use of AIRDUO RESPICLICK.

Use Daily For Best Effect

Patients should use AIRDUO RESPICLICK at regular intervals as directed. The daily dosage of AIRDUO RESPICLICK should not exceed 1 inhalation twice a day. Advise patients, if they miss a dose, to take their next dose at the same time they normally do and to not take 2 doses at one time. Individual patients will experience a variable time to onset and degree of symptom relief and full benefit may not be achieved until treatment has been administered for 1 to 2 weeks or longer. Patients should not increase the prescribed dosage but should contact their physicians if symptoms do not improve or if the condition worsens. Instruct patients not to stop use of AIRDUO RESPICLICK abruptly. Patients should contact their physicians immediately if they discontinue use of AIRDUO RESPICLICK.

Caring For And Storing The Inhaler

Instruct patients to not open their inhaler unless they are taking a dose. Repeated opening and closing the cover without taking medication will waste medication and may damage the inhaler.

Advise patients to keep their inhaler dry and clean at all times. Never wash or put any part of the inhaler in water. Patient should replace inhaler if washed or placed in water. Advise patients to immediately replace inhaler if mouthpiece cover is damaged or broken.

Gently wipe the mouthpiece with a dry cloth or tissue as needed.

Instruct patients to store the inhaler at room temperature and to avoid exposure to extreme heat, cold, or humidity.

Instruct patients to never take the inhaler apart.

Inform patients that AIRDUO RESPICLICK has a dose counter. When the patient receives the inhaler, the number 60 will be displayed. The dose counter will count down each time the mouthpiece cap is opened and closed. The dose-counter window displays the number of actuations left in the inhaler in units of two (e.g., 60, 58, 56, etc.). When the counter displays 20, the color of the numbers will change to red to remind the patient to contact their pharmacist for a refill of medication or consult their physician for a prescription refill. When the dose counter reaches 0, the background will change to solid red. Inform patients to discard AIRDUO RESPICLICK when the dose counter displays 0, 30 days after opening the foil pouch or after the expiration date on the product, whichever comes first.

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment Of Fertility

Fluticasone propionate demonstrated no tumorigenic potential in mice at oral doses up to 1000 mcg/kg (approximately 10 times the MRHDID for adults on a mcg/m² basis) for 78 weeks or in rats at inhalation doses up to 57 mcg/kg (approximately equivalent to the MRHDID for adults on a mcg/m² basis) for 104 weeks.

Fluticasone propionate did not induce gene mutation in prokaryotic or eukaryotic cells in vitro. No significant clastogenic effect was seen in cultured human peripheral lymphocytes in vitro or in the in vivo mouse micronucleus test.

Fertility and reproductive performance were unaffected in male and female rats at subcutaneous doses up to 50 mcg/kg (approximately equivalent to the MRHDID for adults on a mcg/m² basis).

Salmeterol

In an 18-month carcinogenicity study in CD-mice, salmeterol at oral doses of 1400 mcg/kg and above (approximately 240 times the MRHDID on a mcg/m² basis) caused a dose-related increase in the incidence of smooth muscle hyperplasia, cystic glandular hyperplasia, leiomyomas of the uterus, and ovarian cysts. No tumors were seen at 200 mcg/kg (approximately 35 times the MRHDID on a mcg/m² basis).

In a 24 month oral and inhalation carcinogenicity study in Sprague Dawley rats, salmeterol caused a dose related increase in the incidence of mesovarian leiomyomas and ovarian cysts at doses of 680 mcg/kg and above (approximately 240 times the MRHDID on a mcg/m² basis). No tumors were seen at 210 mcg/kg (approximately 75 times the MRHDID on a mcg/m² basis). These findings in rodents are similar to those reported previously for other beta adrenergic agonist drugs. The relevance of these findings to human use is unknown.

Salmeterol produced no detectable or reproducible increases in microbial and mammalian gene mutation in vitro. No clastogenic activity occurred in vitro in human lymphocytes or in vivo in a rat micronucleus test.

Fertility and reproductive performance were unaffected in male and female rats at oral doses up to 2000 mcg/kg (approximately 690 times the MRHDID for adults on a mcg/m² basis).

Use In Specific Populations

Pregnancy

Risk Summary

There are no randomized clinical studies of AIRDUO RESPICLICK or individual monoproducts, fluticasone propionate and salmeterol xinafoate, in pregnant women. There are clinical considerations with the use of AIRDUO RESPICLICK in pregnant women [see Clinical Considerations]. Animal reproduction studies are available with the combination of fluticasone propionate and salmeterol xinafoate as well as individual monoproducts. In animals, teratogenicity characteristic of corticosteroids, decreased fetal body weight and/or skeletal variations, in rats, mice, and rabbits were observed with subcutaneously administered maternal toxic doses of fluticasone propionate less than the maximum recommended human daily inhaled dose (MRHDID) on a mcg/m² basis [see Data]. However, fluticasone propionate administered via inhalation to rats decreased fetal body weight, but did not induce teratogenicity at a maternal toxic dose less than the MRHDID on a mcg/m² basis [see Data]. Experience with oral corticosteroids suggests that rodents are more prone to teratogenic effects from corticosteroids than humans. Oral administration of salmeterol to pregnant rabbits caused teratogenicity characteristic of beta-adrenoceptor stimulation at maternal doses approximately 700 times the MRHDID on a mcg/m² basis. These adverse effects generally occurred at large multiples of the MRHDID when salmeterol was administered by the oral route to achieve high systemic exposures. No such effects occurred at an oral salmeterol dose approximately 420 times the MRHDID [see Data].

The estimated risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

Clinical Considerations

Disease-Associated Maternal and/or Embryo/Fetal Risk

In women with poorly or moderately controlled asthma, there is an increased risk of several perinatal adverse outcomes such as preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate. Pregnant women with asthma should be closely monitored and medication adjusted as necessary to maintain optimal asthma control.

Data

Animal Data

Fluticasone Propionate and Salmeterol: In an embryo/fetal development study with pregnant rats that received the combination of subcutaneous administration of fluticasone propionate and oral administration of salmeterol at doses of 0/1000, 30/0, 10/100, 30/1000, and 100/10,000 mcg/kg/day (as fluticasone propionate/salmeterol) during the period of organogenesis, findings were generally consistent with the individual monoproducts and there was no exacerbation of expected fetal effects. Omphalocele, increased embryo/fetal deaths, decreased body weight, and skeletal variations were observed in rat fetuses, in the presence of maternal toxicity, when combining fluticasone propionate at a dose approximately 2 times the MRHDID (on a mcg/m² basis at a maternal subcutaneous dose of 100 mcg/kg/day) and a dose of salmeterol at approximately 3500 times the MRHDID (on a mcg/m² basis at a maternal oral dose of 10,000 mcg/kg/day). The rat no observed adverse effect level (NOAEL) was observed when combining fluticasone propionate at a dose 0.6 times the MRHDID (on a mcg/m² basis at a maternal subcutaneous dose of 30 mcg/kg/day) and a dose of salmeterol at approximately 350 times the MRHDID (on a mcg/m² basis at a maternal oral dose of 1000 mcg/kg/day).

In an embryo/fetal development study with pregnant mice that received the combination of subcutaneous administration of fluticasone propionate and oral administration of salmeterol at doses of 0/1400, 40/0, 10/200, 40/1400, or 150/10,000 mcg/kg/day (as fluticasone propionate/salmeterol) during the period of organogenesis, findings were generally consistent with the individual monoproducts and there was no exacerbation of expected fetal effects. Cleft palate, fetal death, increased implantation loss, and delayed ossification were observed in mouse fetuses when combining fluticasone propionate at a dose approximately 1.4 times the MRHDID (on a mcg/m² basis at a maternal subcutaneous dose of 150 mcg/kg/day) and salmeterol at a dose approximately 1470 times the MRHDID (on a mcg/m² basis at a maternal oral dose of 10,000 mcg/kg/day). No developmental toxicity was observed at combination doses of fluticasone propionate up to approximately 0.8 times the MRHDID (on a mcg/m² basis at a maternal subcutaneous dose of 40 mcg/kg) and doses of salmeterol up to approximately 420 times the MRHDID (on a mcg/m² basis at a maternal oral dose of 1400 mcg/kg).

Fluticasone Propionate: In embryo/fetal development studies with pregnant rats and mice dosed by the subcutaneous route throughout the period of organogenesis, fluticasone propionate was teratogenic in both species. Omphalocele, decreased body weight, and skeletal variations were observed in rat fetuses, in the presence of maternal toxicity, at a dose approximately 2 times the MRHDID (on a mcg/m² basis with a maternal subcutaneous dose of 100 mcg/kg/day). The rat NOAEL was observed at approximately 0.6 times the MRHDID (on a mcg/m² basis with a maternal subcutaneous dose of 30 mcg/kg/day). Cleft palate and fetal skeletal variations were observed in mouse fetuses at a dose approximately 0.5 times the MRHDID (on a mcg/m² basis with a maternal subcutaneous dose of 45 mcg/kg/day). The mouse NOAEL was observed with a dose approximately 0.16 times the MRHDID (on a mcg/m² basis with a maternal subcutaneous dose of 15 mcg/kg/day).

In an embryo/fetal development study with pregnant rats dosed by the inhalation route throughout the period of organogenesis, fluticasone propionate produced decreased fetal body weights and skeletal variations, in the presence of maternal toxicity, at a dose approximately 0.5 times the MRHDID (on a mcg/m² basis with a maternal inhalation dose of 25.7 mcg/kg/day); however, there was no evidence of teratogenicity. The NOAEL was observed with a dose approximately 0.1 times the MRHDID (on a mcg/m² basis with a maternal inhalation dose of 5.5 mcg/kg/day).

In an embryo/fetal development study in pregnant rabbits that were dosed by the subcutaneous route throughout organogenesis, fluticasone propionate produced reductions of fetal body weights, in the presence of maternal toxicity at doses approximately 0.02 times the MRHDID and higher (on a mcg/m² basis with a maternal subcutaneous dose of 0.57 mcg/kg/day). Teratogenicity was evident based upon a finding of cleft palate for 1 fetus at a dose approximately 0.2 times the MRHDID (on a mcg/m² basis with a maternal subcutaneous dose of 4 mcg/kg/day). The NOAEL was observed in rabbit fetuses with a dose approximately 0.004 times the MRHDID (on a mcg/m² basis with a maternal subcutaneous dose of 0.08 mcg/kg/day).

In a pre-and post-natal development study in pregnant rats dosed by the subcutaneous route from late gestation through delivery and lactation (Gestation Day 17 to Postpartum Day 22), fluticasone propionate was not associated with decreases in pup body weight, and had no effects on developmental landmarks, learning, memory, reflexes, or fertility at doses up to approximate equivalence to the MRHDID (on a mcg/m² basis with maternal subcutaneous doses up to 50 mcg/kg/day).

Fluticasone propionate crossed the placenta following subcutaneous administration to mice and rats and oral administration to rabbits.

Salmeterol: In three embryo/fetal development studies, pregnant rabbits received oral administration of salmeterol at doses ranging from 100 to 10,000 mcg/kg/day during the period of organogenesis. In pregnant Dutch rabbits administered salmeterol doses approximately 700 times the MRHDID (on a mcg/m² basis at maternal oral doses of 1000 mcg/kg/day and higher), fetal toxic effects were observed characteristically resulting from beta-adrenoceptor stimulation. These included precocious eyelid openings, cleft palate, sternebral fusion, limb and paw flexures, and delayed ossification of the frontal cranial bones. No such effects occurred at a salmeterol dose approximately 420 times the MRHDID (on a mcg/m² basis at a maternal oral dose of 600 mcg/kg/day). New Zealand White rabbits were less sensitive since only delayed ossification of the frontal cranial bones was seen at a salmeterol dose approximately 7,000 times the MRHDID (on a mcg/m² basis at a maternal oral dose of 10,000 mcg/kg/day).

In two embryo/fetal development studies, pregnant rats received salmeterol by oral administration at doses ranging from 100 to 10,000 mcg/kg/day during the period of organogenesis. Salmeterol produced no maternal toxicity or embryo/fetal effects at doses up to 3500 times the MRHDID (on a mcg/m² basis at maternal oral doses up to 10,000 mcg/kg/day).

In a peri-and post-natal development study in pregnant rats dosed by the oral route from late gestation through delivery and lactation, salmeterol at a dose 3500 times the MRHDID (on mcg/m² basis with a maternal oral dose of 10,000 mcg/kg/day) was fetotoxic and decreased the fertility of survivors.

Salmeterol xinafoate crossed the placenta following oral administration to mice and rats.

Lactation

Risk Summary

There are no available data on the presence of fluticasone propionate or salmeterol in human milk, the effects on the breastfed child, or the effects on milk production. Other corticosteroids have been detected in human milk. However, fluticasone propionate and salmeterol concentrations in plasma after inhaled therapeutic doses are low and therefore concentrations in human breast milk are likely to be correspondingly low [see CLINICAL PHARMACOLOGY]. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for AIRDUO RESPICLICK and any potential adverse effects on the breastfed child from AIRDUO RESPICLICK or from the underlying maternal condition.

Data

Animal Data

Subcutaneous administration of tritiated fluticasone propionate at a dose in lactating rats approximately 0.2 times the MRHDID for adults (on a mcg/m² basis) resulted in measurable levels in milk. Oral administration of salmeterol at a dose in lactating rats approximately 2900 times the MRHDID for adults (on a mcg/m² basis) resulted in measurable levels in milk.

Pediatric Use

The safety and effectiveness of AIRDUO RESPICLICK in pediatric patients below the age of 12 years have not been established.

Inhaled corticosteroids, including fluticasone propionate, a component of AIRDUO RESPICLICK, may cause a reduction in growth velocity in adolescents [see WARNINGS AND PRECAUTIONS]. The growth of pediatric patients receiving orally inhaled corticosteroids, including AIRDUO RESPICLICK, should be monitored.

If an adolescent on any corticosteroid appears to have growth suppression, the possibility that he/she is particularly sensitive to this effect of corticosteroids should be considered. The potential growth effects of prolonged treatment should be weighed against the clinical benefits obtained. To minimize the systemic effects of orally inhaled corticosteroids, including AIRDUO RESPICLICK, each patient should be titrated to the lowest strength that effectively controls his/her asthma [see DOSAGE AND ADMINISTRATION].

Geriatric Use

No overall differences in safety or efficacy were observed in data collected in 54 subjects aged 65 years and older versus younger subjects who were treated with AIRDUO RESPICLICK in placebo-controlled Phase 2 and 3 studies.

Hepatic Impairment

Formal pharmacokinetic studies using AIRDUO RESPICLICK have not been conducted in patients with hepatic impairment. However, since both fluticasone propionate and salmeterol are predominantly cleared by hepatic metabolism, impairment of liver function may lead to accumulation of fluticasone propionate and salmeterol in plasma. Therefore, patients with hepatic disease should be closely monitored.

Renal Impairment

Formal pharmacokinetic studies using AIRDUO RESPICLICK have not been conducted in patients with renal impairment.

Overdosage & Contraindications

OVERDOSE

AIRDUO RESPICLICK contains both fluticasone propionate and salmeterol; therefore, the risks associated with overdosage for the individual components described below apply to AIRDUO RESPICLICK. Treatment of overdosage consists of discontinuation of AIRDUO RESPICLICK together with institution of appropriate symptomatic and/or supportive therapy. The judicious use of a cardioselective beta-receptor blocker may be considered, bearing in mind that such medication can produce bronchospasm. Cardiac monitoring is recommended in cases of overdosage.

Fluticasone Propionate

Chronic overdosage of fluticasone propionate may result in signs/symptoms of hypercorticism [see WARNINGS AND PRECAUTIONS]. Inhalation by healthy volunteers of a single dose of 4,000 mcg of fluticasone propionate inhalation powder or single doses of 1,760 or 3,520 mcg of fluticasone propionate CFC inhalation aerosol was well tolerated. Fluticasone propionate given by inhalation aerosol at dosages of 1,320 mcg twice daily for 7 to 15 days to healthy human volunteers was also well tolerated. Repeat oral doses up to 80 mg daily for 10 days in healthy volunteers and repeat oral doses up to 20 mg daily for 42 days in subjects were well tolerated. Adverse reactions were of mild or moderate severity, and incidences were similar in active and placebo treatment groups.

Salmeterol

The expected signs and symptoms with overdosage of salmeterol are those of excessive beta-adrenergic stimulation and/or occurrence or exaggeration of any of the signs and symptoms of beta-adrenergic stimulation (e.g., seizures, angina, hypertension or hypotension, tachycardia with rates up to 200 beats/min, arrhythmias, nervousness, headache, tremor, muscle cramps, dry mouth, palpitation, nausea, dizziness, fatigue, malaise, insomnia, hyperglycemia, hypokalemia, metabolic acidosis). Overdosage with salmeterol can lead to clinically significant prolongation of the QTc interval, which can produce ventricular arrhythmias.

As with all inhaled sympathomimetic medicines, cardiac arrest and even death may be associated with an overdose of salmeterol.

CONTRAINDICATIONS

Status Asthmaticus

AIRDUO RESPICLICK is contraindicated in the primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required [see WARNINGS AND PRECAUTIONS].

Hypersensitivity

AIRDUO RESPICLICK is contraindicated in patients with known severe hypersensitivity to milk proteins or who have demonstrated hypersensitivity to fluticasone propionate or any of the excipients [see WARNINGS AND PRECAUTIONS, DESCRIPTION].

Clinical Pharmacology

PATIENT INFORMATION

AIRDUO® RESPICLICK®
(ayr' due oh res-pe-klik)
(fluticasone propionate and salmeterol)
inhalation powder 55 mcg/14 mcg

AIRDUO RESPICLICK
(ayr' due oh res-pe-klik)
(fluticasone propionate and salmeterol)
inhalation powder 113 mcg/14 mcg

AIRDUO RESPICLICK
(ayr" due oh res-pe-klik)
(fluticasone propionate and salmeterol)
inhalation powder 232 mcg/14 mcg

for oral inhalation use

What is AIRDUO RESPICLICK?

  • AIRDUO RESPICLICK combines the inhaled corticosteroid (ICS) medicine fluticasone propionate and the LABA medicine salmeterol.
  • ICS medicines such as fluticasone propionate help to decrease inflammation in the lungs. Inflammation in the lungs can lead to breathing problems.
  • LABA medicines such as salmeterol help the muscles around the airways in your lungs stay relaxed to prevent symptoms, such as wheezing, cough, chest tightness, and shortness of breath. These symptoms can happen when the muscles around the airways tighten. This makes it hard to breathe.
  • AIRDUO RESPICLICK is a prescription medicine used to control symptoms of asthma and to prevent symptoms such as wheezing in people 12 years of age and older.
    • AIRDUO RESPICLICK contains salmeterol. LABA medicines such as salmeterol when used alone increase the risk of hospitalizations and death from asthma problems. AIRDUO RESPICLICK contains an ICS and a LABA. When an ICS and LABA are used together, there is not a significant increased risk in hospitalizations and death from asthma problems.
    • AIRDUO RESPICLICK is not for people 12 years of age and older with asthma who are well controlled with an asthma control medicine, such as a low or medium dose of an inhaled corticosteroid medicine. AIRDUO RESPICLICK is for people 12 years of age and older with asthma who need both an ICS and LABA medicine.
    • AIRDUO RESPICLICK is not used to relieve sudden breathing problems and will not replace a rescue inhaler.
    • It is not known if AIRDUO RESPICLICK is safe and effective in children younger than 12 years of age.

Do not use AIRDUO RESPICLICK:

  • to treat sudden, severe symptoms of asthma.
  • if you have a severe allergy to milk proteins. Ask your healthcare provider if you are not sure.
  • if you are allergic to fluticasone propionate or any of the inactive ingredients in AIRDUO RESPICLICK. See the end of this leaflet for a complete list of ingredients in AIRDUO RESPICLICK.

Tell your healthcare provider about all of your medical conditions, including if you:

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. AIRDUO RESPICLICK and certain other medicines may interact with each other. This may cause serious side effects. Especially, tell your healthcare provider if you take antifungal or anti-HIV medicines.

How should I use AIRDUO RESPICLICK?

  • Read the step-by-step instructions for using AIRDUO RESPICLICK at the end of this Patient Information leaflet.
  • AIRDUO RESPICLICK comes in 3 different strengths. Your healthcare provider prescribed the strength that is best for you.
  • Use AIRDUO RESPICLICK exactly as your healthcare provider tells you to use it. Do not use AIRDUO RESPICLICK more often than prescribed.
  • Use 1 inhalation of AIRDUO RESPICLICK 2 times each day. Use AIRDUO RESPICLICK at the same time each day, about 12 hours apart. If you miss a dose of AIRDUO RESPICLICK, just skip that dose. Take your next dose at your usual time. Do not take 2 doses at one time.
  • If you take too much AIRDUO RESPICLICK, call your healthcare provider or go to the nearest hospital emergency room right away if you have any unusual symptoms, such as worsening shortness of breath, chest pain, increased heart rate, or shakiness.
  • Do not use other medicines that contain a LABA for any reason. Examples of other medicines that contain a LABA include salmeterol, formoterol fumarate, arformoterol tartrate, and indacaterol. Ask your healthcare provider or pharmacist if any of your other medicines are LABA medicines.
  • Do not stop using AIRDUO RESPICLICK unless told to do so by your healthcare provider because your symptoms might get worse. Your healthcare provider will change your medicines as needed.
  • AIRDUO RESPICLICK does not relieve sudden asthma symptoms. You should not take extra doses of AIRDUO RESPICLICK to relieve sudden asthma symptoms. Always have a rescue inhaler with you to treat sudden asthma symptoms. If you do not have a rescue inhaler, call your healthcare provider to have one prescribed for you.
  • Call your healthcare provider or get medical care right away if:
    • your breathing problems get worse.
    • you need to use your rescue inhaler more often than usual.
    • your rescue inhaler does not work as well to relieve your symptoms.
    • your peak flow meter results decrease. Your healthcare provider will tell you the numbers that are right for you.
    • you have asthma and your symptoms do not improve after using AIRDUO RESPICLICK regularly for one week.

What are the possible side effects with AIRDUO RESPICLICK?

AIRDUO RESPICLICK can cause serious side effects, including:

  • fungal infection in your mouth and throat (thrush). Rinse your mouth with water without swallowing after using AIRDUO RESPICLICK to help reduce your chance of getting thrush.
  • weakened immune system and increased chance of getting infections (immunosuppression).
  • reduced adrenal function (adrenal insufficiency). Adrenal insufficiency is a condition where the adrenal glands do not make enough steroid hormones. This can happen when you stop taking oral corticosteroid medicines (such as prednisone) and start taking a medicine containing an inhaled steroid (such as AIRDUO RESPICLICK). When your body is under stress such as from fever, trauma (such as a car accident), infection, or surgery, adrenal insufficiency can get worse and may cause death.
    Symptoms of adrenal insufficiency include:
  • sudden breathing problems immediately after inhaling your medicine. If you have sudden breathing problems immediately after inhaling your medicine, stop using AIRDUO RESPICLICK and call your healthcare provider right away.
  • serious allergic reactions. Stop using AIRDUO RESPICLICK and call your healthcare provider or get emergency medical help if you get any of the following symptoms of a serious allergic reaction:
    • rash
    • hives
    • swelling of your face, mouth, and tongue
    • breathing problems
  • effects on heart.
  • effects on nervous system.
  • bone thinning or weakness (osteoporosis).
  • slowed growth in children. The growth of a child should be checked often.
  • eye problems including glaucoma and cataracts. You should have regular eye exams while using AIRDUO RESPICLICK.
  • changes in laboratory blood values (sugar, potassium, certain types of white blood cells).

Common side effects of AIRDUO RESPICLICK include:

  • infection of nose and throat (nasopharyngitis)
  • thrush in your mouth or throat. Rinse your mouth with water without swallowing after use to help prevent this.
  • back pain
  • headache
  • cough

These are not all the possible side effects of AIRDUO RESPICLICK.

Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store AIRDUO RESPICLICK?

  • Store AIRDUO RESPICLICK at room temperature between 59°F and 77°F (15°C and 25°C).
  • Avoid exposure to extreme heat, cold, or humidity.
  • Store AIRDUO RESPICLICK in the unopened foil pouch and only open when ready for use.
  • Keep the yellow cap on the inhaler closed during storage.
  • Keep your AIRDUO RESPICLICK inhaler dry and clean at all times.
  • Throw away AIRDUO RESPICLICK 30 days after opening the foil pouch, when the dose counter displays ‘0’, or after the expiration date on the product, whichever comes first.

Keep AIRDUO RESPICLICK and all medicines out of the reach of children.

General information about the safe and effective use of AIRDUO RESPICLICK.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use AIRDUO RESPICLICK for a condition for which it was not prescribed. Do not give AIRDUO RESPICLICK to other people, even if they have the same symptoms that you have. It may harm them.

You can ask your healthcare provider or pharmacist for information about AIRDUO RESPICLICK that is written for health professionals.

What are the ingredients in AIRDUO RESPICLICK?

Active ingredients: fluticasone propionate, salmeterol xinafoate

Inactive ingredient: lactose monohydrate (may contain milk proteins)

Instructions for Use

AIRDUO RESPICLICK®
(ayr´due oh res-pe-klik)
(fluticasone propionate and salmeterol)
inhalation powder 55 mcg/14 mcg

AIRDUO RESPICLICK
(ayr´due oh res-pe-klik)
(fluticasone propionate and salmeterol)
inhalation powder 113 mcg/14 mcg

AIRDUO RESPICLICK
(ayr´due oh res-pe-klik)
(fluticasone propionate and salmeterol)
inhalation powder 232 mcg/14 mcg
for oral inhalation use

Your AIRDUO RESPICLICK Inhaler

When you are ready to use AIRDUO RESPICLICK for the first time, remove the AIRDUO RESPICLICK inhaler from the foil pouch.

There are 2 main parts of your AIRDUO RESPICLICK inhaler including the:

  • white inhaler with the mouthpiece. See Figure A.
  • yellow cap that covers the mouthpiece of the inhaler. See Figure A.

There is a dose counter in the back of the inhaler with a viewing window that shows you how many doses of medicine you have left. See Figure A.

White inhaler with the mouthpiece and yellow cap that covers the mouthpiece of the inhaler - Illustration

Figure A

  • Your AIRDUO RESPICLICK inhaler contains 60 doses (inhalations). See Figure B.
  • The dose counter shows the number of doses left in your inhaler.
  • When there are 20 doses left, the color of the numbers on the dose counter will change to red and you should refill your prescription or ask your healthcare provider for another prescription.
  • When the dose counter displays ‘0’ your inhaler is empty and you should stop using the inhaler and throw it away. See Figure B.

Dose indicator - Illustration

Figure B

Important:

  • Always close the cap after each inhalation so your inhaler will be ready for you to take your next dose. Do not open the cap unless you are ready for your next dose.
  • You will hear a “click” sound when the cap is opened all the way. If you do not hear the “click” sound the inhaler may not be activated to give you a dose of medicine.
  • AIRDUO RESPICLICK does not have an activation button or medicine canister. When you open the cap, a dose of AIRDUO will be activated for delivery of the medicine.
  • Do not use a spacer or volume holding chamber with AIRDUO RESPICLICK. AIRDUO RESPICLICK does not need priming.

Using your AIRDUO RESPICLICK inhaler:

Important: Make sure the cap is closed before you start using your inhaler.

Step 1. Open

  • Hold the inhaler upright and open the yellow cap all the way until it “clicks”. See Figure C
  • Each time you open the yellow cap and it “clicks”, 1 dose of AIRDUO RESPICLICK is ready to be inhaled.
  • Hold the inhaler upright and open the yellow cap all the way until it “clicks” - Illustration

    Figure C

Remember:

  • For the correct use of AIRDUO RESPICLICK, hold the inhaler upright as you open the yellow cap. See Figure D.
  • Do not hold the inhaler in any other way as you open the yellow cap.
  • Do not open the yellow cap until you are ready to take a dose of AIRDUO RESPICLICK.
  • For the correct use of AIRDUO RESPICLICK, hold the inhaler upright as you open the yellow cap - Illustration

    Figure D

Step 2. Inhale

  • Before you inhale, breathe out (exhale) through your mouth and push as much air from your lungs as you can. See Figure E.
  • Do not exhale into the inhaler mouthpiece.
  • Before you inhale, breathe out (exhale) through your mouth and push as much air from your lungs as you can - Illustration

    Figure E

  • Put the mouthpiece in your mouth and close your lips tightly around it. See Figure F.
  • Put the mouthpiece in your mouth and close your lips tightly around it - Illustration

    Figure F

  • Do not block the vent above the mouthpiece with your lips or fingers. See Figure G.
  • Do not block the vent above the mouthpiece with your lips or fingers - Illustration

    Figure G

  • Breathe in quickly and deeply through your mouth to deliver the dose of medicine to your lungs.
  • Remove the inhaler from your mouth.
  • Hold your breath for about 10 seconds or for as long as you comfortably can.
  • Your AIRDUO RESPICLICK inhaler delivers your dose of medicine as a very fine powder that you may or may not taste or feel. Do not take an extra dose from the inhaler even if you do not taste or feel the medicine.

Step 3. Close

Close the yellow cap firmly over the mouthpiece - Illustration

Figure H

  • Close the yellow cap firmly over the mouthpiece. See Figure H.
  • Make sure you close the yellow cap after each inhalation so that the inhaler will be ready for your next dose.
  • Rinse your mouth with water without swallowing after each inhalation.

How should I store AIRDUO RESPICLICK?

  • Store AIRDUO RESPICLICK at room temperature between 59°F and 77°F (15°C and 25°C).
  • Avoid exposure to extreme heat, cold, or humidity.
  • Store AIRDUO RESPICLICK in the unopened foil pouch and only open when ready for use.
  • Keep the yellow cap on the inhaler closed during storage.
  • Keep your AIRDUO RESPICLICK inhaler dry and clean at all times.
  • Keep your AIRDUO RESPICLICK inhaler and all medicines out of the reach of children.

Cleaning your AIRDUO RESPICLICK inhaler

  • Do not wash or put any part of your AIRDUO RESPICLICK inhaler in water. Replace your inhaler if washed or placed in water.
  • AIRDUO RESPICLICK contains a powder and must be kept clean and dry at all times.
  • You can clean the mouthpiece if needed using a dry cloth or tissue. Routine cleaning is not required.

Replacing your AIRDUO RESPICLICK inhaler

  • Immediately replace your inhaler if the mouthpiece cover is damaged or broken. Never take the inhaler apart.
  • The dose counter on the back of your inhaler shows how many doses you have left.
  • When there are 20 doses left, the color of the numbers on the dose counter will change to red and you should refill your prescription or ask your healthcare provider for another prescription.
  • When the counter displays ‘0’ your AIRDUO RESPICLICK inhaler is empty and you should stop using the inhaler and throw it away.
  • Throw away AIRDUO RESPICLICK 30 days after opening the foil pouch, when the dose counter displays ‘0’, or after the expiration date on the product, whichever comes first.

Important information

  • Do not open the yellow cap unless you are taking a dose. Repeatedly opening and closing the cap without inhaling a dose will waste the medicine and may damage your inhaler.
  • Your AIRDUO RESPICLICK inhaler contains dry powder so it is important that you do not blow or breathe into it.

Support

  • If you have any questions about AIRDUO RESPICLICK or how to use your inhaler, go to www.AIRDUORESPICLICK.com, or call 1-888-482-9522.

These Instructions for Use have been approved by the U.S. Food and Drug Administration.

Medication Guide

PATIENT INFORMATION

No information provided. Please refer to the WARNINGS AND PRECAUTIONS sections.

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Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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