Fluticasone with eformoterol (Flutiform) for asthma

Published in Medicine Update

Date published: About this date

Health and medicines information in this article may have changed since the date published. This information does not replace advice from a health professional.

This Medicine Update is for people with asthma who are using, or thinking about using, Flutiform (containing fluticasone propionate with eformoterol).

Summary

What is Flutiform?

Fluticasone with eformoterol (brand name Flutiform) is a new inhaled combination of two medicines currently available in separate inhalers. It is a preventer medicine that can be used regularly for long-term control of your asthma. The two active ingredients are:

  • fluticasone (a corticosteroid), and
  • eformoterol (a long-acting beta2-receptor agonist).

Who is Flutiform for?

If fluticasone alone is not effective enough to treat your asthma symptoms, you may be prescribed eformoterol as well. In this case, Flutiform, a combination of fluticasone and eformoterol, may be suitable for you.

You may also be prescribed Flutiform if you are already using fluticasone and eformoterol as separate inhaled medicines, or if your doctor decides to change to this combination from your current combination inhaled corticosteroid and long-acting bronchodilator treatment.

Using Flutiform

If you are using Flutiform (fluticasone with eformoterol) you must not also use fluticasone or eformoterol separately or in any another combination medicine. This could result in you accidentally having a higher dose of either, or both, active ingredients, which could lead to serious side effects.

If you are prescribed Flutiform, you will still need to carry and use your asthma reliever medicine (e.g. salbutamol, terbutaline) when you experience asthma symptoms, but you should not take any other inhaled corticosteroids or long-acting beta2-receptor agonist medicines.

Check with your doctor about which medicines you should stop and which you should continue. Take any medicines you don't need to your pharmacy for safe disposal.

Possible side effects of Flutiform

Possible side effects of Flutiform include throat irritation, headache, thrush infection in the mouth and throat, and hoarseness.

Tell your doctor immediately if you have difficulty breathing or other signs of severe allergy such as swelling of the face, mouth, tongue or throat, itchiness or skin rash.

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What is Flutiform?

Flutiform is a combination inhaled medicine that can be used to treat asthma. It contains two active ingredients:

  • fluticasone (pronounced floo-tikka-zone) — an inhaled corticosteroid
  • eformoterol (pronounced ef-for-mot-er-roll) — a long-acting beta2-receptor agonist.

Flutiform is the brand name.

The active ingredient is the chemical in the medicine that makes the medicine work.

Many medicines are known by their brand names as well as by the name of the active ingredient. Some medicines are available under several different brand names.

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What is Flutiform for?

Flutiform can be used to treat asthma in people:

  • whose asthma symptoms are not well controlled with an inhaled corticosteroid medicine alone
  • who need to have a long-acting beta2-receptor agonist added to the corticosteroid to improve the effect
  • who are already using fluticasone and eformoterol as separate medicines, and whose dose of both medicines is stable.

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What does Flutiform do?

When used regularly over time, Flutiform works by preventing the symptoms of asthma (e.g. wheeze, cough, shortness of breath) and by controlling the underlying airway inflammation that causes these.

Fluticasone

The fluticasone in Flutiform prevents asthma symptoms by:

  • reducing inflammation (i.e. swelling) in the airways
  • reducing the sensitivity/reactivity of the airways to irritants in the environment.

Fluticasone works by inhibiting some of the cells and chemicals in the body responsible for causing allergic reactions and inflammation in the tissues of the airways.

Eformoterol

The eformoterol in Flutiform prevents asthma symptoms by relaxing the muscles surrounding the airways, opening the airways more widely and allowing more air into the lungs.

Eformoterol does this by stimulating receptors in your airways called beta2 receptors, which cause the muscles surrounding the airways to relax. You may hear it referred to as a 'symptom controller' or long-acting beta2-receptor agonist medicine.

Flutiform doesn't treat an asthma attack

Flutiform must not be used to treat an asthma emergency, or to treat the symptoms of an asthma attack. This is because during an asthma attack, you need a fast-acting treatment to control your asthma symptoms. Flutiform is a long-term controller medication and has not been approved for use in the case of an asthma emergency or asthma attack. It should be used every day for a long period of time to prevent asthma symptoms.

Even if you are using Flutiform, you will still need to carry your asthma reliever medicine — such as salbutamol or terbutaline — with you in case you need to use it in an asthma emergency.

Talk with your health professional about all the treatment options for asthma.

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Who is Flutiform for?

If fluticasone alone is not effective enough to treat your asthma symptoms, you may be prescribed eformoterol as well. In this case, Flutiform, a combination of fluticasone and eformoterol, may be suitable for you.

You may also be prescribed Flutiform if you are already using fluticasone and eformoterol as separate inhaled medicines, or if your doctor decides to change to this combination from your current combination inhaled corticosteroid and long-acting bronchodilator treatment.

Can I get Flutiform through the PBS?

You can be prescribed Flutiform through the PBS if your asthma is not controlled with corticosteroids alone.

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Who should not use Flutiform?

You should not use Flutiform if you:

  • are allergic to fluticasone, eformoterol or to any of the inactive ingredients
  • are also using fluticasone and/or eformoterol as separate medicines
  • have COPD (chronic obstructive pulmonary disease)
  • are using another combination inhaled corticosteroid and long-acting bronchodilator.

Flutiform may not be suitable for some people. If you have asthma and one of the conditions listed below, tell your doctor so that they can decide if Flutiform is suitable for you:

  • tuberculosis or any other untreated infection
  • heart disease or high blood pressure
  • an abnormal heart rhythm
  • an overactive thyroid
  • diabetes
  • impaired adrenal function
  • severe liver problems
  • previous long-term treatment with corticosteroids
  • low potassium levels (e.g. if you are taking diuretic medicines to prevent fluid retention).

Tell all your health professionals that you are using Flutiform to treat your asthma symptoms. You may need to take additional steroid medicines if, for example, you have an infection or trauma, or recently had surgery.

As well as the active ingredient(s), medicines contain other ingredients known as excipients or 'inactive ingredients'.

Excipients are ingredients such as fillers, binders or coatings. For most people, inactive ingredients won't matter. However, if you have particular allergies or intolerances, or avoid certain substances for cultural or medical reasons you may need to know what excipients are in your medicine.

You can find a list of excipients under 'inactive ingredients in the consumer medicine information (CMI).

Flutiform is not recommended for children under 12 years

The safety of Flutiform for children younger than 12 years of age has not yet been tested.

At the time of publication, Flutiform is not recommended for children under 12 years of age.

Pregnancy and breastfeeding

Tell your doctor as soon as you know you are pregnant, or if you are planning a pregnancy, so that they can advise you on how best to manage your asthma while you are pregnant or breastfeeding.

If you are pregnant or breastfeeding, it is vital that your asthma is well controlled for your health and your baby's health. If your asthma is not well controlled, the risk to your baby is much greater than the risk of taking your asthma medicines. So it's very important that you keep using your usual asthma medicines to avoid having an asthma attack during pregnancy.

You should see your doctor regularly during your pregnancy to review your asthma and to check your lung function.

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How to use Flutiform

Flutiform comes in a pressurised metered dose inhaler (or pMDI). Learning to use your inhaler properly will help to ensure you receive the full dose of your medicine on each use.

Your health professional will show you how to use your pMDI correctly.

Inhale two puffs of Flutiform twice daily (e.g. two puffs every morning and two puffs every night) even if you don't have any asthma symptoms. Rinse out your mouth, or gargle with water or brush your teeth after inhaling and spit out the residue to prevent thrush in the mouth and throat, and hoarseness of the voice.

Your inhaler should last about 30 days with correct daily use; however, you may use the Flutiform inhaler for up to 3 months after opening the foil pouch, or until the dose indicator reads '0' (whichever comes first). Do not use your Flutiform inhaler after the expiry date printed on the pack.

Take the old inhaler to your pharmacy for safe disposal.

Ask your asthma health professional to show you how to use your asthma delivery device correctly, or watch our videos on how to use your metered dose inhaler (with spacer) and dry powder inhaler devices (including Accuhaler, Autohaler, Handihaler and Turbuhaler.)

Use a spacer

Use an appropriate spacer device (e.g. AeroChamber Plus — a small volume spacer) with your Flutiform inhaler. This will help to ensure that as much as possible of the medicine you have inhaled reaches your lungs, particularly if you have difficulty breathing in at the same time as using the inhaler.

Using a spacer will also help to reduce the chance of side effects, such as hoarseness, or thrush in the mouth and throat.

Rinsing out your mouth and gargling after using Flutiform (whether or not you use a spacer) will also reduce these side effects.

Available dose combinations

Flutiform is available in 3 different dose combinations:

  • 50 micrograms fluticasone with 5 micrograms eformoterol
  • 125 micrograms fluticasone with 5 micrograms eformoterol
  • 250 micrograms fluticasone with 10 micrograms eformoterol.

Adjusting your dose of Flutiform

Do not increase or decrease your Flutiform dose unless advised to do so by your doctor.

If your asthma symptoms are still not adequately controlled with Flutiform, your doctor may advise you to:

  • try a higher strength of Flutiform
  • go back to using the individual medicines and find the dose combination that works best for you
  • change to a different combination of medicines.

To avoid overtreatment and unnecessary side effects, your doctor may lower the strength of Flutiform once you have had good asthma control for longer than 3 months. Ask your doctor to assess your asthma control. Clinical guidelines advise that for long-term treatment, the lowest dose that maintains asthma control should be prescribed.

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Important side effects to consider

Ask your health professional about the possible side effects of this medicine before you use it. Always tell them about any changes to your condition if you're taking a new medicine.

Both of the active ingredients in Flutiform can have side effects. So you may get side effects from either fluticasone or eformoterol.

For a list of all possible side effects, see the consumer medicine information (CMI) for Flutiform (fluticasone with eformoterol).

Side effects from Flutiform

As with all medicines you take, the benefits of Flutiform for controlling your asthma need to be weighed against the possible side effects.

If you have worsening asthma symptoms or signs of severe allergy such as swelling of the face, mouth, tongue or throat, itchiness or skin rash, seek medical attention immediately, or ask someone to call 000 for an ambulance.

Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following side effects:

  • angina (chest pain)
  • palpitations (rapid and/or irregular heart beat)
  • mood changes (e.g. agitation or anxiety)
  • increase in blood glucose levels — hyperglycaemia (although this is uncommon, and usually only with high doses).

Talk to your doctor if you notice any of the following side effects:

  • thrush infection in the mouth and throat
  • bronchitis
  • sinusitis
  • inflammation and/or irritation of the nose and throat
  • urinary tract infection
  • headache
  • hoarseness, changes to voice
  • nausea
  • diarrhoea
  • cough
  • dizziness
  • sleeplessness (insomnia)
  • dry mouth
  • tremor (shaking).

The terms common, uncommon and rare are used to describe the chance of getting a side effect. This is what they mean:

  • common — more than 1 in 100 people may experience this side effect
  • uncommon — more than 1 in 1000 but fewer than 1 in 100 people may experience this side effect
  • rare — fewer than 1 in 1000 people may experience this side effect.

People with questions about their medicines or seeking general information about side effects can call NPS Medicines Line on 1300 633 424.

To report possible side effects call the Adverse Medicine Events (AME) Line on 1300 134 237.

Both these services are available Monday to Friday, 9am to 5pm AEST.

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What else you should know about Flutiform

Always talk to your doctor or pharmacist before you start taking a medicine, as some medicines can interact with the active ingredients in Flutiform.

It is a good idea to make a list of all the medicines you take, including prescription, over-the-counter and complementary medicines (e.g. vitamins, minerals, herbal and natural medicines) bought from a pharmacy, supermarket, the internet or a health food store.

Order or download an NPS MedicineWise Medicines List — it is also available as an eList and smartphone app.

Show your up-to-date medicines list to your health professional and ask them about which medicines you should keep taking and which ones you should stop. Return any unused medicines including fluticasone and/or eformoterol to a pharmacy for safe disposal to avoid confusion.

Tell your doctor or pharmacist if you are taking any of the following medicines:

  • the antibiotics clarithromycin and linezolid
  • antifungal medicines containing itraconazole
  • medicines for treating HIV infection containing atazanavir, darunavir, indinavir, ritonavir, saquinavir, tipranavir
  • antidepressants containing moclobemide, phenelzine and tranylcypromine
  • procarbazine for treating some types of cancer
  • medicines for Parkinson's disease containing rasagiline and selegiline
  • diuretics such as hydrochlorothiazide and frusemide
  • medicines known as beta-blockers that are used to treat high blood pressure or glaucoma.

You may not need to avoid these medicines entirely, but your dose of these medicines may need to be changed or you may need regular checkups or tests to make sure there are no side effects or interactions.

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Other medicines for asthma

Reliever medicines

Most people with asthma will be prescribed a reliever medicine, such as salbutamol (e.g. Ventolin) or terbutaline (e.g. Bricanyl).

Reliever medicines work very quickly and are the most appropriate option for managing the symptoms of an asthma attack. However, the effects of a reliever medicine also wear off quickly after each use and so they do not help to treat the underlying airway inflammation and sensitivity of asthma.

Preventer medicines

Preventer medicines, such as inhaled corticosteroids (e.g. fluticasone, budesonide), help to treat the inflammation of the airways in people with asthma.

These medicines work effectively when used regularly over time but they don't treat the immediate symptoms of an asthma attack.

Symptom controller medicines

A symptom controller medicine, such as salmeterol or eformoterol (both long-acting bronchodilators), may be prescribed for you if your asthma symptoms are not adequately treated by an inhaled corticosteroid medicine alone.

These medicines also work best when used regularly over time but do not treat the immediate symptoms of an asthma attack.

Symptom controller medicines are always prescribed alongside at least one other asthma medicine that is used to control the underlying inflammation in the airways.

Other combination medicines

Aside from Flutiform, two other combination medicines for asthma are available. These are Seretide (fluticasone with salmeterol) and Symbicort (budesonide with eformoterol).

Like Flutiform, Seretide and Symbicort are prescribed for people with asthma who need both an inhaled corticosteroid medicine and a symptom controller medicine to treat their asthma symptoms effectively.

Some other medicines that may be prescribed for people with asthma are:

  • nedocromil (Tilade inhaler) — a preventer medicine
  • cromoglycate (Intal inhaler) — a preventer medicine
  • omalizumab (Xolair injection) — a medicine for treating allergic asthma
  • montelukast (Singulair tablet) — a preventer medicine mainly used in children.

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How to decide between Flutiform and other asthma medicines

Your doctor will help you to understand the potential risks and benefits of Flutiform. The benefits and side effects differ between medicines and from person to person. Your doctor will consider whether:

  • the active ingredients in Flutiform are right for you
  • a combination medicine is suitable for you.

Combinations versus single medicines

Talk with your health professional about all your asthma treatment options. Using a combination medicine may be more convenient for you than using the two different medicines individually, and it will usually cost you less.

However, using medicines individually can be better for some people. For example, if you experience a side effect or interaction, it is easier to work out which medicine is the cause.

When you start a combination medicine, there is the risk that you might accidentally continue using one of the individual medicines as well as the combination medicine, as they will have different brand names. This may result in you using more of the medicine than you need.

It is more complicated to adjust the dose when you are using a combination medicine. Getting the doses right by first using each medicine individually can help to avoid this problem.

Read more about combination medicines.

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What does Flutiform cost?

Cost to the individual

If you are prescribed a medicine through the Pharmaceutical Benefits Scheme (PBS), you will only pay up to a threshold amount called the co-payment. The Australian Government pays any remaining amount to make up the total cost of the medicine.

At the time of publication, the maximum co-payment for people who are entitled to get Flutiform through the PBS is:

  • $36.10 for people without a concession card
  • $5.90 for concession card holders.

If you do not meet the criteria to get Flutiform on the PBS, you will need to pay the full price for a prescription. This can be a different amount from the amount the medicine costs the Australian Government because the cost of private prescriptions varies between pharmacies.

Read more about the PBS and how to keep your medicines costs down.

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Other ways to help manage asthma

You can better-manage your asthma by avoiding asthma triggers and maintaining a healthy lifestyle, diet, and physical activity.

Get an Asthma Action Plan

If you don't have one already, ask your doctor to help you with your personalised Asthma Action Plan. Your written Asthma Action Plan contains details about:

  • what medicines to take regularly
  • how to tell if your asthma symptoms are getting worse and what to do about it
  • what to do if you are having an asthma attack.

You can download an Asthma Action Plan from Asthma Australia. Your doctor will help you fill out the plan and keep it up to date.

Your doctor will advise how often you need to have your Asthma Action Plan reviewed; this might be every 3, 6 or 12 months, depending on how well your asthma is managed and how severe your condition is.

Quit smoking

If you have asthma and you smoke, or you are regularly exposed to cigarette smoke, you are more likely:

  • to have frequent asthma attacks
  • to be admitted to hospital for asthma
  • to have severe asthma symptoms
  • not to respond as well to your asthma medicines
  • to suffer worsening lung function over time.

Quitting smoking will help you to avoid these complications and will also have a positive impact on your general health and substantially reduce your risk of other illnesses (including lung cancer, heart attack and stroke).

Contact the Quitline on 13 78 48 for help to quit smoking or get an online quitting coach.

Keep a symptom diary

Keeping a record of your asthma symptoms and your asthma medicines can help you identify triggers for your asthma and if your asthma symptoms are worsening over time.

This information can also be helpful to you and your health professional when updating your Asthma Action Plan.

You can download a symptom diary from Asthma Australia.

Take peak flow readings

A peak flow test measures your peak expiratory flow (PEF) — that is, how hard and fast you can breathe out.

Some people who have asthma find it useful to keep track of their peak flow test readings because changes in these readings can indicate worsening asthma symptoms or a possible respiratory infection, as well as showing how well their asthma medicines are working.

You can buy a peak flow meter (a simple plastic tube-like device that you blow through) from your pharmacy.

Find out more about asthma

Contact Asthma Australia on 1800 278 462 to learn more about asthma, its causes, medicines and treatments, tests and monitoring.

By registering with the free Asthma Assist information and support service, you will be sent regular updates about new treatments and the latest research.

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Where to find more information about Flutiform

Read the consumer medicine information (CMI) for Flutiform (fluticasone and eformoterol) to find out:

  • who should not use it
  • how to use it
  • most of the possible side effects
  • the ingredients.

You can get the CMI leaflet for Flutiform from:

  • your doctor or pharmacist
  • the NPS MedicineWise website
  • Mundipharma, the makers of Flutiform (fluticasone with eformoterol), on 1800 188 009.

Information over the phone

NPS MedicineWise works with healthdirect Australia to provide consumers with information on medicines.

To get information about Flutiform, call the NPS Medicines Line on 1300 MEDICINE (1300 633 424) from anywhere in Australia. The service is available Monday–Friday, 9am–5pm EST (except NSW public holidays).

To report a side effect with Flutiform

Call the Adverse Medicines Event (AME) Line on 1300 134 237 (Monday–Friday, 9am–5pm EST).

The AME Line lets you report and discuss side effects that might be related to your medicine.

Medicine-related side effects are then reported to the Therapeutic Goods Administration (TGA) for assessment and contribute to national medicine safety efforts. Your personal information will remain confidential and your privacy maintained.

More about asthma

Asthma Australia provides support and education for people with asthma. Call 1800 645 130 for more information about asthma and asthma medicines.

More about using medicines wisely

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