salmeterol/fluticasone inhaled (Rx)

Asthma

Inhaled powder (Advair Diskus or generic): 1 actuation PO q12hr; not to exceed 1 actuation of 50 mcg/500 mcg q12hr; do not use with a spacer

Inhaled powder (AirDuo RespiClick, AirDuo Digihaler): 1 actuation PO q12hr; not to exceed 1 actuation of 14 mcg/232 mcg q12hr; do not use with a spacer or volume holding chamber

Inhaled aerosol (Advair HFA): 2 actuations PO q12hr; not to exceed 2 actuations of 21 mcg/230 mcg q12hr

Chronic Obstructive Pulmonary Disease

Inhaled powder (Advair Diskus or generic): 1 actuation of 50 mcg/250 mcg PO q12hr

Dosing Considerations

Inhaled powder: If dyspnea occurs between doses, chronic obstructive pulmonary disease (COPD) patients may take inhaled short-acting beta agonist (SABA) for immediate relief

Asthma

• For maintenance therapy; not for acute bronchospasm
• Starting dosage is based on prior asthma therapy and disease severity

Exophthalmos (Orphan)

Treatment of symptomatic exophthalmos associated with thyroid-related eye disease

Orphan sponsor

• Lithera, Inc, 9191 Towne Center Drive, San Diego, CA 92122

Asthma

Inhaled powder (Advair Diskus)

• <4 years: Safety and efficacy not established
• 4-11 years: 1 actuation of 50 mcg/100 mcg PO q12hr
• ≥12 years: 1 actuation PO q12hr (initial dose determined by asthma severity); not to exceed 1 actuation of 50 mcg/500 mcg q12hr
• Do not use with spacer

Inhaled powder (AirDuo RespiClick, AirDuo Digihaler)

• <12 years: Safety and efficacy not established
• ≥12 years: 1 actuation PO q12hr; not to exceed 1 actuation of 14 mcg/232 mcg q12hr
• Do not use with a spacer or volume holding chamber

Inhaled aerosol (Advair HFA)

• <12 years: Safety and efficacy not established
• ≥12 years: 2 actuations PO q12hr (initial dose determined by asthma severity); not to exceed 2 actuations of 21 mcg/230 mcg q12hr

Dosing Considerations

Asthma

• For maintenance therapy; not for acute bronchospasm
• Starting dosage is based on prior asthma therapy and disease severity

Contraindicated (7)

• darunavir

  darunavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .

• fosamprenavir

  fosamprenavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .

• indinavir

  indinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .

• lefamulin

  lefamulin will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• lopinavir

  lopinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity.

• nelfinavir

  nelfinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .

• ritonavir

  ritonavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity.

Serious - Use Alternative (35)

• abametapir

  abametapir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
  
  abametapir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

• amisulpride

  amisulpride and salmeterol both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• apalutamide

  apalutamide will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• amitriptyline

  amitriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• amoxapine

  amoxapine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• apalutamide

  apalutamide will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• chloramphenicol

  chloramphenicol will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloroquine

  chloroquine and salmeterol both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  clomipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• cobicistat

  cobicistat increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration not recommended; may result in increased cardiovascular effects associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.

• desipramine

  desipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• doxepin

  doxepin, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fexinidazole

  fexinidazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
  
  fexinidazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
  
  fexinidazole and salmeterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• idelalisib

  idelalisib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of fluticasone inhaled by unspecified interaction mechanism. Avoid or Use Alternate Drug. Coadministration may reduce serum cortisol concentrations; alternative corticosteroids should be considered, particularly for long term use

• imipramine

  imipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• isocarboxazid

  isocarboxazid increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• itraconazole

  itraconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  itraconazole and salmeterol both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ketoconazole

  ketoconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• levoketoconazole

  levoketoconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• linezolid

  linezolid increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• lofepramine

  lofepramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lonafarnib

  lonafarnib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

• maprotiline

  maprotiline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• mefloquine

  mefloquine increases toxicity of salmeterol by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• nefazodone

  nefazodone will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nirmatrelvir

  nirmatrelvir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration may increase risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.

• nirmatrelvir/ritonavir

  nirmatrelvir/ritonavir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration may increase risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.

• nortriptyline

  nortriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of salmeterol by decreasing metabolism. Avoid or Use Alternate Drug. Concurrent administration of Viekira Pak and salmeterol is not recommended; coadministration may result in increased risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations and sinus tachycardia

• panobinostat

  salmeterol and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• phenelzine

  phenelzine increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• primidone

  primidone will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• protriptyline

  protriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

Monitor Closely (300)

• acebutolol

  acebutolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  acebutolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• aceclofenac

  aceclofenac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• acemetacin

  acemetacin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• albuterol

  albuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  albuterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  albuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• alfentanil

  alfentanil increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfuzosin

  alfuzosin and salmeterol both increase QTc interval. Use Caution/Monitor.

• alprazolam

  alprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• amiloride

  amiloride increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• amitriptyline

  amitriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• amobarbital

  amobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• amoxapine

  amoxapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• arformoterol

  arformoterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  arformoterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  arformoterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• aripiprazole

  aripiprazole increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• armodafinil

  salmeterol and armodafinil both decrease sedation. Use Caution/Monitor.

• aspirin

  aspirin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aspirin rectal

  aspirin rectal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• aspirin/citric acid/sodium bicarbonate

  aspirin/citric acid/sodium bicarbonate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• atazanavir

  atazanavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure
  
  atazanavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of systemic effects.

• atenolol

  atenolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  atenolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• carbamazepine

  carbamazepine will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  salmeterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

• azelastine

  azelastine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• belladonna and opium

  belladonna and opium increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bendroflumethiazide

  salmeterol and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.

• benperidol

  benperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benzphetamine

  salmeterol and benzphetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• betaxolol

  betaxolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  betaxolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• bisoprolol

  bisoprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  bisoprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• brompheniramine

  brompheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bumetanide

  salmeterol and bumetanide both decrease serum potassium. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butabarbital

  butabarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butalbital

  butalbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butorphanol

  butorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• caffeine

  salmeterol and caffeine both decrease sedation. Use Caution/Monitor.

• carbenoxolone

  salmeterol and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carvedilol

  carvedilol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  carvedilol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• celecoxib

  celecoxib increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• celiprolol

  celiprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  celiprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• cenobamate

  cenobamate will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
  
  cenobamate will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• chloral hydrate

  chloral hydrate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clarithromycin

  clarithromycin will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• chlordiazepoxide

  chlordiazepoxide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorothiazide

  salmeterol and chlorothiazide both decrease serum potassium. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorthalidone

  salmeterol and chlorthalidone both decrease serum potassium. Use Caution/Monitor.

• choline magnesium trisalicylate

  choline magnesium trisalicylate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• cinnarizine

  cinnarizine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• citalopram

  citalopram and salmeterol both increase QTc interval. Use Caution/Monitor.

• clarithromycin

  clarithromycin will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  clarithromycin and salmeterol both increase QTc interval. Use Caution/Monitor.

• clemastine

  clemastine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clomipramine

  clomipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clonazepam

  clonazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clorazepate

  clorazepate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clozapine

  clozapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  clozapine and salmeterol both increase QTc interval. Use Caution/Monitor.

• cobicistat

  cobicistat increases levels of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• codeine

  codeine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• conivaptan

  conivaptan will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  conivaptan will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• crizotinib

  crizotinib and salmeterol both increase QTc interval. Use Caution/Monitor.

• darunavir

  darunavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• cyclizine

  cyclizine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cyclopenthiazide

  salmeterol and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dabrafenib

  dabrafenib will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dasatinib

  dasatinib and salmeterol both increase QTc interval. Use Caution/Monitor.

• deflazacort

  salmeterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

• degarelix

  degarelix and salmeterol both increase QTc interval. Use Caution/Monitor.

• desipramine

  desipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• deutetrabenazine

  deutetrabenazine and salmeterol both increase QTc interval. Use Caution/Monitor.

• dexchlorpheniramine

  dexchlorpheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexfenfluramine

  salmeterol and dexfenfluramine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dexmedetomidine

  dexmedetomidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmethylphenidate

  salmeterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
  
  salmeterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dextroamphetamine

  salmeterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dextromoramide

  dextromoramide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diamorphine

  diamorphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dichlorphenamide

  dichlorphenamide and salmeterol both decrease serum potassium. Use Caution/Monitor.

• diclofenac

  diclofenac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diethylpropion

  salmeterol and diethylpropion both decrease sedation. Use Caution/Monitor.
  
  salmeterol and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diflunisal

  diflunisal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• digoxin

  digoxin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dimenhydrinate

  dimenhydrinate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diphenoxylate hcl

  diphenoxylate hcl increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dipipanone

  dipipanone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dobutamine

  dobutamine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  dobutamine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  dobutamine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dolasetron

  dolasetron and salmeterol both increase QTc interval. Use Caution/Monitor.

• donepezil

  donepezil and salmeterol both increase QTc interval. Use Caution/Monitor.

• dopamine

  salmeterol and dopamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dopexamine

  dopexamine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  dopexamine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  dopexamine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  dopexamine, salmeterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

• doxepin

  doxepin increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  doxepin and salmeterol both increase QTc interval. Use Caution/Monitor.

• droperidol

  droperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• drospirenone

  drospirenone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• duvelisib

  duvelisib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• efavirenz

  efavirenz and salmeterol both increase QTc interval. Use Caution/Monitor.

• elagolix

  elagolix decreases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure
  
  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  encorafenib, salmeterol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
  
  encorafenib and salmeterol both increase QTc interval. Use Caution/Monitor.

• fedratinib

  fedratinib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• entrectinib

  entrectinib and salmeterol both increase QTc interval. Use Caution/Monitor.

• ephedrine

  ephedrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  ephedrine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  ephedrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• epinephrine

  epinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  epinephrine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  epinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• epinephrine racemic

  epinephrine racemic and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  epinephrine racemic and salmeterol both decrease sedation. Use Caution/Monitor.
  
  epinephrine racemic and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• eribulin

  eribulin and salmeterol both increase QTc interval. Use Caution/Monitor.

• esmolol

  esmolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  esmolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• estazolam

  estazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ethacrynic acid

  salmeterol and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.

• ethanol

  ethanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• etodolac

  etodolac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fedratinib

  fedratinib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• fenfluramine

  salmeterol and fenfluramine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• fenoprofen

  fenoprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fingolimod

  fingolimod and salmeterol both increase QTc interval. Use Caution/Monitor.

• fluoxetine

  fluoxetine and salmeterol both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system

• fluphenazine

  fluphenazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• flurazepam

  flurazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• flurbiprofen

  flurbiprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• formoterol

  formoterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  formoterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  formoterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• fosamprenavir

  fosamprenavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• fosphenytoin

  fosphenytoin will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fostemsavir

  salmeterol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• furosemide

  salmeterol and furosemide both decrease serum potassium. Use Caution/Monitor.

• gemifloxacin

  gemifloxacin and salmeterol both increase QTc interval. Use Caution/Monitor.

• gentamicin

  salmeterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

• gilteritinib

  gilteritinib and salmeterol both increase QTc interval. Use Caution/Monitor.

• grapefruit

  grapefruit will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• green tea

  green tea increases effects of salmeterol by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

• haloperidol

  haloperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrochlorothiazide

  salmeterol and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.

• hydromorphone

  hydromorphone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibuprofen

  ibuprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibuprofen IV

  ibuprofen IV increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• idelalisib

  idelalisib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• iloperidone

  iloperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  iloperidone increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imatinib

  imatinib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• imipramine

  imipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• indapamide

  salmeterol and indapamide both decrease serum potassium. Use Caution/Monitor.

• indinavir

  indinavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• indomethacin

  indomethacin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• isoniazid

  isoniazid will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• isoproterenol

  isoproterenol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  isoproterenol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  isoproterenol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• istradefylline

  istradefylline will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
  
  istradefylline will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  itraconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• ketoprofen

  ketoprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketoconazole

  ketoconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• ketorolac

  ketorolac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketorolac intranasal

  ketorolac intranasal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• ketotifen, ophthalmic

  ketotifen, ophthalmic increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• labetalol

  labetalol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  labetalol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• lenvatinib

  salmeterol and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  letermovir increases levels of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  letermovir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levalbuterol

  levalbuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  levalbuterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  levalbuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• levoketoconazole

  levoketoconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• levorphanol

  levorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lisdexamfetamine

  salmeterol and lisdexamfetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• lofepramine

  lofepramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lofexidine

  lofexidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lopinavir

  lopinavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• loprazolam

  loprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lorazepam

  lorazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lormetazepam

  lormetazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lornoxicam

  lornoxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• loxapine

  loxapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• loxapine inhaled

  loxapine inhaled increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• maprotiline

  maprotiline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• marijuana

  marijuana increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meclofenamate

  meclofenamate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mefenamic acid

  mefenamic acid increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• melatonin

  melatonin increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meloxicam

  meloxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meperidine

  meperidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meprobamate

  meprobamate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaproterenol

  metaproterenol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  metaproterenol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  metaproterenol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• methadone

  methadone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methamphetamine

  salmeterol and methamphetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• methyclothiazide

  salmeterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.

• methylenedioxymethamphetamine

  salmeterol and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• methylphenidate

  salmeterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• metolazone

  salmeterol and metolazone both decrease serum potassium. Use Caution/Monitor.

• metoprolol

  metoprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  metoprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• midazolam

  midazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midodrine

  salmeterol and midodrine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• mifepristone

  mifepristone will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  mifepristone will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• mirtazapine

  mirtazapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mitotane

  mitotane will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• mitotane

  mitotane decreases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• modafinil

  salmeterol and modafinil both decrease sedation. Use Caution/Monitor.

• morphine

  morphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• motherwort

  motherwort increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• moxonidine

  moxonidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nabilone

  nabilone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nabumetone

  nabumetone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nadolol

  nadolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nadolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• nalbuphine

  nalbuphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• naproxen

  naproxen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nebivolol

  nebivolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• nefazodone

  nefazodone will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• nelfinavir

  nelfinavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• nicardipine

  nicardipine will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• nirmatrelvir

  nirmatrelvir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration may increase certain systemic corticosteroid concentrations. Increased risk for Cushing syndrome and adrenal suppression. Consider alternant corticosteroids, including beclomethasone and prednisolone).

• nirmatrelvir/ritonavir

  nirmatrelvir/ritonavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration may increase certain systemic corticosteroid concentrations. Increased risk for Cushing syndrome and adrenal suppression. Consider alternant corticosteroids, including beclomethasone and prednisolone).

• norepinephrine

  norepinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  norepinephrine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  norepinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• nortriptyline

  nortriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ofatumumab SC

  ofatumumab SC, fluticasone inhaled. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

• olanzapine

  olanzapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• olodaterol inhaled

  salmeterol and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

• opium tincture

  opium tincture increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• osilodrostat

  osilodrostat and salmeterol both increase QTc interval. Use Caution/Monitor.

• oxaprozin

  oxaprozin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxazepam

  oxazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxycodone

  oxycodone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxymorphone

  oxymorphone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• paliperidone

  paliperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• papaveretum

  papaveretum increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• parecoxib

  parecoxib increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• penbutolol

  penbutolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  penbutolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• pentazocine

  pentazocine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pentobarbital

  pentobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• perphenazine

  perphenazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phendimetrazine

  salmeterol and phendimetrazine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• phenobarbital

  phenobarbital will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenoxybenzamine

  phenoxybenzamine, salmeterol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

• phenytoin

  phenytoin will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• phentermine

  salmeterol and phentermine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• phenylephrine

  salmeterol and phenylephrine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• phenylephrine PO

  salmeterol and phenylephrine PO both decrease sedation. Use Caution/Monitor.
  
  salmeterol and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• pholcodine

  pholcodine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  pimozide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pindolol

  pindolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  pindolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• pirbuterol

  pirbuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  pirbuterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  pirbuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• piroxicam

  piroxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• posaconazole

  posaconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  posaconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• potassium acid phosphate

  potassium acid phosphate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• quinidine

  quinidine will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• potassium chloride

  potassium chloride increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• potassium citrate

  potassium citrate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• primidone

  primidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• procarbazine

  procarbazine increases effects of salmeterol by pharmacodynamic synergism. Use Caution/Monitor.

• prochlorperazine

  prochlorperazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• promethazine

  promethazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• propranolol

  propranolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  propranolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• propylhexedrine

  salmeterol and propylhexedrine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• protriptyline

  protriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pseudoephedrine

  salmeterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• quazepam

  quazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quetiapine

  quetiapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ribociclib

  ribociclib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifabutin

  rifabutin will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• risperidone

  risperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ritonavir

  ritonavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• rucaparib

  rucaparib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
  
  rucaparib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• sacubitril/valsartan

  sacubitril/valsartan increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• saquinavir

  saquinavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• salicylates (non-asa)

  salicylates (non-asa) increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  salsalate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• saquinavir

  saquinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of QT prolongation and cardiac arrhythmias.

• scullcap

  scullcap increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• secobarbital

  secobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  salmeterol and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• shepherd's purse

  shepherd's purse increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  salmeterol and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

• solriamfetol

  salmeterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• sotalol

  sotalol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  sotalol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• spironolactone

  spironolactone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• stiripentol

  stiripentol, fluticasone inhaled. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol, salmeterol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

• succinylcholine

  succinylcholine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tazemetostat

  tazemetostat will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• sufentanil

  sufentanil increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sulfasalazine

  sulfasalazine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sulindac

  sulindac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tapentadol

  tapentadol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tazemetostat

  tazemetostat will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  tecovirimat will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• temazepam

  temazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• terbutaline

  salmeterol and terbutaline both decrease serum potassium. Use Caution/Monitor.
  
  salmeterol and terbutaline both decrease sedation. Use Caution/Monitor.
  
  salmeterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• thioridazine

  thioridazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• thiothixene

  thiothixene increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• timolol

  timolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  timolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• tipranavir

  tipranavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• tolfenamic acid

  tolfenamic acid increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tolmetin

  tolmetin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tolvaptan

  tolvaptan increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• topiramate

  topiramate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• torsemide

  salmeterol and torsemide both decrease serum potassium. Use Caution/Monitor.

• tramadol

  tramadol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trastuzumab

  trastuzumab, fluticasone inhaled. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

• trastuzumab deruxtecan

  trastuzumab deruxtecan, fluticasone inhaled. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

• trazodone

  trazodone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• triamterene

  triamterene increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• triazolam

  triazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• triclofos

  triclofos increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trifluoperazine

  trifluoperazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trimipramine

  trimipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• triprolidine

  triprolidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• voriconazole

  voriconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• xylometazoline

  salmeterol and xylometazoline both decrease sedation. Use Caution/Monitor.
  
  salmeterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

Minor (16)

• bendroflumethiazide

  salmeterol, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• bumetanide

  salmeterol, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• chlorothiazide

  salmeterol, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• chlorthalidone

  salmeterol, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• cyclopenthiazide

  salmeterol, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• ethacrynic acid

  salmeterol, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• eucalyptus

  eucalyptus increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• furosemide

  salmeterol, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• hydrochlorothiazide

  salmeterol, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• indapamide

  salmeterol, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• methyclothiazide

  salmeterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• metolazone

  salmeterol, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• noni juice

  noni juice increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• ribociclib

  ribociclib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sage

  sage increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• torsemide

  salmeterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• abametapir

  Serious - Use Alternative (2)abametapir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
  
  abametapir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

• acebutolol

  Monitor Closely (2)acebutolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  acebutolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aceclofenac

  Monitor Closely (1)aceclofenac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• acemetacin

  Monitor Closely (1)acemetacin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• albuterol

  Monitor Closely (3)albuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  albuterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  albuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• alfentanil

  Monitor Closely (1)alfentanil increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (1)alfuzosin and salmeterol both increase QTc interval. Use Caution/Monitor.

• alprazolam

  Monitor Closely (1)alprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• amiloride

  Monitor Closely (1)amiloride increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• amisulpride

  Serious - Use Alternative (1)amisulpride and salmeterol both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Monitor Closely (1)amitriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• amobarbital

  Monitor Closely (1)amobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• amoxapine

  Monitor Closely (1)amoxapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amoxapine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• apalutamide

  Serious - Use Alternative (2)apalutamide will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
  
  apalutamide will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• arformoterol

  Monitor Closely (3)arformoterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  arformoterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  arformoterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (1)aripiprazole increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• armodafinil

  Monitor Closely (1)salmeterol and armodafinil both decrease sedation. Use Caution/Monitor.

• aspirin

  Monitor Closely (1)aspirin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aspirin rectal

  Monitor Closely (1)aspirin rectal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• atazanavir

  Monitor Closely (2)atazanavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure
  
  atazanavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of systemic effects.

• atenolol

  Monitor Closely (2)atenolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  atenolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• atomoxetine

  Monitor Closely (1)salmeterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

• azelastine

  Monitor Closely (1)azelastine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• belladonna and opium

  Monitor Closely (1)belladonna and opium increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bendroflumethiazide

  Monitor Closely (1)salmeterol and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• benperidol

  Monitor Closely (1)benperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benzphetamine

  Monitor Closely (2)salmeterol and benzphetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• betaxolol

  Monitor Closely (2)betaxolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  betaxolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bisoprolol

  Monitor Closely (2)bisoprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  bisoprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brompheniramine

  Monitor Closely (1)brompheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bumetanide

  Monitor Closely (1)salmeterol and bumetanide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• buprenorphine buccal

  Monitor Closely (1)buprenorphine buccal increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butabarbital

  Monitor Closely (1)butabarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butalbital

  Monitor Closely (1)butalbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butorphanol

  Monitor Closely (1)butorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• caffeine

  Monitor Closely (1)salmeterol and caffeine both decrease sedation. Use Caution/Monitor.

• carbamazepine

  Monitor Closely (1)carbamazepine will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carbenoxolone

  Monitor Closely (1)salmeterol and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

• carbinoxamine

  Monitor Closely (1)carbinoxamine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carvedilol

  Monitor Closely (2)carvedilol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  carvedilol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• celecoxib

  Monitor Closely (1)celecoxib increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• celiprolol

  Monitor Closely (2)celiprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  celiprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cenobamate

  Monitor Closely (2)cenobamate will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
  
  cenobamate will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• chloral hydrate

  Monitor Closely (1)chloral hydrate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloramphenicol

  Serious - Use Alternative (1)chloramphenicol will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloroquine

  Serious - Use Alternative (1)chloroquine and salmeterol both increase QTc interval. Avoid or Use Alternate Drug.

• chlorothiazide

  Monitor Closely (1)salmeterol and chlorothiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)chlorpromazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorthalidone

  Monitor Closely (1)salmeterol and chlorthalidone both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• choline magnesium trisalicylate

  Monitor Closely (1)choline magnesium trisalicylate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• cinnarizine

  Monitor Closely (1)cinnarizine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• citalopram

  Monitor Closely (1)citalopram and salmeterol both increase QTc interval. Use Caution/Monitor.

• clarithromycin

  Monitor Closely (3)clarithromycin and salmeterol both increase QTc interval. Use Caution/Monitor.
  
  clarithromycin will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure
  
  clarithromycin will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• clemastine

  Monitor Closely (1)clemastine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clomipramine

  Monitor Closely (1)clomipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• clonazepam

  Monitor Closely (1)clonazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clorazepate

  Monitor Closely (1)clorazepate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clozapine

  Monitor Closely (2)clozapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  clozapine and salmeterol both increase QTc interval. Use Caution/Monitor.

• cobicistat

  Monitor Closely (1)cobicistat increases levels of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)cobicistat increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration not recommended; may result in increased cardiovascular effects associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.

• codeine

  Monitor Closely (1)codeine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• conivaptan

  Monitor Closely (2)conivaptan will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  conivaptan will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• crizotinib

  Monitor Closely (1)crizotinib and salmeterol both increase QTc interval. Use Caution/Monitor.

• cyclizine

  Monitor Closely (1)cyclizine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cyclopenthiazide

  Monitor Closely (1)salmeterol and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• cyproheptadine

  Monitor Closely (1)cyproheptadine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dabrafenib

  Monitor Closely (1)dabrafenib will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• darunavir

  Contraindicated (1)darunavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .Monitor Closely (1)darunavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• dasatinib

  Monitor Closely (1)dasatinib and salmeterol both increase QTc interval. Use Caution/Monitor.

• deflazacort

  Monitor Closely (1)salmeterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

• degarelix

  Monitor Closely (1)degarelix and salmeterol both increase QTc interval. Use Caution/Monitor.

• desipramine

  Monitor Closely (1)desipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• deutetrabenazine

  Monitor Closely (1)deutetrabenazine and salmeterol both increase QTc interval. Use Caution/Monitor.

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (2)salmeterol and dexfenfluramine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (2)salmeterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
  
  salmeterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dextroamphetamine

  Monitor Closely (2)salmeterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dextromoramide

  Monitor Closely (1)dextromoramide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diamorphine

  Monitor Closely (1)diamorphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dichlorphenamide

  Monitor Closely (1)dichlorphenamide and salmeterol both decrease serum potassium. Use Caution/Monitor.

• diclofenac

  Monitor Closely (1)diclofenac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diethylpropion

  Monitor Closely (2)salmeterol and diethylpropion both decrease sedation. Use Caution/Monitor.
  
  salmeterol and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diflunisal

  Monitor Closely (1)diflunisal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• digoxin

  Monitor Closely (1)digoxin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (1)diphenhydramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dobutamine

  Monitor Closely (3)dobutamine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  dobutamine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  dobutamine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dolasetron

  Monitor Closely (1)dolasetron and salmeterol both increase QTc interval. Use Caution/Monitor.

• donepezil

  Monitor Closely (1)donepezil and salmeterol both increase QTc interval. Use Caution/Monitor.

• dopamine

  Monitor Closely (2)salmeterol and dopamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dopexamine

  Monitor Closely (4)dopexamine, salmeterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
  
  dopexamine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  dopexamine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  dopexamine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• doxepin

  Monitor Closely (2)doxepin and salmeterol both increase QTc interval. Use Caution/Monitor.
  
  doxepin increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)doxepin, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• droperidol

  Monitor Closely (1)droperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• drospirenone

  Monitor Closely (1)drospirenone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• duvelisib

  Monitor Closely (1)duvelisib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• efavirenz

  Monitor Closely (1)efavirenz and salmeterol both increase QTc interval. Use Caution/Monitor.

• elagolix

  Monitor Closely (1)elagolix decreases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (2)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
  
  elvitegravir/cobicistat/emtricitabine/tenofovir DF will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• encorafenib

  Monitor Closely (2)encorafenib, salmeterol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
  
  encorafenib and salmeterol both increase QTc interval. Use Caution/Monitor.

• entrectinib

  Monitor Closely (1)entrectinib and salmeterol both increase QTc interval. Use Caution/Monitor.

• ephedrine

  Monitor Closely (3)ephedrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  ephedrine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  ephedrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• epinephrine

  Monitor Closely (3)epinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  epinephrine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  epinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• epinephrine racemic

  Monitor Closely (3)epinephrine racemic and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  epinephrine racemic and salmeterol both decrease sedation. Use Caution/Monitor.
  
  epinephrine racemic and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• eribulin

  Monitor Closely (1)eribulin and salmeterol both increase QTc interval. Use Caution/Monitor.

• esmolol

  Monitor Closely (2)esmolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  esmolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• estazolam

  Monitor Closely (1)estazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ethacrynic acid

  Monitor Closely (1)salmeterol and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• ethanol

  Monitor Closely (1)ethanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• etodolac

  Monitor Closely (1)etodolac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• eucalyptus

  Minor (1)eucalyptus increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• fedratinib

  Monitor Closely (2)fedratinib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
  
  fedratinib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• fenfluramine

  Monitor Closely (2)salmeterol and fenfluramine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• fenoprofen

  Monitor Closely (1)fenoprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fexinidazole

  Serious - Use Alternative (3)fexinidazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
  
  fexinidazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
  
  fexinidazole and salmeterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• fingolimod

  Monitor Closely (1)fingolimod and salmeterol both increase QTc interval. Use Caution/Monitor.

• fluoxetine

  Monitor Closely (1)fluoxetine and salmeterol both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system

• fluphenazine

  Monitor Closely (1)fluphenazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• flurazepam

  Monitor Closely (1)flurazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• flurbiprofen

  Monitor Closely (1)flurbiprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• formoterol

  Monitor Closely (3)formoterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  formoterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  formoterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• fosamprenavir

  Contraindicated (1)fosamprenavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .Monitor Closely (1)fosamprenavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• fosphenytoin

  Monitor Closely (1)fosphenytoin will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fostemsavir

  Monitor Closely (1)salmeterol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• furosemide

  Monitor Closely (1)salmeterol and furosemide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and salmeterol both increase QTc interval. Use Caution/Monitor.

• gentamicin

  Monitor Closely (1)salmeterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

• gilteritinib

  Monitor Closely (1)gilteritinib and salmeterol both increase QTc interval. Use Caution/Monitor.

• grapefruit

  Monitor Closely (1)grapefruit will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• green tea

  Monitor Closely (1)green tea increases effects of salmeterol by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

• haloperidol

  Monitor Closely (1)haloperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrochlorothiazide

  Monitor Closely (1)salmeterol and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• hydromorphone

  Monitor Closely (1)hydromorphone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydroxyzine

  Monitor Closely (1)hydroxyzine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibuprofen

  Monitor Closely (1)ibuprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibuprofen IV

  Monitor Closely (1)ibuprofen IV increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• idelalisib

  Monitor Closely (1)idelalisib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposureSerious - Use Alternative (1)idelalisib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  Monitor Closely (2)iloperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  iloperidone increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imatinib

  Monitor Closely (1)imatinib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• imipramine

  Monitor Closely (1)imipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)imipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• indapamide

  Monitor Closely (1)salmeterol and indapamide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• indinavir

  Contraindicated (1)indinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .Monitor Closely (1)indinavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• indomethacin

  Monitor Closely (1)indomethacin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• isocarboxazid

  Serious - Use Alternative (1)isocarboxazid increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• isoniazid

  Monitor Closely (1)isoniazid will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• isoproterenol

  Monitor Closely (3)isoproterenol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  isoproterenol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  isoproterenol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• istradefylline

  Monitor Closely (2)istradefylline will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
  
  istradefylline will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  Monitor Closely (1)itraconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposureSerious - Use Alternative (2)itraconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  itraconazole and salmeterol both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  Serious - Use Alternative (1)ivosidenib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ketoconazole

  Monitor Closely (1)ketoconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposureSerious - Use Alternative (1)ketoconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ketoprofen

  Monitor Closely (1)ketoprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketorolac

  Monitor Closely (1)ketorolac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketorolac intranasal

  Monitor Closely (1)ketorolac intranasal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• ketotifen, ophthalmic

  Monitor Closely (1)ketotifen, ophthalmic increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• labetalol

  Monitor Closely (2)labetalol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  labetalol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lefamulin

  Contraindicated (1)lefamulin will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• lenvatinib

  Monitor Closely (1)salmeterol and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  Monitor Closely (2)letermovir increases levels of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  letermovir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levalbuterol

  Monitor Closely (3)levalbuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  levalbuterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  levalbuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• levoketoconazole

  Monitor Closely (1)levoketoconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposureSerious - Use Alternative (1)levoketoconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• levorphanol

  Monitor Closely (1)levorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• linezolid

  Serious - Use Alternative (1)linezolid increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• lisdexamfetamine

  Monitor Closely (2)salmeterol and lisdexamfetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• lofepramine

  Monitor Closely (1)lofepramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)lofepramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lofexidine

  Monitor Closely (1)lofexidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lonafarnib

  Serious - Use Alternative (1)lonafarnib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

• lopinavir

  Contraindicated (1)lopinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity.Monitor Closely (1)lopinavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• loprazolam

  Monitor Closely (1)loprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lormetazepam

  Monitor Closely (1)lormetazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lornoxicam

  Monitor Closely (1)lornoxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• loxapine

  Monitor Closely (1)loxapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (1)loxapine inhaled increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• maprotiline

  Monitor Closely (1)maprotiline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• marijuana

  Monitor Closely (1)marijuana increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meclofenamate

  Monitor Closely (1)meclofenamate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mefenamic acid

  Monitor Closely (1)mefenamic acid increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mefloquine

  Serious - Use Alternative (1)mefloquine increases toxicity of salmeterol by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• melatonin

  Monitor Closely (1)melatonin increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meloxicam

  Monitor Closely (1)meloxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meperidine

  Monitor Closely (1)meperidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meprobamate

  Monitor Closely (1)meprobamate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaproterenol

  Monitor Closely (3)metaproterenol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  metaproterenol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  metaproterenol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• methadone

  Monitor Closely (1)methadone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (2)salmeterol and methamphetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• methyclothiazide

  Monitor Closely (1)salmeterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• methylenedioxymethamphetamine

  Monitor Closely (2)salmeterol and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• methylphenidate

  Monitor Closely (1)salmeterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• metolazone

  Monitor Closely (1)salmeterol and metolazone both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• metoprolol

  Monitor Closely (2)metoprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  metoprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midazolam

  Monitor Closely (1)midazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midodrine

  Monitor Closely (2)salmeterol and midodrine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• mifepristone

  Monitor Closely (2)mifepristone will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  mifepristone will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• mirtazapine

  Monitor Closely (1)mirtazapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mitotane

  Monitor Closely (2)mitotane will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  mitotane decreases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• modafinil

  Monitor Closely (1)salmeterol and modafinil both decrease sedation. Use Caution/Monitor.

• morphine

  Monitor Closely (1)morphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)motherwort increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• moxonidine

  Monitor Closely (1)moxonidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)nabilone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nabumetone

  Monitor Closely (1)nabumetone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nadolol

  Monitor Closely (2)nadolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nadolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nalbuphine

  Monitor Closely (1)nalbuphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• naproxen

  Monitor Closely (1)naproxen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nebivolol

  Monitor Closely (2)nebivolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nefazodone

  Monitor Closely (1)nefazodone will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposureSerious - Use Alternative (1)nefazodone will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nelfinavir

  Contraindicated (1)nelfinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .Monitor Closely (1)nelfinavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• nicardipine

  Monitor Closely (1)nicardipine will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• nirmatrelvir

  Monitor Closely (1)nirmatrelvir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration may increase certain systemic corticosteroid concentrations. Increased risk for Cushing syndrome and adrenal suppression. Consider alternant corticosteroids, including beclomethasone and prednisolone).Serious - Use Alternative (1)nirmatrelvir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration may increase risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.

• nirmatrelvir/ritonavir

  Monitor Closely (1)nirmatrelvir/ritonavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration may increase certain systemic corticosteroid concentrations. Increased risk for Cushing syndrome and adrenal suppression. Consider alternant corticosteroids, including beclomethasone and prednisolone).Serious - Use Alternative (1)nirmatrelvir/ritonavir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration may increase risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.

• noni juice

  Minor (1)noni juice increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• norepinephrine

  Monitor Closely (3)norepinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  norepinephrine and salmeterol both decrease sedation. Use Caution/Monitor.
  
  norepinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• nortriptyline

  Monitor Closely (1)nortriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ofatumumab SC

  Monitor Closely (1)ofatumumab SC, fluticasone inhaled. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

• olanzapine

  Monitor Closely (1)olanzapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• olodaterol inhaled

  Monitor Closely (1)salmeterol and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  Serious - Use Alternative (2)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of fluticasone inhaled by unspecified interaction mechanism. Avoid or Use Alternate Drug. Coadministration may reduce serum cortisol concentrations; alternative corticosteroids should be considered, particularly for long term use
  
  ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of salmeterol by decreasing metabolism. Avoid or Use Alternate Drug. Concurrent administration of Viekira Pak and salmeterol is not recommended; coadministration may result in increased risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations and sinus tachycardia

• opium tincture

  Monitor Closely (1)opium tincture increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• osilodrostat

  Monitor Closely (1)osilodrostat and salmeterol both increase QTc interval. Use Caution/Monitor.

• oxaprozin

  Monitor Closely (1)oxaprozin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxazepam

  Monitor Closely (1)oxazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)oxycodone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxymorphone

  Monitor Closely (1)oxymorphone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• paliperidone

  Monitor Closely (1)paliperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• panobinostat

  Serious - Use Alternative (1)salmeterol and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• papaveretum

  Monitor Closely (1)papaveretum increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• parecoxib

  Monitor Closely (1)parecoxib increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• penbutolol

  Monitor Closely (2)penbutolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  penbutolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pentazocine

  Monitor Closely (1)pentazocine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• perphenazine

  Monitor Closely (1)perphenazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phendimetrazine

  Monitor Closely (2)salmeterol and phendimetrazine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• phenelzine

  Serious - Use Alternative (1)phenelzine increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• phenobarbital

  Monitor Closely (2)phenobarbital will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenoxybenzamine

  Monitor Closely (1)phenoxybenzamine, salmeterol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

• phentermine

  Monitor Closely (2)salmeterol and phentermine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• phenylephrine

  Monitor Closely (2)salmeterol and phenylephrine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• phenylephrine PO

  Monitor Closely (2)salmeterol and phenylephrine PO both decrease sedation. Use Caution/Monitor.
  
  salmeterol and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• phenytoin

  Monitor Closely (1)phenytoin will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pholcodine

  Monitor Closely (1)pholcodine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  Monitor Closely (1)pimozide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pindolol

  Monitor Closely (2)pindolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pindolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pirbuterol

  Monitor Closely (3)pirbuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
  
  pirbuterol and salmeterol both decrease sedation. Use Caution/Monitor.
  
  pirbuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• piroxicam

  Monitor Closely (1)piroxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• posaconazole

  Monitor Closely (2)posaconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  posaconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• potassium acid phosphate

  Monitor Closely (1)potassium acid phosphate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• potassium chloride

  Monitor Closely (1)potassium chloride increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• potassium citrate

  Monitor Closely (1)potassium citrate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• primidone

  Monitor Closely (1)primidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)primidone will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• procarbazine

  Monitor Closely (1)procarbazine increases effects of salmeterol by pharmacodynamic synergism. Use Caution/Monitor.

• prochlorperazine

  Monitor Closely (1)prochlorperazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• promethazine

  Monitor Closely (1)promethazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• propranolol

  Monitor Closely (2)propranolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  propranolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• propylhexedrine

  Monitor Closely (2)salmeterol and propylhexedrine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• protriptyline

  Monitor Closely (1)protriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pseudoephedrine

  Monitor Closely (1)salmeterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• quazepam

  Monitor Closely (1)quazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quetiapine

  Monitor Closely (1)quetiapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quinidine

  Monitor Closely (1)quinidine will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• ribociclib

  Monitor Closely (1)ribociclib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)ribociclib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rifabutin

  Monitor Closely (1)rifabutin will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• risperidone

  Monitor Closely (1)risperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ritonavir

  Contraindicated (1)ritonavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity.Monitor Closely (1)ritonavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• rucaparib

  Monitor Closely (2)rucaparib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
  
  rucaparib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• sacubitril/valsartan

  Monitor Closely (1)sacubitril/valsartan increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sage

  Minor (1)sage increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• salicylates (non-asa)

  Monitor Closely (1)salicylates (non-asa) increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  Monitor Closely (1)salsalate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• saquinavir

  Monitor Closely (2)saquinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of QT prolongation and cardiac arrhythmias.
  
  saquinavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure

• scullcap

  Monitor Closely (1)scullcap increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• secobarbital

  Monitor Closely (1)secobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  Monitor Closely (1)salmeterol and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• shepherd's purse

  Monitor Closely (1)shepherd's purse increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  Monitor Closely (1)salmeterol and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

• solriamfetol

  Monitor Closely (1)salmeterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• sotalol

  Monitor Closely (2)sotalol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  sotalol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• spironolactone

  Monitor Closely (1)spironolactone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• stiripentol

  Monitor Closely (2)stiripentol, salmeterol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol, fluticasone inhaled. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

• succinylcholine

  Monitor Closely (1)succinylcholine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sufentanil

  Monitor Closely (1)sufentanil increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sulfasalazine

  Monitor Closely (1)sulfasalazine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sulindac

  Monitor Closely (1)sulindac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tapentadol

  Monitor Closely (1)tapentadol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tazemetostat

  Monitor Closely (2)tazemetostat will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tazemetostat will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  Monitor Closely (1)tecovirimat will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• temazepam

  Monitor Closely (1)temazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• terbutaline

  Monitor Closely (3)salmeterol and terbutaline both decrease serum potassium. Use Caution/Monitor.
  
  salmeterol and terbutaline both decrease sedation. Use Caution/Monitor.
  
  salmeterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• thioridazine

  Monitor Closely (1)thioridazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• thiothixene

  Monitor Closely (1)thiothixene increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• timolol

  Monitor Closely (2)timolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  timolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tipranavir

  Monitor Closely (1)tipranavir will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposureSerious - Use Alternative (1)tipranavir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tolfenamic acid

  Monitor Closely (1)tolfenamic acid increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tolmetin

  Monitor Closely (1)tolmetin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tolvaptan

  Monitor Closely (1)tolvaptan increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• topiramate

  Monitor Closely (1)topiramate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• torsemide

  Monitor Closely (1)salmeterol and torsemide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• tramadol

  Monitor Closely (1)tramadol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tranylcypromine

  Serious - Use Alternative (1)tranylcypromine increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• trastuzumab

  Monitor Closely (1)trastuzumab, fluticasone inhaled. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

• trastuzumab deruxtecan

  Monitor Closely (1)trastuzumab deruxtecan, fluticasone inhaled. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

• trazodone

  Monitor Closely (1)trazodone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trazodone, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• triamterene

  Monitor Closely (1)triamterene increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• triazolam

  Monitor Closely (1)triazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• triclofos

  Monitor Closely (1)triclofos increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (1)trifluoperazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trimipramine

  Monitor Closely (1)trimipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• triprolidine

  Monitor Closely (1)triprolidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tucatinib

  Serious - Use Alternative (1)tucatinib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• voriconazole

  Monitor Closely (1)voriconazole will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposureSerious - Use Alternative (1)voriconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• xylometazoline

  Monitor Closely (2)salmeterol and xylometazoline both decrease sedation. Use Caution/Monitor.
  
  salmeterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• yohimbine

  Monitor Closely (2)salmeterol and yohimbine both decrease sedation. Use Caution/Monitor.
  
  salmeterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• ziconotide

  Monitor Closely (1)ziconotide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziprasidone

  Monitor Closely (1)ziprasidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.