Advair interactions: Alcohol, medications, and other factors

Advair (salmeterol/fluticasone propionate) is a brand-name prescription drug used to treat asthma and chronic obstructive pulmonary disease (COPD) in certain people. As with other medications, Advair can interact with certain other drugs. It can also interact with some foods. An interaction occurs when one substance causes another substance to have a different effect than expected.

Advair comes in two different inhalers: Advair Diskus and Advair HFA. These forms have the same interactions.

For details about Advair’s interactions, keep reading. For additional information about Advair, including details about its uses, see this article.

In some cases, factors or conditions could prevent your doctor from prescribing Advair due to the risk of harm. These are known as contraindications. The contraindications of Advair include the ones listed below.

Note: Before you start treatment with Advair, it’s important to tell your doctor whether any of these contraindications apply to you. They can determine whether to prescribe the drug.

Having an asthma attack or sudden breathing difficulties

You should not use Advair to treat an asthma attack or sudden breathlessness due to chronic obstructive pulmonary disease (COPD). It’s important to treat sudden breathing difficulties with a fast-acting rescue medication, such as albuterol (ProAir, Ventolin HFA, others).

Your doctor will likely prescribe a rescue medication to keep with you at all times. Having it on hand allows you to treat sudden breathing difficulties. Advair is not a rescue medication.

Having had an allergic reaction to milk proteins (Advair Diskus only)

If you’ve had a severe allergic reaction to milk proteins, your doctor will likely not prescribe Advair Diskus. This form of Advair contains lactose monohydrate, which could cause an allergic reaction if you have had a past allergic reaction to milk proteins. Advair HFA does not contain lactose monohydrate.

Having had an allergic reaction to Advair or any of its ingredients

If you have had an allergic reaction to Advair or any of its ingredients, your doctor will likely not prescribe Advair. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better options for you.

Advair isn’t known to interact with alcohol. However, if you have certain side effects from Advair, such as headache, nausea, and dizziness, drinking alcohol could worsen them.

Also, studies have found that long-term misuse of alcohol can increase your risk of developing lung infections such as pneumonia. Lung infections can worsen symptoms of asthma and chronic obstructive pulmonary disease (COPD). And Advair itself can increase the risk of pneumonia in people with COPD.

If you drink alcohol, talk with your doctor about how much, if any, is safe for you to consume with Advair.

Before you start treatment with Advair, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. Sharing this information with them may help prevent possible interactions. (To learn whether Advair interacts with supplements, herbs, or vitamins, see “Advair and other interactions” below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

This table lists the drugs that can interact with Advair. Keep in mind that this table does not include all drugs that may interact with Advair. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about Advair’s side effects, see this article.

Here’s a closer look at certain drug interactions of Advair.

Long-acting beta agonists

Long-acting beta agonists (LABAs) are drugs that help keep your airways open. They’re prescribed to treat asthma and chronic obstructive pulmonary disease (COPD). One of the active drugs in Advair is a LABA called salmeterol.

Interaction result. Taking Advair with other medications that contain a LABA can increase the risk of serious and sometimes life threatening side effects. (For details about Advair’s side effects, see this article.)

Interaction explained. Different LABAs can cause similar side effects. These include increased blood pressure and heart-related effects, such as a fast or irregular heartbeat. Taking more than one LABA can increase these side effects to the point that they become serious and possibly life threatening.

Examples of LABA drugs. Here are some medications that contain a LABA and may interact with Advair:

• arformoterol (Brovana)
• formoterol (Perforomist)
• formoterol/budesonide (Symbicort)
• formoterol/glycopyrrolate (Bevespi Aerosphere)
• salmeterol (Serevent)

Steps you or your doctor may take. Before starting Advair treatment, tell your doctor about all the other drugs you take for asthma or COPD. Your doctor will likely not prescribe Advair if you take any drugs that contain a LABA. You can ask your doctor about other treatments that may be better options.

Certain HIV drugs

HIV is a type of virus that impacts the immune system. Certain drugs used to treat HIV can interact with Advair.

Interaction result. Taking certain HIV medications during Advair treatment can increase the risk of side effects from Advair. (For details about Advair’s side effects, see this article.)

Interaction explained. An enzyme in your liver helps remove Advair from your body. (An enzyme is a type of protein that helps chemical reactions occur.) Taking certain HIV drugs during Advair treatment can reduce the enzyme’s activity. As a result, the HIV medications can cause Advair to build up in your system.

This buildup could increase your risk of side effects from Advair, such as a fast or irregular heartbeat and tremor. Other possible side effects include Cushing’s syndrome and problems with your adrenal glands.

Examples of HIV drugs. Here are some HIV medications that may interact with Advair:

• atazanavir (Reyataz)
• cobicistat (Tybost)
• nelfinavir (Viracept)
• ritonavir (Norvir)

Steps you or your doctor may take. Before starting Advair treatment, tell your doctor if you take any HIV drugs. Due to the above interaction,your doctor will likely not prescribe Advair if you take certain HIV medications. You can ask your doctor about other treatments that may be better options for you.

Certain antifungals

Antifungals are drugs used to treat fungal infections.

Interaction result. Taking certain antifungals with Advair can increase the risk of side effects from Advair. (To learn more about Advair’s side effects, see this article.)

Interaction explained. An enzyme in your liver helps remove Advair from your system. Certain antifungals can reduce the activity of the enzyme. As a result, these drugs can cause Advair to build up in your body.

Too much Advair in your system could increase your risk of side effects from the drug. These side effects can include problems with your adrenal glands and tremor. They can also include a fast or irregular heartbeat and Cushing’s syndrome.

Examples of antifungal drugs. Here are some antifungal drugs that may interact with Advair:

• itraconazole (Sporanox, Tolsura)
• ketoconazole
• posaconazole (Noxafil)
• voriconazole (Bfend)

Steps you or your doctor may take. If you develop a fungal infection while using Advair, talk with your doctor or pharmacist. Due to the interaction mentioned above,your doctor will likely not prescribe certain antifungals during your Advair treatment. Your doctor or pharmacist can recommend an antifungal that does not interact with Advair.

Advair may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Advair.

Advair and supplements

Before you start treatment with Advair, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Advair may interact with caffeine,* which is available in supplement form. Both caffeine and Advair can cause a fast heart rate and palpitations. The combination of the two substances may make the effects more likely to occur. Your doctor may recommend that you do not take caffeine supplements during your Advair treatment.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

* Caffeine is also found in certain foods and drinks. For details, see “Advair interactions with food” below.

Advair and herbs

There have been no specific reports of herbs interacting with Advair. However, that does not mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Advair treatment.

Advair and vitamins

No vitamins have been specifically reported to interact with Advair. Keep in mind that does not mean vitamin interactions won’t occur or be recognized sometime in the future. Due to this, you should talk with your doctor or pharmacist before taking any vitamin product with Advair.

Advair interactions with food

Advair may interact with certain foods. Specifically, this medication can interact with grapefruit and grapefruit juice and caffeine.

Grapefruit and grapefruit juice. Your doctor will likely recommend that you do not eat grapefruit or drink grapefruit juice while using Advair.

Grapefruit can reduce the activity of an enzyme that helps remove Advair from your body. (An enzyme is a type of protein that helps chemical reactions occur.) So, consuming grapefruit can cause Advair to build up in your system.

This buildup could increase your risk of side effects from the drug, such as Cushing’s syndrome and tremor.* Other possible side effects may include a fast or irregular heartbeat and problems with your adrenal glands.

Caffeine. Consuming caffeine* while using Advair may increase your risk of heart-related side effects.†

Both caffeine and Advair can cause a fast heart rate and palpitations. The combination of the two substances may make the effects more likely to occur.

Foods and drinks that may contain caffeine include coffee, tea, energy drinks, cola, and chocolate. Be sure to ask your doctor if you should avoid or limit your caffeine consumption while using Advair.

* Caffeine is also found in certain supplements. To learn more, see “Advair and supplements” above.
† For details about Advair’s side effects, see this article.

Advair and vaccines

There have not been any specific reports of vaccines interacting with Advair. However, that does not mean vaccine interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before getting vaccines during Advair treatment.

Advair and lab tests

There have been no specific reports of Advair affecting the results of lab tests. Keep in mind that this does not mean lab test interactions won’t occur or be recognized in the future. Due to this, be sure to talk with your doctor or pharmacist if you need any lab tests while using Advair.

ADVAIR AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Advair. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Advair. The impact of cannabis may affect how well you stick to your Advair treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Advair. Before you use this medication, be sure to talk with your doctor about your health history. Advair may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Advair include:

• Asthma attack or sudden breathing difficulties. You should not use Advair to treat an asthma attack or sudden breathlessness due to chronic obstructive pulmonary disease (COPD). To learn more, see “When to avoid Advair” above.

• Allergic reaction. If you’ve had an allergic reaction to Advair, any of its ingredients, or milk proteins, your doctor will likely not prescribe Advair. To learn more, see “When to avoid Advair” above.
• Weak immune system. One of the active drugs in Advair is a corticosteroid called fluticasone. Corticosteroids can sometimes weaken your immune system. If you already have a weak immune system, Advair could weaken it further. This could increase your risk of infection. Before using Advair, talk with your doctor about its risks and benefits.
• Infections. Advair may weaken your immune system and make it harder for it to fight infection. Before starting Advair treatment, tell your doctor about any infections you have. They may prescribe medication to treat the infection before you begin using Advair. To help prevent infection, talk with your doctor about whether you need any vaccines before starting Advair treatment.
• Heart problems or high blood pressure. Advair can sometimes cause heart-related side effects, such as a fast or irregular heartbeat, or increased blood pressure. If you have a heart problem or high blood pressure, these side effects could worsen your condition. Be sure to talk with your doctor about whether Advair is right for you.
• High thyroid hormone levels. Advair can worsen symptoms of high thyroid hormone levels, such as a fast heartbeat and tremor. If you have high thyroid hormone levels, talk with your doctor about whether Advair is the right treatment for you.
• Seizures. In rare cases,Advair can cause seizures. If you have a seizure disorder such as epilepsy, Advair may increase your risk of having a seizure. Your doctor can help determine whether you should use Advair.
• Diabetes. Advair can sometimes increase blood sugar levels. If you have diabetes, this could make your levels harder to manage. Your doctor may want to monitor your blood sugar levels more frequently while you’re using Advair. If needed, they may adjust the dosage of your diabetes medication.
• Liver problems. Your liver is responsible for clearing Advair from your body. If you have a liver problem, Advair could build up in your body. This could increase your risk of side effects. To see whether Advair is right for you, talk with your doctor.
• Osteoporosis. Long-term use of Advair could weaken your bones. If you have osteoporosis or risk factors for osteoporosis, your doctor may monitor your bone health while you’re using Advair. They may also prescribe medication or supplements to help protect your bones.
• Glaucoma or cataracts. Advair could worsen glaucoma and cataracts. If you have one or both of these eye conditions, talk with your doctor about whether Advair is right for you. They may recommend having regular eye exams while using Advair.
• Pregnancy. There haven’t been enough studies to know exactly how safe Advair is for use during pregnancy. However, having asthma or chronic obstructive pulmonary disease (COPD) that’s not well-managed during pregnancy can pose serious risks for the pregnant person and fetus. If you’re pregnant or planning to become pregnant, talk with your doctor about whether Advair is right for you.
• Breastfeeding. It’s not known whether the active drugs in Advair (fluticasone propionate and salmeterol) can pass into breast milk. If you’re breastfeeding or plan to breastfeed, talk with your doctor about whether Advair is right for you. They can advise you on the right treatment plan for you and recommend how to feed your child.

Note: For details about Advair’s side effects, see this article.

Here are some frequently asked questions about Advair and possible interactions.

Is it safe to use my rescue inhaler with Advair?

Yes, it is.

Rescue inhalers are used to provide fast relief from sudden breathing problems, such as asthma attacks. Examples of these inhalers include albuterol (ProAir, Ventolin HFA, others) and levalbuterol (Xopenex, Xopenex HFA). Your doctor will likely prescribe a rescue medication to keep with you at all times. You can use it to relieve sudden breathing difficulties.

Advair is not a rescue medication. You’ll take it every day to help manage your condition. While using Advair, you can use your rescue inhaler whenever you need to relieve sudden breathing problems.

However, if you need to use your rescue inhaler more often than usual, talk with your doctor. You should also talk with them if your rescue inhaler becomes less effective at relieving breathing difficulties. You may be having a flare-up of your condition, and your doctor may need to adjust your treatment plan.

Can I take over-the-counter pain relievers with Advair?

It depends. Over-the-counter pain relievers typically don’t interact with Advair. However, that doesn’t mean that all these medications are right for you.

If you have asthma or chronic obstructive pulmonary disease (COPD), which Advair treats, there are some medications you should not usually take. For example, medications containing aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve) could cause an asthma attack or worsen breathing problems.

In addition, some pain relievers contain extra ingredients, such as caffeine. Taking caffeine with Advair could raise your risk of side effects, such as increased heart rate, palpitations, and tremor. For more information, see “Advair interactions with food” in “Advair and other interactions” above.

It’s usually safe to take acetaminophen (Tylenol) if you have asthma or COPD. This pain reliever should not affect your breathing and does not interact with Advair.

If you need a pain reliever while using Advair, ask your pharmacist to recommend a suitable medication.

You can take certain steps to help prevent interactions with Advair. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Advair label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. If Advair doesn’t come with paperwork, you can ask your pharmacist to print a copy.

If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Advair by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Advair. These resources might help:

• Overview of Advair. For a general overview of Advair, you can see this article.
• Dosage specifics. To learn about Advair’s dosage, see this article.
• Side effects. To find out about side effects of Advair, see this article. You can also refer to the prescribing information for the form of the drug you’re prescribed: Advair Diskus or Advair HFA.
• Drug comparison. Find information about how Advair compares with Symbicort and Wixela.
• Facts about your condition. To learn details about your condition, see our asthma & allergies hub and COPD hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.