The Seretide 250 Evohaler is a fixed combination preventer. GlaxoSmithKline UK makes it. Each puff delivers two active ingredients. Firstly, fluticasone propionate 250 micrograms is an inhaled steroid. Additionally, salmeterol 25 micrograms is a long-acting reliever. As a result, one twice-daily inhaler covers both the swelling and the airway tightening that drive asthma. The Seretide 250 Summary of Product Characteristics confirms the ingredients and doses.
Why the high strength matters
The 250 microgram strength is the highest in the Seretide Evohaler range. Meanwhile, the range also includes 50 and 125 microgram versions. In particular, the 250 microgram version suits patients whose asthma needs a high inhaled steroid dose. Additionally, at 4 puffs a day this counts as a high ICS dose in adults. Furthermore, it’s typically reserved for more severe asthma or where lower strengths haven’t held control.
A preventer, not a rescue inhaler
Above all, the Seretide 250 Evohaler is a preventer. It works quietly in the background over weeks. However, it will not open your airways quickly during an asthma attack. In particular, salmeterol is a slow-onset long-acting reliever. As a result, always keep a short-acting reliever with you. NICE NG245 makes the reliever-alongside-preventer point clearly.
Key features and specifications
Active ingredients: fluticasone propionate 250 micrograms and salmeterol xinafoate 25 micrograms per metered dose
Delivered dose: 220 micrograms fluticasone and 21 micrograms salmeterol
A high-strength combination preventer for more severe asthma
If your asthma isn’t holding on a lower-strength combination, or your prescriber has stepped you up from Seretide 125, the Seretide 250 Evohaler is the highest strength in the Evohaler range. Firstly, it delivers 250 micrograms of fluticasone plus 25 micrograms of salmeterol per puff. Additionally, it uses a standard pressurised device with a built-in dose counter. Meanwhile, at 4 puffs a day it counts as a high adult ICS dose. At Courier Pharmacy, we help you make sense of whether this high-strength option fits your control needs.
Five key takeaways
The Seretide 250 Evohaler is a fixed combination of fluticasone 250 micrograms and salmeterol 25 micrograms per puff.
It’s a pressurised metered-dose inhaler with a built-in dose counter and a purple actuator.
Licensed for adults and adolescents from 12 years whose asthma needs high-dose inhaled steroid cover.
At 4 puffs a day, it delivers a high ICS daily dose of 1,000 micrograms of fluticasone.
The Seretide 250 Evohaler is a Prescription Only Medicine. A UK-qualified prescriber reviews every request at courierpharmacy.co.uk.
Treatment dosage Seretide 250 Evohaler
Adult and adolescent dose
For adults and adolescents aged 12 and over, the usual dose is 2 inhalations twice daily. As a result, that’s 4 puffs a day in total. Additionally, doses are usually taken 12 hours apart. Furthermore, this delivers 1,000 micrograms of fluticasone and 100 micrograms of salmeterol daily.
When your reliever use signals a problem
Above all, needing your rescue reliever more than 3 times a week is a signal. Firstly, it usually means your control isn’t holding. Additionally, it flags that a review is due. In fact, NICE NG245 links heavy reliever use to worse asthma outcomes. Rather than reaching for more Seretide, contact your prescriber.
Stepping up or down
Your prescriber may step you down once your control has been stable for a while. In particular, this may mean switching to Seretide 125 or another combination. Furthermore, any step-down should be planned. Meanwhile, never stop your preventer suddenly. As a result, disclose any recent changes to your inhaler during consultation.
What is Seretide 250 Evohaler: overview
A twice-daily combination preventer containing fluticasone (a steroid) and salmeterol (a long-acting reliever).
A pressurised suspension pMDI in a purple actuator with a built-in dose counter.
Licensed for adults and adolescents from 12 years with more severe asthma requiring high-dose ICS cover.
Made by GlaxoSmithKline UK, and one of the most-used combination inhalers over the past two decades.
Prescription only, and the highest-strength option in the Seretide Evohaler range.
Why combination inhalers exist
Combination inhalers answer a practical problem. Before they existed, patients on both an inhaled steroid and a long-acting reliever used two separate devices. As a result, adherence often suffered. Additionally, technique varied between devices. However, a single device delivers both medicines together. Meanwhile, this improves consistency and simplifies the daily routine.
Fluticasone and salmeterol together
Seretide combines two well-established medicines. Firstly, fluticasone propionate has been used in inhaled form since the 1990s. Additionally, salmeterol was one of the first long-acting relievers introduced. As a result, this combination has decades of clinical experience behind it. Furthermore, twice-daily dosing keeps steady cover across each 24 hours.
The Evohaler device
The Seretide 250 Evohaler is a pressurised metered-dose inhaler, or pMDI. Additionally, it’s a standard press-and-breathe type. It uses HFA-134a as the propellant. Notably, this is a modern ozone-friendly gas. Meanwhile, the built-in dose counter shows how many doses remain. As a result, you always know when to reorder.
Where the 250 strength fits
The Seretide Evohaler range includes 50, 125, and 250 microgram strengths of fluticasone. Meanwhile, all three contain the same 25 micrograms of salmeterol per puff. In particular, the 250 microgram version delivers a high ICS daily dose in adults. Furthermore, it suits patients who need more steroid than Seretide 125 offers.
Typically for more severe asthma
The Seretide 250 Evohaler is often used in patients with more severe asthma. However, some patients respond well to lower steroid doses. As a result, higher strengths are not automatically better. Additionally, using the lowest effective dose is the general principle. Meanwhile, your prescriber will match strength to severity.
Why choose Courier Pharmacy for your Seretide 250 Evohaler
Registered, independent, and patient-led
Courier Pharmacy is a UK-registered independent pharmacy. The General Pharmaceutical Council regulates us. Firstly, respiratory disease looks different for every patient. Additionally, your triggers, history, and device preferences all matter. As a result, our prescribers ask about those things. Getting your combination inhaler right is about the fit.
Dr Ada Jex-Cori, our brand pharmacist
Our brand pharmacist is Dr Ada Jex-Cori. She represents the spirit of what we do. Named for Ada Lovelace, Sophia Jex-Blake, and Gerty Cori, she stands for evidence-led, unafraid-of-questions medicine. Her message is straightforward. You’re not broken. The system is. We’re here to change that.
Care that keeps showing up
We don’t disappear after we’ve dispensed. Furthermore, if your control shifts, we’re here. Additionally, if a side effect appears, we help you make sense of it. For patients navigating MCAS, chronic fatigue, or fibromyalgia alongside respiratory care, that continuity matters. Care that fits you means care that keeps showing up.
Buy Seretide 250 Evohaler (Prescription Only) from Courier Pharmacy
The Seretide 250 Evohaler is a Prescription Only Medicine. You can request it at courierpharmacy.co.uk. Firstly, complete an online consultation. Then, a UK-qualified prescriber reviews your answers. If approved, we dispense and deliver discreetly.
Complete a quick online consultation
A UK prescriber reviews your answers
If approved, a prescription is issued
We dispense and deliver discreetly to your door
If it isn’t suitable for you, we’ll explain why and suggest the next best option.
Active ingredients in Seretide 250 Evohaler
Fluticasone at a glance
Fluticasone propionate is an inhaled steroid. Firstly, each puff of Seretide 250 delivers 250 micrograms of it. In particular, it binds to steroid receptors in airway cells. As a result, it switches off the genes that produce inflammatory chemicals. Additionally, airway swelling reduces over 1 to 2 weeks. Peer-reviewed studies have shown fluticasone reduces asthma flare-ups significantly.
Salmeterol at a glance
Salmeterol xinafoate is a long-acting beta-2 agonist. Meanwhile, each puff delivers 25 micrograms. Additionally, it activates beta-2 receptors on airway smooth muscle. As a result, the muscle relaxes and airways open. However, salmeterol has a slow onset of around 10 to 20 minutes. Furthermore, the effect lasts 12 hours.
Other ingredients
The Seretide Evohaler also contains HFA-134a as the propellant. Notably, this carries the fine suspension out of the canister. Additionally, there are no other significant excipients. As a result, the formulation is CFC-free and lactose-free. Meanwhile, mention any allergy concerns during your consultation.
What is Seretide 250 Evohaler for?
Licensed for asthma maintenance
The Seretide 250 Evohaler is licensed for the regular treatment of asthma. In particular, it suits patients not adequately controlled on inhaled steroids and short-acting relievers. Additionally, it suits patients already stable on a similar high-dose combination. Above all, this is a preventer, taken every day even when you feel well. The NHS covers combination inhalers for asthma in detail.
Where it fits in the treatment ladder
In practical terms, Seretide 250 is a step up from lower-strength combinations. If your Seretide 125 isn't holding, this is one route forward. Furthermore, NICE NG245 recognises high-strength combinations as an appropriate next step. However, unlike some other combinations, Seretide is not used for MART regimens.
When you'll still need a reliever
Above all, always keep a short-acting reliever with you. Meanwhile, salmeterol is a slow-onset long-acting reliever, so it cannot be used for rescue. As a result, ask your prescriber about salbutamol or terbutaline as your rescue medicine. If you're using your rescue reliever more than 3 times a week, contact your prescriber.
How does Seretide 250 Evohaler work?
Fluticasone calms the swelling
Fluticasone binds to steroid receptors in airway cells. Firstly, this switches off the genes that produce inflammatory chemicals. As a result, airway swelling reduces over 1 to 2 weeks. Additionally, the airways become less twitchy. Think of it as turning down the alarm system in your airways.
Salmeterol keeps the airways open
Salmeterol activates beta-2 receptors on airway smooth muscle. Meanwhile, the signal tells the muscle to relax. As a result, the airways stay open for around 12 hours. However, salmeterol has a slow onset compared to formoterol. Additionally, this is why it cannot be used for rescue relief.
Two medicines, one device
The two medicines work through different mechanisms. In particular, fluticasone tackles the underlying swelling. Meanwhile, salmeterol tackles the airway muscle. As a result, taking them together often gives better control than either alone. Furthermore, one device improves adherence over two separate inhalers.
How long until you feel the full effect
You may notice some airway opening from salmeterol within the first day. However, the full anti-inflammatory benefit takes 1 to 2 weeks. Furthermore, maximum control usually shows within 4 to 6 weeks. As a result, sticking with twice-daily use matters. Above all, take it even when you feel well.
How to use Seretide 250 Evohaler inhaler
Step-by-step technique
Firstly, remove the mouthpiece cap. Shake the inhaler well before each use. Then, breathe out fully, away from the mouthpiece. Next, put the mouthpiece between your teeth with lips closed. Now start to breathe in slowly and press the top at the same time. Hold your breath for 10 seconds if you can. The NHS provides an inhaler technique guide for reference.
Using a spacer
A spacer can improve delivery to the lungs. In particular, the Seretide Evohaler pairs with 50 different spacers, including AeroChamber Plus. Additionally, using a spacer reduces the amount of medicine landing in your mouth or throat. As a result, side effects like thrush and hoarseness are less likely. Furthermore, ask your prescriber which spacer suits your inhaler.
Mouth care and storage
Rinse your mouth and spit afterwards, or brush your teeth. Additionally, inhaled steroids can cause oral thrush or a hoarse voice. Meanwhile, rinsing removes any medicine that hasn't reached your lungs. In particular, mouth care matters more at higher steroid strengths. Furthermore, store the canister below 30 degrees Celsius.
Warnings and precautions for Seretide 250 Evohaler
Who should not use it
Firstly, don't use Seretide if you're allergic to fluticasone, salmeterol, or any of the other ingredients. Additionally, tell your prescriber about heart disease, irregular heartbeat, or high blood pressure. Similarly, mention diabetes, thyroid problems, tuberculosis, or any lung infection. As a result, these conditions need extra care with Seretide.
Steroid effects at high doses
Inhaled steroids can affect the body's natural steroid production. In particular, this matters at the high doses delivered by Seretide 250. As a result, patients on Seretide 250 usually need a steroid safety card. Above all, tell any healthcare team you're on Seretide, especially before surgery. Furthermore, don't stop suddenly without medical advice.
Cardiovascular considerations
Salmeterol can slightly raise heart rate and blood pressure. However, palpitations are uncommon. Meanwhile, patients with existing heart disease need extra care. Additionally, potassium can drop at high doses. As a result, mention any cardiac history during consultation.
Adrenal function and growth
Long-term high-dose inhaled steroid use can affect adrenal gland function. Additionally, it can slightly slow growth in adolescents. Meanwhile, your prescriber may monitor these effects during regular reviews. However, uncontrolled asthma also affects growth. As a result, the benefit of treatment usually outweighs the small growth effect.
Paradoxical bronchospasm
Very rarely, inhalers cause paradoxical bronchospasm. This is when airways tighten straight after use. Firstly, if this happens, stop Seretide and use your reliever. Additionally, contact your prescriber urgently. Above all, don't continue with the same inhaler until reviewed.
Pregnancy and breastfeeding
Both fluticasone and salmeterol have been used in pregnancy. However, data is more limited than for older ICS medicines. Meanwhile, both pass into breast milk in small amounts. As a result, if you're pregnant, planning pregnancy, or breastfeeding, mention it during your consultation.
Side effects of Seretide 250 Evohaler
Common side effects
The most common side effects affect up to 1 in 10 people. These include sore throat, hoarse voice, headache, and oral thrush. Additionally, palpitations and tremor can occur. Meanwhile, some patients notice muscle cramps. Most are manageable with good technique and mouth care.
Uncommon side effects
Uncommon side effects (up to 1 in 100) include skin rashes and dizziness. Furthermore, sleep problems and irritability can occur. Additionally, cataract has been reported with long-term high-dose use. Your prescriber may monitor these during regular reviews.
Rare and very rare side effects
Rare side effects (up to 1 in 1,000) include irregular heartbeat and behavioural changes. Very rare side effects (up to 1 in 10,000) include serious allergic reactions and adrenal effects. Additionally, glaucoma has been reported very rarely. Above all, high-dose users need periodic review for these effects.
When to seek urgent help
Seek urgent help for sudden worsening breathlessness after a puff. Similarly, seek help for facial swelling or difficulty breathing. Additionally, get help for severe chest pain or an irregular heartbeat. Meanwhile, any widespread rash needs immediate attention.
Yellow Card reporting
You can report any suspected side effects directly via the MHRA Yellow Card Scheme at https://yellowcard.mhra.gov.uk. Reporting side effects helps provide more information on the safety of this medicine.
Drug interactions with Seretide 250 Evohaler
Beta-blockers
Firstly, beta-blockers can reduce or block the effect of salmeterol. This includes non-selective ones like propranolol. Additionally, cardioselective beta-blockers can interact to a lesser extent. Meanwhile, some glaucoma eye drops contain beta-blockers. Tell your prescriber about any of these.
CYP3A4 inhibitors
Meanwhile, strong CYP3A4 inhibitors can raise blood levels of fluticasone. In particular, ritonavir and cobicistat matter most. Additionally, ketoconazole, itraconazole, and clarithromycin also count. As a result, this matters more at the 250 microgram strength than at lower doses. Furthermore, disclose any of these during your consultation.
Other airway medicines and diuretics
Additionally, other beta-2 agonists can add up to more side effects. Similarly, xanthines like theophylline deserve mention. In particular, diuretics that lower potassium can interact with salmeterol. Furthermore, digoxin and other steroids need discussion. Above all, tell your prescriber about every medicine you take.
Frequently asked questions about Seretide 250 Evohaler
How quickly does the Seretide 250 Evohaler start working?
Salmeterol opens your airways within 10 to 20 minutes of the first dose. However, the full anti-inflammatory benefit from fluticasone takes 1 to 2 weeks. Furthermore, maximum control usually shows within 4 to 6 weeks. Stick with it every day, even when you feel well.
Can I use Seretide 250 as a rescue inhaler?
No. Seretide is a maintenance preventer only. In particular, salmeterol has a slow onset and cannot be used for rescue. As a result, always keep a separate short-acting reliever with you. If you're using your reliever more than 3 times a week, contact your prescriber.
What's the difference between Seretide 50, 125, and 250?
All three contain the same 25 micrograms of salmeterol per puff. However, they differ in fluticasone. Firstly, Seretide 50 gives 50 micrograms per puff. Additionally, Seretide 125 gives 125 and Seretide 250 gives 250. As a result, the 250 is the highest strength.
Is 250 micrograms a high dose?
Yes. At 4 puffs a day, Seretide 250 delivers 1,000 micrograms of fluticasone daily. In particular, this counts as a high adult ICS dose. As a result, patients on this strength usually need a steroid safety card. Additionally, regular reviews with your prescriber matter more at this dose.
Do I need a steroid safety card with Seretide 250?
Usually yes. Steroid safety cards are recommended for patients on high daily inhaled steroid doses. Additionally, they alert healthcare teams that you may need extra steroid cover in illness or surgery. Above all, ask your prescriber about getting a card if you're on Seretide 250.
Can I use Seretide 250 for MART?
No. Seretide is not licensed for MART (maintenance and reliever therapy). Meanwhile, salmeterol's slow onset makes it unsuitable for as-needed use. As a result, always keep a separate short-acting reliever with you. Discuss any MART questions with your prescriber.
Why do I need to rinse my mouth after every use?
Inhaled steroids can cause oral thrush, hoarseness, or a sore throat. As a result, rinsing removes medicine that didn't reach your lungs. Additionally, using a spacer also helps. Above all, mouth care matters more at the higher 250 strength. Don't swallow the rinse water.
Can I use Seretide 250 with a spacer?
Yes. The Seretide Evohaler pairs with 50 different spacers, including AeroChamber Plus. Additionally, this improves delivery and reduces mouth side effects. Meanwhile, your prescriber can advise which spacer suits your inhaler. Above all, at higher steroid strengths a spacer often helps significantly.
Can I stop Seretide 250 if I feel well?
No. Seretide is a preventer, and it works because you take it every day. As a result, stopping it lets airway swelling come back. Additionally, sudden stops after high-dose steroid use can affect adrenal function. Above all, speak to your prescriber before any change.
Does Seretide 250 Evohaler have a dose counter?
Yes. The current Seretide 250 Evohaler has a built-in dose counter. Additionally, the counter shows how many doses remain. As a result, you always know when to reorder. Meanwhile, older versions without a dose counter have been phased out.
Will Seretide 250 affect my heart?
Salmeterol can slightly raise heart rate and blood pressure. Meanwhile, palpitations are uncommon. However, existing heart disease needs discussion before starting. Above all, contact your prescriber urgently for new chest pain or an irregular heartbeat.
Will Seretide 250 affect my adrenal function?
At high daily doses, inhaled steroids can affect the body's natural steroid production. In particular, this matters more with Seretide 250 than with lower strengths. Meanwhile, your prescriber may monitor this if you're on the 250 strength long-term. As a result, don't stop suddenly without medical advice.
Can Seretide 250 make me hoarse?
Yes. Hoarseness is a common side effect of inhaled steroids. Additionally, the risk rises with higher steroid strengths. Above all, it usually settles as your voice adjusts. Rinsing your mouth after use and using a spacer both reduce the risk.
Can I use Seretide 250 during pregnancy?
Only after careful discussion. Firstly, both ingredients have been used in pregnancy but with less data than older ICS medicines. Meanwhile, both pass into breast milk in small amounts. Additionally, high-dose use raises the level of caution. As a result, if you're pregnant or breastfeeding, tell your prescriber.
What if Seretide 250 still isn't controlling my asthma?
If Seretide 250 doesn't hold your control at 4 puffs a day, other approaches may be needed. In particular, add-on therapies like a LAMA or biologic treatment may help. Furthermore, this needs specialist review. Discuss any ongoing symptoms with your prescriber for referral if needed.
Will Seretide 250 affect my blood sugar?
Salmeterol can raise blood sugar slightly. Additionally, at high steroid doses, blood sugar effects can be more noticeable. Meanwhile, if you have diabetes, your monitoring may need tightening. Above all, disclose any diabetes during your consultation.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it's nearly time for the next dose, skip it. Never double up. Consistency over weeks matters more than any single missed puff.
How should I store Seretide 250 Evohaler?
Store below 30 degrees Celsius. Additionally, don't leave it in a hot car or direct sunlight. Never pierce or burn the canister, even when empty. Keep it out of the reach of children. Don't use it past the expiry date.
Will I need a prescription from Courier Pharmacy?
Yes. Seretide 250 Evohaler is a Prescription Only Medicine. A UK-qualified prescriber must review your suitability. You can complete the consultation at courierpharmacy.co.uk. Additionally, if you're already stable on Seretide 250, mention this in the consultation.
What if Seretide 250 isn't right for me?
Sometimes a different combination inhaler suits better. In other cases, a completely different approach is the answer. Whatever the situation, we'll explain why and suggest the next best option. Honesty over sales, every time.
More than a prescription: our community
Free fortnightly drop-in clinics in Derby
Healthcare shouldn't only happen when you're paying for it. Every fortnight, we run free drop-in talks at Insomnia, Derby, from 12 to 1pm. Anyone can come. No appointment. No cost. No pressure.
Topics we cover
We cover asthma control and inhaler technique. Additionally, we discuss weight management and hormone health. Furthermore, we cover MCAS, chronic fatigue, and more. Learn more about our community talks at courierpharmacy.co.uk.
How this content was created
The Courier Pharmacy editorial team writes our content. Additionally, a GPhC-registered pharmacist reviews every piece. We ground our work in NHS, NICE, BNF, and EMC guidance. Furthermore, we use peer-reviewed studies and questions from our Derby drop-in clinics.
Disclaimer
Disclaimer: This information is for education only and isn't a substitute for personal medical advice. Always follow your prescriber's instructions.
National Institute for Health and Care Excellence (2024) Asthma: diagnosis, monitoring and chronic asthma management. NICE guideline NG245. Available at: https://www.nice.org.uk/guidance/ng245
