Consider dose reduction of sensitive CYP3A4 substrates.itraconazoleMonitor 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.ivosidenibSerious - 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.ketoconazoleMonitor 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.ketoprofenMonitor Closely (1)ketoprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.ketorolacMonitor Closely (1)ketorolac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.ketorolac intranasalMonitor Closely (1)ketorolac intranasal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .ketotifen, ophthalmicMonitor Closely (1)ketotifen, ophthalmic increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.labetalolMonitor 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.larotrectinibMinor (2)larotrectinib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. larotrectinib will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.lefamulinContraindicated (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.lenvatinibMonitor 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.letermovirMonitor 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.levalbuterolMonitor 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.levoketoconazoleMonitor 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.levorphanolMonitor Closely (1)levorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.linezolidSerious - Use Alternative (1)linezolid increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.lisdexamfetamineMonitor 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.lofepramineMonitor 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.lofexidineMonitor Closely (1)lofexidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.lonafarnibSerious - 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.lopinavirContraindicated (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 exposureloprazolamMonitor Closely (1)loprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.lorazepamMonitor Closely (1)lorazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.lormetazepamMonitor Closely (1)lormetazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.lornoxicamMonitor Closely (1)lornoxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.loxapineMonitor Closely (1)loxapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.loxapine inhaledMonitor Closely (1)loxapine inhaled increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.maprotilineMonitor 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.marijuanaMonitor Closely (1)marijuana increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.meclofenamateMonitor Closely (1)meclofenamate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.mefenamic acidMonitor Closely (1)mefenamic acid increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.mefloquineSerious - 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.melatoninMonitor Closely (1)melatonin increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.meloxicamMonitor Closely (1)meloxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.meperidineMonitor Closely (1)meperidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.meprobamateMonitor Closely (1)meprobamate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.metaproterenolMonitor 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.methadoneMonitor Closely (1)methadone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methamphetamineMonitor 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.methyclothiazideMonitor Closely (1)salmeterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.methylenedioxymethamphetamineMonitor 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.methylphenidateMonitor Closely (1)salmeterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.metolazoneMonitor Closely (1)salmeterol and metolazone both decrease serum potassium. Use Caution/Monitor.Minor (1)salmeterol, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.metoprololMonitor 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.midazolamMonitor Closely (1)midazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.midodrineMonitor 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.mifepristoneMonitor 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 exposuremirtazapineMonitor Closely (1)mirtazapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mitotaneMonitor 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.modafinilMonitor Closely (1)salmeterol and modafinil both decrease sedation. Use Caution/Monitor.morphineMonitor Closely (1)morphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.motherwortMonitor Closely (1)motherwort increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.moxonidineMonitor Closely (1)moxonidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nabiloneMonitor Closely (1)nabilone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nabumetoneMonitor Closely (1)nabumetone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.nadololMonitor 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.nalbuphineMonitor Closely (1)nalbuphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.naproxenMonitor Closely (1)naproxen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.nebivololMonitor 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.nefazodoneMonitor 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.nelfinavirContraindicated (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 exposurenicardipineMonitor 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 exposurenirmatrelvirMonitor 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/ritonavirMonitor 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 juiceMinor (1)noni juice increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.norepinephrineMonitor 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.nortriptylineMonitor 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 SCMonitor 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.olanzapineMonitor Closely (1)olanzapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.olodaterol inhaledMonitor 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 effectsombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)Serious - Use Alternative (2)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of