Flixotide inhaler versus Flovent - what is the difference?

The goal of this article is to explain the differences between Flovent, a commonly prescribed medication for Asthma in the USA, and Flixotide, an equivalent inhaler containing the same ingredient. The article will also explain why these interchangeable inhalers are labelled with different strengths.

Flixotide compared to Flovent

Flixotide inhaler is the equivalent of Flovent inhaler (or puffer) and contains the same active ingredient fluticasone propionate. It is CFC free.

Flixotide is not a generic equivalent – it is a brand medication made by GlaxoSmithKline. The manufacturer decided to market this product as Flovent in the US and Canada and as Flixotide in New Zealand and the United Kingdom.

How can two different strengths be the same?

Flovent inhalers are available in 3 strengths: 44 mcg, 110 mcg and 220 mcg for the US version of Flovent, which is equivalent to 50 mcg, 125 mcg and 250 mcg, respectively, in New Zealand, Canada and the United Kingdom. (See table below) The difference in the labelled strengths is due to the measurement at a different point in the device. When the inhaler delivers the medication, 50 mcg is delivered from the valve (upstream), but only 44 mcg from the actuator (mouth piece). The actual amount delivered to the patient lungs is variable and depends on good inhalation technique.

The regulatory authorities in the US chose the amount of medication delivered from the actuator as the labelled inhaler strength (i.e. 44 mcg, 110 mcg and 220 mcg). The New Zealand, Canada and UK labelled strength reflects the amount dispensed from the valve of the same device.

The UK and New Zealand products, in addition to the labelled strengths, have had the names changed to Flixotide and Floair.

The above table shows strengths as measured from different point from the aerosol outlet. This explains why values are stated differently for equivalent inhalers in different countries.

You can verify this Flovent strength description by following this link to the prescribing information GlaxoSmithKline submitted to the FDA in 2006.

www.accessdata.fda.gov/drugsatfda_docs/label/2006/021433s004lbl.pdf

What about other inhalers?

This same phenomenon, where the posted strength of the medication is slightly different in different countries, occurs with inhaled devices such as Symbicort and Advair as well.

Symbicort is known as Vannair in New Zealand:

Advair adds to the already confusing comparisons:

1. The strengths of the respective medications (fluticasone and salmeterol) have been reversed in in the UK and New Zealand when labelling Advair.
2. Advair’s Canadian prescription drug labels do not indicate the amount of salmeterol present.
3. Advair Discus is known as AirFluSal Forspiro in the UK and Seretide Accuhaler in New Zealand.

See the Advair comparison table below:

Stiolto Respimat in the USA is named Inspiolto Respimat in Canada and Spiolto Respimat in the UK.

Breztri Aerosphere has three ingredients:

• Budesonide 160mcg in the USA or 182mcg in Canada

• Glycopyrrolate 9mcg in the USA is stated as Glycopyronium 8.2mcg in Canada (they are the same ingredient but are weighted differently)

• Formoterol Fumarate 4.8mcg in the USA is stated as Formoterol Fumarate Dihydrate 5mcg in Canada

In simpler terms Breztri Aerosphere 182mcg/8.2mcg/5.8mcg in Canada is equivalent to Breztri Aerosphere 160mcg/9mcg/4.8mcg in the USA.

Conclusion

Inhalers such as Flovent, Breztri Aerosphere, Stiolto Respimat, Advair and others may have different names and different strengths posted on their labels. We are here to help! Canadian online pharmacies and their pharmacist staff have become experts in determining the similarities between the various medication labels. In fact, our Canadian pharmacists have spent a lot of time investigating and researching these products so they can ensure the medication that is available in a US pharmacy is the same or equivalent to a medication found at a pharmacy elsewhere in the world. This information can get confusing quickly, so please speak with an online pharmacist that has experience working with medications at the global level. These specially trained pharmacists are available to assist you and provide information and counseling on the medications you may need.