Salmeterol (Inhalation Route)

Salmeterol inhaler is used in combination with other drugs to treat the symptoms of patients who suffer from asthma. The drug is also very effective in treating other chronic breathing-related health conditions, including emphysema and bronchitis.

Overview

Salmeterol inhalation preparation is used in combination with other drugs for the treatment of the symptoms of asthma. The drug is also used in the effective prevention of bronchospasm in asthmatics. When used on a daily basis, salmeterol can decrease the frequency and severity of attacks of asthma. It should be noted, however, that this medication does not provide relief for an attack that is already in progress.

Salmeterol belongs to a family of drugs called long-acting bronchodilators. The medication is dispensed via an inhaler and is sucked into the lungs through the patient’s mouth. The drug works by relieving blockages in the passages of the lungs, opening up the tubes, and thus aiding easier air flow. Salmeterol is also useful in treating certain other chronic respiratory conditions, including bronchitis and emphysema. The drug can also be used to prevent the wheezing that is caused by a condition called exercise-induced bronchospasm. Patients who suffer from COPD may also benefit from receiving treatment with this drug.

The US brand name for salmeterol is, Serevent. In Canada, the drug is sold under various brand names, including:

  • Serevent Diskus
  • Serevent Diskhaler Disk
  • Serevent Diskhaler
  • Serevent

You can only obtain salmeterol with a prescription from your treating physician. The medication comes in the form of a disk, aerosol powder, or powder. Your nurse or GP will give you full instructions on how to use whichever form of inhaler that you are prescribed.

Conditions Treated

  • Asthma
  • Chronic bronchitis
  • Emphysema
  • Exercise-induced bronchospasm
  • COPD

Type of Medicine

  • Long-acting bronchodilator
  • Inhaler
  • Disk
  • Aerosol powder
  • Powder

Side Effects

In addition to the benefits provided by salmeterol, there are some side effects that do affect some patients. You will probably not experience many or any of these effects, but if they do occur, you should seek further medical attention.

If you notice any of the side effects listed below, you must contact your GP immediately:

  • White patches on the tongue or inside the mouth
  • Wheezing
  • Vomiting
  • Very slow or very fast heartbeat
  • Unexplained weight loss
  • Trouble with sleeping
  • Tightness of the chest
  • Sweating
  • Stuffy or blocked nose
  • Stomach or abdominal pains
  • Sore throat
  • Sore mouth or tongue
  • Sneezing
  • Shortness of breath
  • Shivering
  • Runny nose
  • Pounding in the ears
  • Pain or tenderness near the eyes and cheekbones
  • Pain
  • Noisy breathing
  • Nervousness
  • Nausea
  • Muscle aches and pains
  • Loss of appetite
  • Joint pain
  • Irritation of the throat
  • Increased urination
  • Increased thirst
  • Increased hunger
  • Headaches
  • General feeling of being unwell or in discomfort
  • Fruit-like breath odor
  • Flushed, dry skin
  • Flu-like symptoms
  • Fever
  • Feeling unusually tired or weak
  • Dry mouth
  • Dizziness
  • Difficulty breathing
  • Diarrhea
  • Crawling, burning, itching, pricking, numbness, "pins and needles", or tingling feelings ‘under’ the skin
  • Coughing that produces mucus
  • Coughing or hoarseness
  • Colds
  • Chills
  • Breathing difficulties
  • Blurred vision

Summon emergency medical assistance straight away if any of the following symptoms occur; these could indicate an overdose:

  • Sleeplessness
  • Shakiness or trembling of the arms, legs, hands, or feet
  • Seizures
  • Jaw, arm, or back pain
  • Irregular, fast, slow, pounding heartbeat or pulse
  • Fast or irregular heartbeat
  • Fainting
  • Dizziness, faintness, or lightheadedness when rising abruptly from a prone or sitting position
  • Confusion

There are some side effects that may be noticed by patients being treated with salmeterol that may resolve by themselves, once your body becomes used to the medication. There will probably be various ways in which you can prevent or manage these effects, and your GP or specialist will advise you on this. However, if you find some of the side effects especially difficult to cope with or manage, go to see your doctor and ask for more assistance.

The following side effects generally disappear after a week or two:

  • Swelling and redness of the eye, eyelid, or inner lining of the eyelid
  • Stomach pain, discomfort, or upset
  • Severe, throbbing headache
  • Redness, pain, or irritation of the eyes
  • Rash, severe redness, itching, scaling, soreness, or swelling of the skin
  • Muscle stiffness or tightness
  • Muscle cramps and spasm
  • Mouth or tooth pain
  • Itching, burning, or dry eyes
  • Indigestion
  • Hives or welts
  • Heartburn
  • Encrusted, scaly and oozing skin rash
  • Discharge or excessive tearing from the eyes
  • Difficulty in moving
  • Bone pain
  • Blistering, crusting, burning, flaking, or dryness of the skin
  • Belching
  • Anxiety
  • Acid or sour stomach

There may be other effects that you notice, which are not mentioned above. In this case, you should ask your GP for advice.

Dosage

Salmeterol (inhalation route) is used to offer prevention against asthma attacks and also in the treatment of chronic obstructive pulmonary disease. The medication cannot be used to treat an asthma attack that is already underway. If you are already suffering an asthma attack, you should use an alternative drug. If you have not been prescribed anything suitable, you should discuss this with your doctor.

When you collect your prescription of salmeterol, you will be given a medication guide or a leaflet containing more information for patients. Be sure to read through all the information before you begin using the medication. If there is anything that you do not understand about the drug or how to use it, ask your pharmacist or GP for guidance.

You must only use this medication as you have been directed by your treating specialist or GP. Do not exceed the dose of the drug than you have been told to use, and do not increase the amount of times you use it. Never stop taking the medication without first consulting your GP, as this could increase your risk of developing breathing difficulties.

If your prescription of salmeterol is to work efficiently in preventing COPD or asthma attacks, you must use it daily in evenly-spaced doses, as directed by your GP. One of the doses should be taken before you go to bed to prevent the likelihood of an asthma attack during the night. Make a note of your usual dosage times to ensure that consistency of treatment remains regular.

Using the Device

  • Remove the Device from its protective foil pouch.
  • First of all, open the device by moving the finger grip to its furthest extent. When it is in the correct position, the device will click. When the device is opened, a mouthpiece will emerge.
  • Slide the lever on the mouthpiece right back until there is a click. The device is now primed and ready for you to use. Do not shut the Device or depress the lever again. If you do, the dose the device contains will be lost.
  • Breathe out completely, holding the device away from you. Avoid breathing into the device.
  • Take the device and, holding it level, put the mouthpiece in your mouth between your teeth and lips. Without biting down on it, close your lips around the device’s mouthpiece. Make sure that you are not obstructing the mouthpiece with your tongue or your teeth.
  • Take a full, deep breath in. Avoid breathing in through your nose.
  • Hold in your breath and take the mouthpiece out of your mouth. Try to hold your breath for at least 10 seconds, and then breathe out slowly. This allows time for the drug to be absorbed into your lungs and airways.
  • Breathe out very slowly until your lungs feel empty, without breathing into the device.
  • You may have been prescribed more than one inhalation of salmeterol at every dose. In this case, simply repeat the steps that you used for the first inhalation.
  • When you have taken your prescribed dose, you will need to close the device. To do so, put your slide the finger grip right back until it clicks closed.
  • Keep the device dry. If necessary, you may clean the Device by wiping it with a dry cloth. Do not wash it.
  • Your Device has a small window that displays the quantity of treatments that remain after each use. This facility enables you to see when your supply of medication is becoming low. When the device indicates that you have five treatments left, the numbers will display in red, reminding you to get a repeat prescription.

The dose of salmeterol prescribed by your doctor will usually vary between patients, as will the frequency of doses and the time that you leave between them. This will depend on a number of factors, including the condition for which you are being treated and the strength of the preparation that you have been prescribed. Always follow your doctor’s directions exactly or observe the instructions on the dispensary label. If your dose is not the same, you must not alter it unless your GP tells you to.

For prevention of an asthma attack (powder):

  • Adults, teens, and children over the age of four years: take one puff (50 mcg) twice daily, morning and evening. Allow at least 12 hours between doses.
  • Children under aged four years: Your doctor will determine the dose and use.

For COPD maintenance (powder):

  • Adults, teens, and children over the age of four years: take one puff (50 mcg) twice daily, morning and evening. Allow at least 12 hours between doses.
  • Children under aged four years: Your doctor will determine the dose and use.

For prevention of exercise-induced bronchospasm (powder):

  • Adults, teens, and children over the age of four years: take one puff (50 mcg) 30 minutes prior to commencing exercise.
  • Children under aged four years: Your doctor will determine the dose and use.

If you inadvertently miss a dose of your medication, you should leave out the dose that you have missed and revert to your usual dosing regimen. Do not take a double dose or add in an extra dose without first checking with your doctor.

Interactions

Some forms of medication should never be used concurrently as an interaction may occur between them. However, in some cases, it may be appropriate to use two drugs together, where an interaction can be managed or prevented. In this instance, your GP or specialist may adjust the dose of one or both of your medicines. You will be offered advice on how you can mitigate any interactions that may take place

If you are already taking fluconazole or posaconazole, using salmeterol is not recommended. Your GP may opt not to use this medication to treat you or may change one of the other drugs that you are currently using

The following medications should not be used with salmeterol, but your doctor may decide to do so if this is the best treatment option in your case. If both drugs are to be used simultaneously, your dose or frequency of use of one or both medicines may be changed:

  • Voriconazole
  • Vardenafil
  • Trifluoperazine
  • Trazodone
  • Toremifene
  • Tipranavir
  • Tetrabenazine
  • Telithromycin
  • Telavancin
  • Telaprevir
  • Sunitinib
  • Sorafenib
  • Solifenacin
  • Sodium Phosphate, Monobasic
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate
  • Saquinavir
  • Ritonavir
  • Ranolazine
  • Quinine
  • Quinidine
  • Propafenone
  • Promethazine
  • Prochlorperazine
  • Procainamide
  • Perflutren Lipid Microsphere
  • Paritaprevir
  • Paliperidone
  • Ondansetron
  • Ombitasvir
  • Ofloxacin
  • Octreotide
  • Norfloxacin
  • Nilotinib
  • Nelfinavir
  • Nefazodone
  • Mifepristone
  • Methadone
  • Mefloquine
  • Lumefantrine
  • Lopinavir
  • Lapatinib
  • Ketoconazole
  • Itraconazole
  • Indinavir
  • Iloperidone
  • Idelalisib
  • Ibutilide
  • Haloperidol
  • Halofantrine
  • Granisetron
  • Gemifloxacin
  • Gatifloxacin
  • Fosamprenavir
  • Flecainide
  • Fingolimod
  • Droperidol
  • Domperidone
  • Dolasetron
  • Dofetilide
  • Disopyramide
  • Dasatinib
  • Dasabuvir
  • Darunavir
  • Conivaptan
  • Cobicistat
  • Clozapine
  • Clarithromycin
  • Citalopram
  • Ciprofloxacin
  • Chlorpromazine
  • Chloroquine
  • Ceritinib
  • Boceprevir
  • Azithromycin
  • Atazanavir
  • Astemizole
  • Asenapine
  • Arsenic Trioxide
  • Apomorphine
  • Amprenavir
  • Amiodarone
  • Alfuzosin
  • Erythromycin

Some drugs should not be taken at mealtimes or when eating certain food groups, as interactions could take place. In addition, using tobacco or drinking alcohol with some medications is not recommended as interactions might occur. Ask your GP for advice concerning your use of tobacco, alcohol, and consuming certain food groups.

Warnings

There is no evidence to suggest that using salmeterol may harm an unborn baby. However, you should seek the advice of your treating physician if you are pregnant or think you are likely to become pregnant during the course of your treatment.

It is unknown if using salmeterol while breastfeeding could present a risk to a nursing infant. You should discuss this with your midwife or doctor and assess the benefits of treatment with this medicine against the risks to your child before you begin your course of treatment.

Some medical conditions may have an adverse impact on the effect of salmeterol. You must discuss your recent and historical medical history in full with your GP before you start taking this drug.

If you are suffering from an acute asthma attack, acute bronchospasm or COPD flare-up, you should NOT use salmeterol. Use an alternative drug or seek further advice from your doctor.

Using salmeterol in patients who have a history of any of the following conditions could make the symptoms worse and should, therefore, be avoided:

  • Diabetes
  • Heart or blood vessel disease
  • Problems with heart rhythm, including QT prolongation or arrhythmia
  • High blood pressure
  • Overactive thyroid
  • Low potassium levels in the blood
  • High levels of ketones in the blood
  • Seizures

If you are likely to be a long-term user of salmeterol, you must attend regular check-up appointments with your doctor in order that your GP can monitor your progress and discuss any side effects with you.

If you are already using other medication for COPD, you must tell your GP as it may be necessary for you to stop using this medicine or only use it during a very severe attack of COPD. Be sure to take your medication exactly as directed by your doctor.

Do not use salmeterol if you are having an acute COPD attack or if you think that you are about to have one. Your GP will prescribe you another drug to use in this case. If the alternative medication does not work, tell your doctor immediately.

Salmeterol is only suitable for use a complementary treatment in asthma patients who cannot take other asthma medications, including inhaled corticosteroids or for people who need two medicines, including salmeterol. If you have any questions, ask your GP.

This medication can be very effective in reducing the number of asthma attacks that may be suffered by a patient. However, if may also increase the likelihood of a severe asthma attack taking place. It is important that you read the patient guide that will be given to you with your prescription, and put any questions or concerns that you have to your treating physician.

Do not use salmeterol if you have already begun having an asthma attack. Your GP will prescribe you an alternative drug, such as a short-acting inhaler for you to use when you have an asthma attack.

You must not use your asthma medication for any other breathing problems unless your doctor has told you to. Do not use salmeterol with other inhalers that contain formoterol and budesonide combination, including Symbicort®.

Medications containing salmeterol and fluticasone combination should also be avoided, including:

  • Perforomist™
  • Foradil®
  • Device
  • Brovana™
  • Aerolizer®
  • Advair® HFA
  • Advair®

If you or your child’s symptoms do not get better following taking this drug for a week or if you think that they have become worse, contact your doctor immediately.

If you do not think that your short-action inhaler is working as it should be or if it is beginning to lose effect, you should talk to your doctor. The same applies if you are finding that you have to use your inhaler more often, for example, if you use a whole canister of your inhaler in eight weeks or less, or if you need to take four puffs or more of the short-acting inhaler over two or more consecutive days.

You should consult your GP if you or your child notice a large fall in your peak flow when you measure it as shown by your doctor.

Never stop taking your medication or change the dose without first consulting your GP.

Your treating physician may suggest that you carry a medical identification card, indication that you or your child are using salmeterol. The card will indicate that you may need alternative or additional medication in case of a severe asthma attack, during an emergency, or when you are placed under unusual stress.

In some patients, salmeterol may cause paradoxical bronchospasm. This condition will cause your wheezing or breathing to become worse. Paradoxical bronchospasm can be a potentially life-threatening condition. If you or your child develop a cough, breathing problems, shortness of breath, or wheezing after taking salmeterol, stop using the drug and consult your GP immediately.

If you or your child develop hives, a skin rash or any other allergic reaction to salmeterol, stop taking the medication and seek medical advice immediately.

You should seek medical attention immediately if you or your child begin to show any of the following symptoms:

  • Chest pains
  • Rapid heartbeat
  • Anxiety
  • Trembling of the hands or feet
  • Noisy breathing
  • Feeling of throat constriction or choking

Salmeterol can cause low blood potassium levels in some people. If you or your child begin to experience one or more of the following symptoms, you should seek medical attention immediately:

  • Shortness of breath
  • Numbness or tingling in the lips, hands, or feet
  • Nausea or vomiting
  • Muscle pains or cramp
  • Mood swings
  • Loss of appetite
  • Irregular heartbeat
  • Increased thirst
  • Feeling unusually tired or weak
  • Dry mouth
  • Decreased urine output
  • Convulsions

Salmeterol may cause issues with blood sugar levels in some people. If you or your child suffer from diabetes, you might notice a variance in the results of your urine or blood sugar tests. If so, you should mention this to your doctor.

Do not take any other forms of medication, including non-prescription drugs, vitamin pills or powders, or treatments made from herbs or herbal extracts while using salmeterol, without first consulting your GP.

Storage

  • You must keep your salmeterol medication in the packaging it came in until you are ready to use it.
  • Keep the medicine at room temperature. Do not freeze or refrigerate it, or expose it to sources of heat or direct sunlight.
  • Make sure that children or pets cannot gain access to your medicines. In the unlikely event that a pet does manage to consume salmeterol, ask your vet’s advice as soon as possible.
  • Do not retain any medicine that appears to have been damaged or if the packaging has been interfered with. Do not use salmeterol that has passed its use-by date.
  • Do not keep any salmeterol that has been removed from its foil pouch or once all the blisters have been used up.
  • Do not throw unused salmeterol down the drain or into the toilet. Place unwanted medication and its packaging into a bag and seal it, before placing the whole lot into your garbage can, where it cannot be accessed by children or pets.
  • If you are unsure of how to dispose of leftover medicines, just ask your GP or pharmacist for instructions.

Summary

Salmeterol for inhalation is used together with other drugs as part of a treatment program for the symptoms of asthma. Although you cannot use the medication to treat an asthma attack that is already underway, salmeterol can be very effective in preventing acute asthma attacks from occurring. Salmeterol is also used to treat patients who suffer from chronic bronchitis and emphysema. The medication is also extremely effective in relieving the effects of a condition caused exercise-induced bronchospasm.

Salmeterol is dispensed via an inhaler, the active medication being breathed into the patient’s lungs and airways, where it helps to clear obstructions, open up the airways and thus assist and improve airflow.

There are a considerable number of medications that will interact adversely if used in combination with salmeterol. In addition, there are a number of existing and historical health conditions that can be exacerbated if treated with salmeterol. For this reason, it is extremely important that you mention to your doctor any prescription medication or over-the-counter products that you use on a regular basis. You must also divulge your medical history in full.

During the course of your treatment with salmeterol, you will be expected to see your GP or specialist on a regular basis in order to monitor your progress and to make sure the dose and frequency of use of the medicine do not require alteration. You may also need to have blood tests to make sure that the drug is not causing any unwanted side effects that have not become apparent.

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Last Reviewed:
January 30, 2018
Last Updated:
January 27, 2018