Adult Dosing
Maintenance treatment of asthma including nocturnal asthma or reversible obstructive airway disease
- 50 mcg (1 inhalation) q12 hrs
Prevention of exercise-induced bronchospasm
- 50 mcg (1 inhalation) 30-60 minutes before exercise
- Do not use additional doses for at least 12 hrs. Patients on a regular regimen (e.g., twice-daily inhalations) should not use additional doses
COPD (including chronic bronchitis and emphysema)
- 50 mcg (1 inhalation) q12 hrs
Pediatric Dosing
Maintenance treatment of asthma including nocturnal asthma or reversible obstructive airway disease
- Child
4 yrs: 50 mcg (1 inhalation) q12 hrs
Prevention of Exercised-induced bronchospasm
- Child 4 yrs: 50 mcg (1 inhalation) 30-60 minutes before exercise
- Do not use additional doses for at least 12 hrs. Patients on a regular regimen (e.g., twice-daily inhalations) should not use additional doses
[Outline]
- Due to increased risk of asthma related death and hospitalization, use of salmeterol for the treatment of asthma without concomitant use of long term asthma control medication, such as inhaled corticosteroid is contraindicated [US Black Box Warning ]
- Salmeterol is not indicated for the treatment of acute symptoms and it should not be initiated in patients with acutely deteriorating asthma
- Salmeterol is not a substitute for inhaled or oral corticosteroids. Therapy with corticosteroids should not be stopped when treatment with salmeterol is started
- It should not be used in conjunction with an inhaled, long acting beta-2 agonist
- Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use. Discontinue therapy and institute appropriate alternative therapy
- Excessive beta-adrenergic stimulation due to slametrol may produce serious cardiovascular and CNS effects like arrhythmias, tachycardia, angina, palpitation, seizures and insomnia
- Changes in ECG such as QT prolongation, ST segment depression, T wave flattening have been reported with use of salmeterol
- Use of salmeterol may cause significant hypokalemia resulting in adverse cardiovascular effects. Changes in blood glucose may occur during therapy
- Immediate hypersensitivity reactions may occur manifested by urticaria, angioedema, rash, and bronchospasm may occur after administration of salmeterol
- Monitor patients for signs of worsening asthma such as increasing use of inhaled, short-acting beta2-agonists or a significant decrease in PEF or lung function
Cautions: Use cautiously in
- Hypertension
- Alcoholic cardiomyopathy
- Cardiovascular disease
- Cardiac arrhythmias
- Diabetes mellitus
- Seizure disorder
- Thyrotoxicosis
- History of seizure disorder
- Ketoacidosis
- Hyperthyroidism
- Pheochromocytoma
- Concomitant use with strong CYP3A4 inhibitors
- Severe milk allergy as milk protein in the inhalation powder
Pregnancy Category:C
Breastfeeding: Low bioavailability and low maternal serum levels after inhalation. Acceptable during breastfeeding based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 22 July 2010). As per manufacturer’s data, a decision should be made whether to discontinue nursing or to discontinue drug, condsidering the importance of the drug to the mother. Caution advised while administering to a nursing woman.
