• As concomitant therapy for the treatment of asthma and the prevention of bronchospasm in patients who are currently taking but are inadequately controlled on an inhaled corticosteroid.
• Prevention of exercise-induced bronchospasm.
• Maintenance treatment to prevent bronchospasm in COPD.

Contraindicated in:

• Hypersensitivity to salmeterol or milk proteins
• Acute attack of asthma (onset of action is delayed)
• Patients not receiving a inhaled corticosteroid (↑ risk of asthma-related death)
• Patients whose asthma is currently controlled on low- or medium-dose inhaled corticosteroid therapy.

Use Cautiously in:

• Cardiovascular disease (including angina and hypertension)
• Seizure disorders
• Diabetes
• Glaucoma
• Hyperthyroidism
• Pheochromocytoma
• Excessive use (may lead to tolerance and paradoxical bronchospasm)
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk; may inhibit contractions during labor
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: Children <4 yr (safety and effectiveness not established).

CV: palpitations, tachycardia.

GI: abdominal pain, diarrhea, nausea.

MS: muscle cramps/soreness.

Neuro: headache, nervousness, tremor.

Resp: cough, paradoxical bronchospasm.

Drug-Drug:

• Beta blockers may ↓ therapeutic effects.
• MAO inhibitors and tricyclic antidepressants may potentiate cardiovascular effects.
• Strong CYP3A4 inhibitors, including ketoconazole, itraconazole, ritonavir, atazanavir, clarithromycin, nefazodone, or nelfinavir, may ↑ levels and the risk of toxicity; concurrent use not recommended.

Drug-Natural Products:

• Use with caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) ↑ stimulant effect.

• Powder for oral inhalation: 50 mcg/blister;
• In combination with: fluticasone (Advair Diskus, Advair HFA, AirDuo Digihaler, AirDuo RespiClick, Wixela Inhub). See Appendix [not included in this PDA edition].

Asthma

• Inhaln (Adults and Children 4 yr): 50 mcg (1 inhalation) twice daily (approximately 12 hr apart).

Prevention of Exercise-Induced Bronchospasm

• Inhaln (Adults and Children 4 yr): 50 mcg (1 inhalation) 30 min before exercise; additional doses should not be used for 12 hr.

COPD

• Inhaln (Adults): 50 mcg (1 inhalation) twice daily (approximately 12 hr apart).

Serevent Diskus

• Produces accumulation of cyclic adenosine monophosphate at beta₂-adrenergic receptors.
• Relatively specific for beta₂ (pulmonary) receptors.

• Bronchodilation.

Therapeutic Classification: bronchodilators

Pharmacologic Classification: adrenergics

Absorption: Minimal systemic absorption follows inhalation.

Distribution: Action is primarily local.

Metabolism/Excretion: Metabolized in the liver via the CYP3A4 isoenzyme; 60% excreted in feces, 25% excreted in urine.

Half-life: 3–4 hr.

(bronchodilation)

†9 hr in adolescents.

• Advise patient to take salmeterol as directed. Do not use more than the prescribed dose. If a regularly scheduled dose is missed, use as soon as possible and resume regular schedule. Do not double doses. If symptoms occur before next dose is due, use a rapid-acting inhaled bronchodilator.
• Instruct patient using powder for inhalation never to exhale into diskus device and always to hold device in a level horizontal position. Mouthpiece should be kept dry; never wash.
• Caution patient not to use salmeterol to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator should be used for relief of acute asthma attacks.
• Advise patients on chronic therapy not to use additional salmeterol to prevent exercise-induced bronchospasm. Patients using salmeterol for prevention of exercise-induced bronchospasm should not use additional doses of salmeterol for 12 hr after prophylactic administration.
• Advise patient to notify health care professional immediately if difficulty in breathing persists after use of salmeterol, if condition worsens, if more inhalations of rapid-acting bronchodilator than usual are needed to relieve an acute attack, or if using 4 or more inhalations of a rapid-acting bronchodilator for 2 or more consecutive days or more than 1 canister in an 8-wk period.
• Salmeterol should be used with inhaled corticosteroids and is not a substitute for corticosteroids or adrenergic bronchodilators. Advise patients using inhalation or systemic corticosteroids to consult health care professional before stopping or reducing therapy.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Emphasize the importance of regular follow-up exams to determine progress during therapy.

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