Salmeterol

A to Z Drug Facts

Salmeterol

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(sal-MEET-ah-rahl)

Serevent, Serevent Diskus

Class: Bronchodilator/sympathomimetic

Action Produces bronchodilation by relaxing bronchial smooth muscle through beta-2 receptor stimulation.

Indications Maintenance treatment of asthma and prevention of bronchospasm with reversible obstructive airway disease; prevention of exercise-induced bronchospasm; maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis).

Contraindications Cardiac tachyarrhythmias.

Route/Dosage

Asthma/Bronchospasm

ADULTS & CHILDREN ³ 12 YR: Inhalation 2 inhalations twice daily, » 12 hrs apart. ADULTS & CHILDREN ³ 4 YRS FOR INHALATION POWDER: Inhalation 1 inhalation (50 mcg) twice daily, » 12 hrs apart.

Exercise-Induced Bronchospasm

ADULTS & CHILDREN ³ 12 YR: Inhalation 2 inhalations at least 30 to 60 mins before exercise; additional doses should not be used for up to 12 hrs. ADULTS & CHILDREN ³ 4 YRS FOR INHALATION POWDER: Inhalation 1 inhalation ³ 30 mins before exercise; additional doses should not be used for up to 12 hrs.

COPD

ADULTS: Inhalation 2 inhalations (42 mcg) twice daily, » 12 hrs apart.

Interactions

Diuretics: ECG changes and hypokalemia associated with these diuretics may worsen with coadministration. MAO inhibitors, tricyclic antidepressants: May increase cardiovascular effects of salmeterol.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Tachycardia; palpitations. CNS: Tremor; anxiety; malaise; fatigue; dizziness; vertigo; nervousness; headache. EENT: Rhinitis; throat dryness/irritation. GI: GI distress; nausea; vomiting; diarrhea. META: Hyponatremia. RESP: Cough; paradoxical bronchospasm; upper respiratory tract infection; nasopharyngitis; nasal cavity/sinus disease; sinus headache; lower respiratory tract infection; allergic rhinitis; laryngitis; tracheitis/bronchitis. OTHER: Joint/back pain; muscle cramp/contraction; myalgia/myositis; muscular soreness; giddiness; influenza; viral gastroenteritis; urticaria; dental pain; malaise/fatigue; eruption; dysmenorrhea.

Precautions

Pregnancy: Category C. Children: Not recommended for children < 12 yr. Acute asthma seizures: Do not use to treat acute symptoms. Cardiovascular disease: Use with caution in patients with cardiovascular disease, toxic symptoms may occur. Excessive use: Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use. Hypersensitivity: Allergic reactions can occur after administration. Hypokalemia: Decreases in potassium levels may occur.

PATIENT CARE CONSIDERATIONS

Administration/Storage

This medication is available only in a pressurized, metered-dose inhalation aerosol unit.
Use only with supplied aerosol actuator. Do not use the actuator with other medications.
Do not use a spacer with the inhalation powder. Keep the device dry and never wash the mouthpiece or any part of the device.
Store at room temperature. The therapeutic effects are reduced when cold; the container may explode if exposed to temperatures above 120°F. Protect from freezing and direct sunlight.
Store canister with nozzle end down.
Do not puncture or incinerate canister.
Shake well before using.

Assessment/Interventions

Obtain patient history.
Closely monitor patients with a history of arrhythmias, seizures or peptic ulcers.
Obtain baseline pulmonary function tests.
Note frequency and severity of asthma attacks.

OVERDOSAGE: SIGNS & SYMPTOMS
	Tremor, palpitations, tachycardia, headache, hypokalemia, hyperglycemia, cardiac arrest

Patient/Family Education

Instruct patient on the proper storage and use of the aerosol inhaler, referring patient to the instruction sheet included with the medication.
Advise patient not to exceed the recommended dosage and frequency of the medication.
Warn patient not to alter the dose or discontinue the medication without consulting the health care provider.
Instruct patient to check with his/her physician first before taking any otc or prescription medications.
Emphasize to patient that this medication is NOT to be used for the treatment of acute or deteriorating asthma.
Inform patient that this medication is NOT a substitute for other medications he/she may be on, including oral or inhaled corticosteroids.
Instruct patient to call the health care provider if the medication seems to be less effective.
Alert patient that this medication may be used 30 to 60 mins BEFORE exercise to reduce or prevent exercise-induced bronchospasm.
Have patient report any serious side effects to the health care provider, including: Tachycardia, palpitations, tremors, change in personality, insomnia, shortness of breath and stomach cramps.