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Action/Kinetics:
Selective for beta-2 adrenergic receptors, located in the bronchi and heart. Acts by stimulating intracellular adenyl cyclase, the enzyme that converts ATP to cyclic AMP. Increased AMP levels cause relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity, especially from mast cells.
Onset: Within 20 min.
Duration: 12 hr. Significantly bound to plasma proteins. Cleared by hepatic metabolism.
Uses:
(1) Long-term maintenance treatment of asthma or bronchospasm in clients 12 years and older (4 years and older for inhalation powder) associated with reversible obstructive airway disease. Includes those with symptoms of nocturnal asthma who require regular treatment with inhaled, short-acting ß
2-agonists. Not for use in asthmatics who can be managed by occasional use of a short-acting ß
2-agonist. May be used with or without concurrent inhaled or systemic steroid therapy. (2) Prevention of exercise-induced bronchospasms in clients 12 years and older (4 years and older for inhalation powder). (3) Chronic treatment of bronchospasms associated with COPD, including emphysema and chronic bronchitis.
Contraindications:
Use in clients who can be controlled by short-acting, inhaled beta-2 agonists. Use to treat acute symptoms of asthma or in those who have worsening or deteriorating asthma. Lactation.
Special Concerns:
Not a substitute for PO or inhaled corticosteroids. The safety and efficacy of using salmeterol with a spacer or other devices has not been studied adequately. Use with caution in impaired hepatic function; with cardiovascular disorders, including coronary insufficiency, cardiac arrhythmias, and hypertension; with convulsive disorders or thyrotoxicosis; and in clients who respond unusually to sympathomimetic amines. Because of the potential of the drug interfering with uterine contractility, use of salmeterol during labor should be restricted to those in whom benefits clearly outweigh risks. Safety and efficacy have not been determined in children less than 12 years of age.
Side Effects:
Respiratory: Paradoxical bronchospasms, upper or lower respiratory tract infection, nasopharyngitis, disease of nasal cavity/sinus, cough, pharyngitis, allergic rhinitis, laryngitis, tracheitis, bronchitis.
Allergic:
Immediate hypersensitivity reactions including urticaria, rash, and
bronchospasm.
CV: Palpitations, chest pain, increased BP, tachycardia.
CNS: Headache, sinus headache, tremors, nervousness, malaise, fatigue, dizziness, giddiness.
GI: Stomachache.
Musculoskeletal: Joint pain, back pain, muscle cramps, muscle contractions, myalgia, myositis, muscle soreness.
Miscellaneous: Flu, dental pain, rash, skin eruption, dysmenorrhea.
Laboratory Test Alterations:
Serum potassium.
Overdose Management:
Symptoms: Tachycardia, arrhythmia, tremors, headache, muscle cramps, hypokalemia, hyperglycemia.
Treatment: Supportive therapy. Consider judicious use of a beta-adrenergic blocking agent, although these drugs can cause bronchospasms. Cardiac monitoring is necessary. Dialysis is not an appropriate treatment of overdosage.
Drug Interactions:
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Diuretics / Worsening of diuretic-induced ECG changes and hypokalemia
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MAO Inhibitors /
Salmeterol effect
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Tricyclic antidepressants /
Salmeterol effect
How Supplied:
Metered dose inhaler (Aerosol): 25 mcg base/inh;
Powder for Inhalation: 50 mcg/inh
Dosage
?Metered Dose Aerosol Inhaler, Powder for Inhalation
Maintenance of bronchodilation, prevention of symptoms of asthma, including nocturnal asthma.
Adults and children over 12 years of age: Two inhalations (42 mcg) using the aerosol b.i.d. (morning and evening, approximately 12 hr apart).
Children 4 years and over: 1 inhalation (50 mcg) using the inhalation powder b.i.d. (morning and evening, approximately 12 hr apart).
Prevention of exercise-induced bronchospasms.
Adults and children over 12 years of age: Two inhalations (42 mcg) of the aerosol or 1 inhalation (50 mcg) of the inhalation powder at least 30-60 min before exercise. Additional doses should not be used for 12 hr.
Maintenance treatment of asthma or bronchospasm associated with COPD.
Adults and children over 12 years of age: Two inhalations (42 mcg) of the aerosol b.i.d. in the morning and evening (about 12 hr apart).
NOTE: Even though the metered dose inhaler and the inhalation powder are used for the same conditions, they are not interchangeable.
