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Dosage/Direction for Use
Inhalation Chronic asthma Adult: As metered dose aerosol or dry powd inhaler: 50 mcg bid, or up to 100 mcg bid if necessary, in asthma patients w/ more severe airways obstruction. Child: 4-12 yr 50 mcg bid. Inhalation Chronic obstructive pulmonary disease Adult: As metered dose aerosol or dry powd inhaler: 50 mcg bid. Inhalation Prophylaxis of exercise-induced asthma Adult: As metered dose aerosol or dry powd inhaler: 50 mcg at least 30 min prior to exercise. Child: ≥4 yr Same as adult dose. |
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Contraindications
Monotherapy in the treatment of asthma. Treatment of status asthmaticus, other acute episodes of asthma or COPD.
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Special Precautions
Patient w/ CV disease, CNS disorders, DM, hyperthyroidism, hypokalaemia, seizure disorders, ketoacidosis. Not intended for the relief of acute bronchospasm. Hepatic impairment. Pregnancy and lactation. Monitoring Parameters Monitor pulmonary function, BP, heart rate, CNS stimulation, hepatic function; glucose and K levels.
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Adverse Reactions
Asthma: Headache, influenza, nasal/sinus congestion, pharyngitis, rhinitis, tracheitis/bronchitis. COPD: Cough, headache, musculoskeletal pain, throat irritation, viral resp infection.
Potentially Fatal: Paradoxical bronchospasm. |
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Overdosage
Symptoms: Dizziness, HTN or hypotension, tremor, headache, tachycardia, hypokalaemia, seizures, angina, arrhythmias, nervousness, muscle cramps, dry mouth, palpitations, nausea, fatigue, malaise, insomnia, hyperglycaemia, metabolic acidosis. Management: Symptomatic and supportive treatment. β-blockers may be considered but should be used w/ caution.
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Drug Interactions
Increased risk of CV effects w/ potent CYP3A4 inhibitors (e.g. ketoconazole, ritonavir). Reduced bronchodilatory effect w/ β-blockers. Increased risk of hypokalaemia w/ non K-sparing diuretics. MAOIs and TCAs may potentiate the effect of salmeterol on vascular system.
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Action
Salmeterol stimulates intracellular adenyl cyclase, the enzyme that catalyses the conversion of ATP to cyclic-3',5'-adenosine monophosphate (cAMP) resulting in relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from mast cells.
Onset: Asthma: 30-48 min. COPD: 2 hr. Duration: Approx 12 hr. Absorption: Low or undetectable systemic absorption. Time to peak plasma concentration: Approx 20 min. Distribution: Plasma protein binding: 96%. Metabolism: Extensively metabolised via hydroxylation to α-hydroxy-salmeterol by CYP3A4 isoenzyme. Excretion: Via faeces (60%), urine (25%). Half-life: 5.5 hr. |
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Storage
Inhalation: Store between 20-25°C. Protect from heat or sunlight.
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CIMS Class
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ATC Classification
R03AC12 - salmeterol ; Belongs to the class of adrenergic inhalants, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
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