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/Respiratory 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.
Adult: As metered dose aerosol or dry powd inhaler: 50 mcg bid.
Contraindications
Monotherapy in the treatment of asthma. Treatment of status asthmaticus, other acute episodes of asthma or COPD.
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.
Monitor pulmonary function, BP, heart rate, CNS stimulation, hepatic function; glucose and K levels.
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.
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.
Action
Description: Mechanism of 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. Pharmacokinetics: 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.
Chemical Structure
Salmeterol Source: National Center for Biotechnology Information. PubChem Database. Salmeterol, CID=5152, https://pubchem.ncbi.nlm.nih.gov/compound/Salmeterol (accessed on Jan. 22, 2020)
Storage
Store between 20-25°C. Protect from heat or sunlight.
R03AC12 - salmeterol ; Belongs to the class of adrenergic inhalants, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
References
Anon. Salmeterol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 01/07/2015.Buckingham R (ed). Salmeterol Xinafoate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/07/2015.Serevent Diskus (GlaxoSmithKline LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 01/07/2015.
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