salmeterol

(sal mee' ter ol)

Serevent Diskus

Pregnancy Category C

Drug classes
Beta2-selective adrenergic agonist
Antasthmatic

Therapeutic actions
Long-acting agonist that binds to beta2 receptors in the lungs, causing bronchodilation;
also inhibits the release of inflammatory mediators in the lung, blocking swelling and
inflammation.

Indications
 Prevention of and maintenance therapy for bronchospasm in select patients with
asthma, chronic obstructive pulmonary disease, and exercise-induced asthma

Contraindications and cautions

 Contraindicated with hypersensitivity to salmeterol, acute asthma attack,
worsening or deteriorating asthma (life-threatening), acute airway obstruction.
 Use cautiously with pregnancy, lactation.

Available forms
Inhalation powder—50 mcg

Dosages
ADULTS AND PEDIATRIC PATIENTS > 12 YR
 Asthma or bronchospasm: 1 inhalation (50 mcg) bid.
 Exercise-induced asthma: 1 inhalation 30–60 min before exertion.
 COPD: 1 inhalation bid.
PEDIATRIC PATIENTS 4–12 YR
1 inhalation bid, 12 hr apart; if used to prevent exercise-induced asthma, 1 inhalation >
30 min before exercising.

Pharmacokinetics
Route Onset Peak Duration
Inhalation 13–20 min 3–4 hr 7.5–17 hr

Metabolism: Hepatic; T1/2: Unknown

Distribution: Crosses placenta; may enter breast milk
Excretion: Feces

Adverse effects
 CNS: Headache, tremor
 CV: Tachycardia, palpitations, hypertension
  Respiratory: Worsening of asthma, difficulty breathing, bronchospasm

Interactions
Drug-drug
 Risk of severe bronchospasm if combined with beta-blockers; use a
cardioselective beta-blocker and monitor patient closely if this combination is
used
 Potential for worsened hypokalemia and ECG abnormalities if combined with
diuretics; monitor patient very closely
 Administer with extreme caution to patients being treated with MAOIs or TCAs,
or within 2 wk of discontinuation of such agents because the action of salmeterol
may be potentiated by these agents

Nursing considerations
Assessment
 History: Allergy to salmeterol; pregnancy, acute asthma attack, worsening
asthma, lactation
 Physical: R, adventitious sounds; P, BP, ECG; orientation, reflexes; liver function
tests

Interventions
 Ensure that drug is not used to treat acute asthma or with worsening or
deteriorating asthma (risk of death).
 Instruct in the proper use of diskus.
 Monitor use of inhaler; use of more than 4 puffs/day may worsen asthma; obtain
evaluation by physician.
 Have patients who experience exercise-induced asthma use it 30–60 min before
activity.
 Arrange for periodic evaluation of respiratory condition.

Teaching points
 Use the pressurized metered-dose inhaler as instructed. Shake well before using.
Use only twice a day. If drug is to be used periodically for exercise-induced
asthma, use 30–60 min before activity.
 To gain full therapeutic benefit in the treatment of reversible airway obstruction,
administer twice a day (morning and evening).
 Obtain periodic evaluations of your respiratory problem.
 These side effects may occur: Headache (request analgesics); tremors (use care in
performing dangerous tasks); fast heart, palpitations (monitor activity; rest
frequently).
 Report severe headache, irregular heartbeat, worsening of asthma, difficulty
breathing.

Adverse effects in Italic are most common; those in Bold are life-threatening.