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Salmeterol General Information
Salmeterol is used as a long-term (maintenance) treatment to prevent or decrease wheezing and trouble breathing caused by asthma or ongoing lung disease (chronic obstructive pulmonary disease-COPD, which includes chronic bronchitis and emphysema). Salmeterol should only be used long-term if your asthma symptoms are not controlled by your other asthma medications (such as inhaled corticosteroids). Salmeterol must not be used alone to treat asthma. (See also Warning section.) It is also used to prevent asthma brought on by exercise (bronchospasm). Salmeterol works in the airways by relaxing muscles and opening air passages to improve breathing. Controlling symptoms of breathing problems can decrease time lost from work or school.
Salmeterol does not work immediately and should not be used for sudden attacks of breathing trouble. Your doctor must prescribe a quick-relief medicine/inhaler (e.g., albuterol) for sudden shortness of breath/asthma attacks while you are on Salmeterol. You should always have a quick-relief inhaler with you. Consult your doctor or pharmacist for more details.
Salmeterol should be used in combination with other medications such as long-acting inhaled corticosteroids. However, it should not be used with other long-acting inhaled beta agonists (e.g., formoterol, combination Salmeterol/fluticasone) since this may increase your risk for side effects.
It is recommended that children and teenagers, who need to use Salmeterol to treat their asthma, should use a combination Salmeterol/fluticasone product. Check with your child's doctor to see if Salmeterol is the right product for your child.
In patients with asthma, Salmeterol should not be used when breathing problems can be controlled with inhaled corticosteroids (e.g., flunisolide, fluticasone) and occasional use of quick-relief inhalers. (See also Warning section.)
If you are regularly taking corticosteroids by mouth (e.g., prednisone), you should not stop using them or use this inhaled medication instead. Continue to follow your doctor's instructions for taking the corticosteroids by mouth.
How to Use Salmeterol
Read the Medication Guide available from your pharmacist before you start using Salmeterol and each time you get a refill. Refer to the illustrated directions provided by the manufacturer for directions on how to use Salmeterol. If any of the information is unclear, consult your doctor or pharmacist.
Always activate and use Salmeterol in a level, horizontal position.
Inhale Salmeterol by mouth, usually twice daily in the morning and evening (12 hours apart), or use as directed by your doctor. You may or may not taste/feel the drug when you inhale. Either is normal. Never exhale into the device. Do not use with a spacer. Never wash the mouthpiece or any part of the device.
If you are using other inhalers at the same time, wait at least 1 minute between the use of each medication.
The dosage is based on your medical condition and response to therapy. Use Salmeterol regularly to receive the most benefit from it. To help you remember, use it at the same times each day. Do not use it more often than prescribed or use more than 1 inhalation twice daily since this may increase the risk of side effects.
Do not stop taking Salmeterol or change your dose without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.
If you have been using a quick-relief inhaler on a regular daily schedule (such as 4 times daily), you must stop this schedule and only use it as needed for sudden shortness of breath/asthma attacks. Consult your doctor for details.
If you are only using Salmeterol occasionally to prevent asthma brought on by exercise (bronchospasm), use it at least 30 minutes before exercise, and do not use another dose for at least 12 hours. If you have sudden asthma/shortness of breath, use a quick-relief inhaler (e.g., albuterol). Consult your doctor for details.
If Salmeterol stops working well, or you need to use your quick-relief inhaler more often than usual (4 or more puffs daily or use of more than 1 inhaler every 8 weeks), seek immediate medical attention. Salmeterol may be a sign of worsening asthma, which is a serious condition.
Learn which of your inhalers you should use every day (controller drugs) and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing, increased sputum, worsening peak flow meter readings, waking up at night with trouble breathing, if you use your quick-relief inhaler more often (more than 2 days a week), or if your quick-relief inhaler does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.
Tell your doctor if your symptoms do not improve or if they worsen.
Salmeterol Possible Side Effects
Hoarseness, throat irritation, headache, rapid heartbeat, nervousness, cough, dry mouth/throat, or upset stomach may occur.
To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.
If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed Salmeterol because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using Salmeterol do not have serious side effects.
Seek immediate medical attention if any of these rare but very serious side effects occur: chest pain, fast/slow/irregular heartbeat, severe dizziness, fainting, seizures.
An allergic reaction to Salmeterol is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Rarely, Salmeterol has caused severe (rarely fatal), sudden worsening of breathing problems/asthma (paradoxical bronchospasm). If you have trouble breathing or experience sudden wheezing, use your quick-relief inhaler and seek immediate medical attention.
Salmeterol Precautions
Before using Salmeterol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Salmeterol may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using Salmeterol, tell your doctor or pharmacist your medical history, especially of: heart problems (e.g., angina, irregular heartbeat), high blood pressure, diabetes, liver problems, seizures, thyroid problems (e.g., overactive thyroid).
Salmeterol may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can infrequently result in serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.
The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using Salmeterol, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).
Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using Salmeterol safely.
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Older adults may be more sensitive to the side effects of Salmeterol, especially QT prolongation (see above).
Salmeterol should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.
It is not known if Salmeterol passes into breast milk. Consult your doctor before breast-feeding.
Salmeterol Possible Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Many drugs besides Salmeterol may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others. Therefore, before using Salmeterol, report all medications you are currently using to your doctor or pharmacist.
Other medications can affect the removal of Salmeterol from your body, which may affect how Salmeterol works. Examples include cobicistat, nefazodone, telithromycin, azole antifungals (such as ketoconazole, itraconazole), macrolide antibiotics (such as clarithromycin), HIV protease inhibitors (such as ritonavir, saquinavir), among others.
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