Salmeterol

CAUTION:
A large clinical study found a small increase in deaths from asthma in patients who used salmeterol. Do not use salmeterol if you have asthma that is quickly getting worse. If you have any of the following signs of worsening asthma, call your doctor without delay: short-acting inhaler (e.g., albuterol) does not work as well as it used toneed to use more puffs than usual of short-acting inhaler or use it more oftenpeak-flow meter shows breathing is worseningneed to use four or more puffs per day of short-acting inhaler for two or more days in a row use of more than one canister (200 inhalations) of short-acting inhaler during an 8-week periodneed to go to the emergency room for asthma treatment.Talk to your doctor about the risk of using this medication.

O  General Information and Indications:

Salmeterol is used to treat wheezing, shortness of breath, and troubled breathing caused by asthma and chronic obstructive pulmonary disease (COPD), a group of lung diseases that includes chronic bronchitis and emphysema. It also is used to prevent bronchospasm (breathing difficulties) during exercise. Salmeterol is in a class of medications called long-acting beta agonists. It works by relaxing and opening air passages in the lungs, making it easier to breathe.

O  Information For Users:

Salmeterol comes as a dry powder to inhale by mouth using a special inhaler. It is usually used twice a day, in the morning and evening, about 12 hours apart. To help you remember to use salmeterol, use it around the same times every day. To prevent breathing difficulties during exercise, it is usually used 30 minutes before exercise, not more often than once every 12 hours. Follow the directions on your prescription label, ask your doctor or pharmacist If you have any questions. Use salmeterol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Do not use salmeterol during an attack of asthma or COPD. Your doctor will prescribe a short-acting inhaler to use during attacks. If you are using salmeterol twice a day, do not use another dose before exercising.

Salmeterol controls symptoms of asthma and other lung diseases but does not cure them. Do not stop using salmeterol without informing your doctor. If you suddenly stop using salmeterol, your symptoms may worsen. Also Do not discontinue taking your other inhaled or oral medications for asthma without informing your doctor.

Before you use the salmeterol inhaler the first time, read the written instructions that come with it. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler while he or she watches.

To use the inhaler, follow these steps:

o Hold the inhalation device in one hand, and put the thumb of your other hand on the thumbgrip. Push your thumb away from you as far as it will go until the mouthpiece appears and snaps into position.
o Hold the inhalation device in a horizontal position with the mouthpiece toward you. Slide the lever away from you as far as it will go until it clicks.
o Every time the lever is pushed back, a dose is ready to inhale. You will see the number in the dose counter go down. Do not waste doses by closing the device, playing with the lever, or advancing the lever more than once.
o Hold the inhalation device level and away from your mouth, and breathe out as far as you comfortably can.
o Put the mouthpiece to your lips. Breathe in quickly and deeply though the inhalation device, not through your nose.
o Remove the inhalation device from your mouth, and hold your breath for 10 seconds or as long as you comfortably can. Breathe out slowly.
o You will probably taste or feel the salmeterol powder released by the inhaler. Even if you do not, do not take another dose. If you are not sure you are getting your dose of salmeterol, call your doctor or pharmacist.
o Put your thumb on the thumbgrip and slide it back toward you as far as it will go. The device will click shut.

Never exhale into the inhalation device, take the device apart, or wash the mouthpiece or any part of the device. Keep the device dry. Do not use the device with a spacer.

O  Special precautions:

o Inform your doctor or pharmacist if you have allergy to salmeterol, any other medications, or milk protein.
o Inform your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); diuretics ('water pills'); and other medications for asthma or COPD. Also Inform your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past 2 weeks: antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); and monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
o inform your doctor if you are breast-feeding irregular heartbeat, high blood pressure, hyperthyroidism (overactive thyroid), diabetes, seizures, or liver or heart disease.
o Inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using salmeterol, call your doctor.
o if you have been using a short-acting beta-agonist inhaler such as albuterol (Proventil, Ventolin) on a regular basis (for example, four times a day), your doctor will probably tell you to stop using it regularly when you start using salmeterol. Keep your other inhaler to use during an attack of asthma or COPD.

O  Possible Adverse Effects:

Salmeterol may cause adverse effects. Inform your doctor if any of the following symptoms are severe or do not go away:

o hand tremor, shaking hands
o headache
o nervousness
o dizziness
o cough
o stuffy nose
o runny nose
o ear pain
o pale skin
o muscle pain or cramps
o sore throat
o throat irritation

Some adverse effects could be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor without delay:

o increased difficulty breathing
o fast or pounding heartbeat
o unusual excitement
o chest pain
o skin rash
o hives (Urticaria)
o swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
o hoarseness
o choking or difficulty swallowing
o loud, high-pitched breathing
 

O  Possible Symptoms of Overdose:

o seizures
o chest pain
o dizziness
o fainting
o blurred vision (Impaired vision)
o fast, pounding, or irregular heartbeat
o nervousness
o headache
o hand tremor, shaking hands
o muscle cramps or weakness
o dry mouth
o upset stomach
o dizziness
o extreme tiredness (fatigue)
o lack of energy
o difficulty falling asleep or staying asleep
o thirst
o flushing
o dry skin
o frequent urination
o loss of appetite (anorexia)
o problem with breathing

O  Brand Name(s):

o Serevent®
o Serevent® Diskus®

O  Other Name(s):

o Advair® containing Salmeterol Xinafoate and Fluticasone Propionate