What is salmeterol, and how does it work (mechanism of action)?

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Asthma is a breathing problem involving narrowing of the airways. Airways are breathing passages that allow air to move in and out of the lungs. In patients with asthma, airways can be narrowed by accumulation of mucus, spasm of the muscles that surround these airways, or swelling of the lining of the airways. Airway narrowing lead to symptoms of shortness of breath, wheezing, cough, and congestion. Medications used in treating asthma open airways are called bronchodilators. Salmeterol is a bronchodilator of the beta-2 agonist type. Beta-2 agonists are medications that stimulate beta-2 receptors on the smooth muscle cells that line the airways, causing these muscle cells to relax, thus, opening airways.

Certain allergens (such as pollen) can cause airway narrowing by inducing release of histamine by mast cells. Histamine is a natural chemical that causes tissue swelling and other allergic reactions in the body when released into the tissue. Mast cells belong to a class of immune cells located around the airways. Salmeterol is an inhaled medication that blocks the release of histamine by the mast cells, thus preventing airway narrowing when exposed to allergens.

What brand names are available for salmeterol?

Serevent

Is salmeterol available as a generic drug?

No

Do I need a prescription for salmeterol?

Yes

What are the side effects of salmeterol?

Side effects include:

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Throat and upper airway irritation can occur.

Use of long acting drugs like salmeterol may increase the risk of asthma-related death. Therefore, salmeterol should only be used in patients uncontrolled by other agents and who are using other long-term asthma-controlling medications such as an inhaled corticosteroid.

What is the dosage for salmeterol?

Salmeterol inhalations should not be used more often than prescribed (twice per day) and proper techniques of inhalation closely followed. Salmeterol is metabolized by the liver and should be used with caution in patients with liver dysfunction. Salmeterol is not meant to be used in treating acute asthma attacks; short acting inhaler medications are used for acute attacks. When using salmeterol in preventing exercised induced asthma, the medication is administered 30 to 60 minutes before exercise. Salmeterol does not take the place of oral or inhaled corticosteroids.

Which drugs or supplements interact with salmeterol?

Salmeterol can increase heart rate, blood pressure, and cause chest pain and excitement, especially if used in higher doses than recommended or used in those with coronary heart disease or high blood pressure. Tricyclic antidepressants and salmeterol should not be combined because of additive effect on the vascular system. In rare instances, salmeterol can induce paradoxical worsening of bronchospasm (which can be life-threatening). If this occurs, salmeterol should be discontinued, and the doctor notified immediately. Rare allergic reactions to salmeterol can cause skin rash, hives, swelling, bronchospasm, and anaphylaxis. Worsening of diabetes and lowering of potassium have also been described.

Is salmeterol safe to take if I’m pregnant or breastfeeding?

Adequate studies of salmeterol during pregnancy have not been done. In some, but not all, pregnant animal models exposure to very high doses of oral salmeterol has led to offspring with birth defects. The concentrations of salmeterol in the blood after these very high doses, however, were much higher than the concentrations observed after inhalation. Salmeterol inhalation should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

In rats, salmeterol is excreted in milk. Therefore, caution should be exercised when salmeterol is administered to nursing women.

What else should I know about salmeterol?

What preparations of salmeterol are available?

Canisters (13g with 120 inhalations and 6.5g with 60 inhalations).

How should I keep salmeterol stored?

Salmeterol should be stored from 36 F to 86 F (2.2 C to 30 C). The canister should be kept away from heat or flame and not punctured; it should not be frozen or placed in direct sunlight .

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Medically Reviewed on 3/13/2019

References

Medically reviewed by John P. Cunha, DO, FACOEP; Board Certified Emergency Medicine

REFERENCE:

FDA Prescribing Information