salmeterol xinafoate

salmeterol xinafoate

(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 (Diskus)

Dosages

ADULTS AND PEDIATRIC PATIENTS > 12 YR

Diskus

·        Asthma or bronchospasm: 1 inhalation (50 mcg) bid.

·        Exercise-induced asthma: 1 inhalation 30–60 min before exertion.

·        COPD: 1 inhalation bid.

Oral aerosol inhalation

·        Asthma or bronchospasm; COPD: 2 inhalations bid, approximately 12 hr apart. Exercise-induced asthma: 2 inhalations 30–60 min before activity.

PEDIATRIC PATIENTS 4–12 YR

Diskus

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; T_1/2: 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, asthma related deaths (risk higher in black than white patients)

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 ofsalmeterol 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; LFTs

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 minutes 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.

·        You may experience these side effects: Headache (request analgesics); tremors (use care in performing dangerous tasks); fast heartbeat, 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.