What It's Used For

Side Effects

Common Side Effects:

Headache
Pharyngitis
Nasal congestion
Upper respiratory tract infection
Cough
Throat irritation

Serious Side Effects:

Asthma-related death (when used without ICS)
Paradoxical bronchospasm
Cardiovascular effects (tachycardia, arrhythmias)
Hypokalemia
Hyperglycemia

Additional Information

Salmeterol is a long-acting beta-2 adrenergic agonist (LABA) used for maintenance treatment of asthma and chronic obstructive pulmonary disease (COPD). It provides sustained bronchodilation and is always used in combination with an inhaled corticosteroid for asthma.

Mechanism of Action

Salmeterol works through beta-2 receptor stimulation:

Beta-2 receptor agonism: Binds to beta-2 receptors on bronchial smooth muscle
Increased cyclic AMP: Activates adenylyl cyclase, increasing intracellular cAMP
Bronchial smooth muscle relaxation: cAMP-dependent protein kinase mediates relaxation
Long duration of action: Lipophilic side chain allows prolonged receptor binding
Duration: ~12 hours of bronchodilation

Onset is slower than short-acting beta-agonists (15-20 minutes vs 5 minutes).

Available Formulations

Dry powder inhaler (Serevent Diskus): 50 mcg per inhalation
Combination products:
- Salmeterol/fluticasone (Advair Diskus, Advair HFA)
- Salmeterol/fluticasone (Wixela Inhub, AirDuo RespiClick)

Medical Uses

FDA-Approved Indications:

Asthma maintenance treatment in patients ≥4 years (in combination with inhaled corticosteroid only)
Prevention of exercise-induced bronchospasm (EIB) in patients ≥4 years
Maintenance treatment of COPD including chronic bronchitis and emphysema

Important: For asthma, salmeterol must be used with an inhaled corticosteroid (ICS).

Dosing Guidelines

Asthma Maintenance (with ICS):

Adults and children ≥4 years: 50 mcg (one inhalation) twice daily, approximately 12 hours apart

COPD Maintenance:

50 mcg twice daily, approximately 12 hours apart

Exercise-Induced Bronchospasm:

50 mcg at least 30 minutes before exercise
Do not use additional doses for 12 hours
Patients already on twice-daily dosing should not use additional doses for EIB prevention

Important Safety Information

Black Box Warning:

Asthma-related death: LABAs increase the risk of asthma-related death. This risk may be mitigated by using LABAs with ICS.
Use only in combination with an ICS for asthma
Do not use for acute bronchospasm

Contraindications:

Acute asthma or COPD exacerbation
Hypersensitivity to salmeterol or any component

Warnings and Precautions:

Not for acute symptoms (use short-acting beta-agonist)
Paradoxical bronchospasm may occur
Cardiovascular effects: May cause increased pulse, blood pressure, or arrhythmias
Hypokalemia possible
Hyperglycemia in diabetic patients

Drug Interactions

Strong CYP3A4 inhibitors (ketoconazole, ritonavir): May increase cardiovascular adverse effects; use with caution
Beta-blockers: May antagonize effects; use cardioselective beta-blockers with caution
Diuretics (non-potassium-sparing): May worsen hypokalemia
MAO inhibitors, tricyclic antidepressants: May potentiate cardiovascular effects

Special Populations

Hepatic Impairment: Use with caution (limited data)
Pregnancy: Use only if benefit outweighs risk
Lactation: Unknown if excreted in milk
Pediatric: Approved for ≥4 years with ICS for asthma; EIB in ≥4 years
Elderly: No specific adjustment

Related Health Conditions

This medication is commonly used to treat or manage the following conditions:

Asthma

Asthma, a chronic lung disease, causes airway inflammation and narrowing, resulting in wheezing, coughing, and shortness of breath, triggered by allergens, irritants, infections, or stress.

Learn More

Chronic Obstructive Pulmonary Disease (COPD)

COPD, a progressive lung disease causing irreversible airflow limitation, encompassing emphysema and chronic bronchitis, is primarily driven by irritant exposure like smoking, leading to shortness of breath and chronic cough.