salmeterol xinafoate: clinical use

Prescribing considerations

• Do not initiate during an acute severe exacerbation or rapidly deteriorating asthma.
• In asthma, use only as an adjunct to corticosteroid therapy.
• Confirm a fast-acting reliever remains available and investigate worsening control or increasing reliever use.
• Review clinical benefit, adherence and inhaler technique regularly.
• Consider cardiovascular disease, thyrotoxicosis, diabetes, hypokalaemia risk and hepatic impairment.

Contraindications and cautions

• Hypersensitivity to salmeterol xinafoate or a formulation excipient.
• The selected Soltel pressurised inhaler is contraindicated in peanut or soya allergy because it contains soya lecithin.
• The Accuhaler contains lactose with milk protein; assess relevant excipient hypersensitivity.

Monitoring

• Asthma or COPD symptoms, exacerbations and reliever use
• Inhaler technique and adherence
• Heart rate or rhythm when systemic beta2-agonist effects are suspected
• Serum potassium during severe asthma or when interacting medicines increase hypokalaemia risk
• Blood glucose where clinically relevant, particularly in diabetes

Clinical pharmacology

A selective long-acting beta2-adrenoceptor agonist that produces sustained airway smooth-muscle relaxation. It is metabolised predominantly through CYP3A4 and has no corticosteroid-like anti-inflammatory action.

Formulation and product differences

• Soltel is a pressurised suspension inhaler containing ethanol, soya lecithin and a non-CFC propellant; a compatible Volumatic spacer can assist with coordination difficulty.
• Serevent Accuhaler is a breath-actuated dry-powder device containing lactose with milk protein.
• The selected products have different licensed paediatric age ranges and are not automatically interchangeable without considering device technique and product licensing.

Inhaled preparation

Route: Inhaled

Strengths: 25 micrograms/actuation