SALMETEROL XINAFOATE

SALMETEROL XINAFOATe
(sal-me'ter-ol xin'a-fo-ate)
Serevent
Classifications: beta2-adrenergic agonist; bronchodilator; respiratory smooth muscle relaxant;
Therapeutic: bronchodilator
; smooth muscle relaxant
Prototype: Albuterol
Pregnancy Category: C

Availability

25 mcg aerosol; 50 mcg powder diskus for inhalation

Action

Long-acting beta2-adrenoreceptor agonist and an analog of albuterol. Stimulation of beta2-adrenoreceptors relaxes bronchospasm and increases ciliary motility, thus facilitating expectoration. Inhibits the release of mediators (i.e., histamine) from mast cells, macrophages, and eosinophils.

Therapeutic Effect

Relaxes bronchospasm and increases ciliary motility, thus facilitating expectoration of pulmonary secretions. Salmeterol also decreases airway reaction to allergens.

Uses

Maintenance therapy for asthma or bronchospasm. Prevention of exercise-induced bronchospasm. Do not use to treat acute bronchospasm.

Contraindications

Hypersensitivity to salmeterol; other long-acting beta2-adrenergic agonists; primary treatment of status asthmaticus; acute bronchospasm; MAOI therapy; pregnancy (category C); safety and efficacy in children <4 y not established.

Cautious Use

Cardiovascular disorders, cardiac arrhythmias, hypertension; history of seizures or thyrotoxicosis; liver and renal impairment, older adults, diabetes mellitus, sensitivity to other beta-adrenergic agonists; women in labor; lactation.

Route & Dosage

Asthma or Bronchospasm
Adult/Child (≥4 y): Inhalation 2 inhalations of aerosol (42 mcg) or 1 powder diskus (50 mcg) b.i.d. approximately 12 h apart

Prevention of Exercise-Induced Bronchospasm
Adult/Child (≥4 y): Inhaled 2 inhalations of aerosol (42 mcg) or 1 powder diskus (50 mcg) 30–60 min before exercise

Administration

Inhalation
  • Do not use to relieve symptoms of acute asthma.
  • Shake canister well before using; close lips tightly around the mouthpiece, and patient inhales deeply during each actuation.
  • Store at room temperature, 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

CNS: Dizziness, headache, tremor. CV: Palpitations, sinus tachycardia. Respiratory: Respiratory arrest (rare). Skin: Rash. Body as a Whole: Tolerance (tachyphylaxis).

Interactions

Drug: Effects antagonized by beta blockers.

Pharmacokinetics

Onset: 10–20 min. Peak: Effect 2 h. Duration: Up to 12 h. Distribution: 94–95% protein bound. Metabolism: Dissociates in solution; salmeterol base and xinafoate salt are metabolized, absorbed, distributed, and excreted independently; salmeterol is extensively metabolized by hydroxylation. Elimination: Primarily in feces. Half-Life: 3–4 h.

Nursing Implications

Assessment & Drug Effects

  • Withhold drug and notify physician immediately if bronchospasms occur following its use.
  • Monitor cardiovascular status; report tachycardia.
  • Monitor liver enzymes periodically with long-term therapy.

Patient & Family Education

  • Notify physician immediately of worsening asthma or failure to respond to the usual dose of salmeterol.
  • Do not use an additional dose prior to exercise if taking twice-daily doses of salmeterol.
  • Take the preexercise dose 30–60 min before exercise and wait 12 h before an additional dose.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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