Salmeterol is a bronchodilator which is similar to albuterol (Proventil® or Ventolin®) and other "shorter-acting" medications such as bitolterol (Tornalate®), pirbuterol (Maxair®) and terbutaline (Brethaire®). Salmeterol differs from these medications in that it does not begin working immediately and has a longer duration of action. This allows for twice daily dosing rather than the usual four times daily or every 4-6 hours dosing.

Recently, there has been concern over the potential for a greater risk of dying of acute asthma attacks in persons treated with salmeterol. This has received much attention in newspapers and magazines. While the association between salmeterol and deaths due to asthma remains unclear, proper use of this medication can minimize any risks.

Salmeterol, with its slow onset of action and long duration of action, is not intended for use as a "rescue" medication. Therefore it should not be used for relief of acute symptoms such as coughing, wheezing, chest tightness or shortness of breath. Salmeterol's longer onset of action, the time it takes to begin working, means that you may not feel immediate relief after taking a treatment. Thus, you should continue to use your shorter-acting agent for relief of symptoms, especially those that occur suddenly. Because salmeterol is a long-acting bronchodilator, you may feel relief for a longer period of time and may require fewer treatments of your shorter-acting bronchodilator.

Why is this drug prescribed?

Serevent relaxes the muscles in the walls of the bronchial tubes, allowing the passageways to expand and carry more air. Taken regularly (twice a day), the drug helps prevent wheezing and other symptoms of asthma, as well as exercise-induced asthma. A relatively long-acting medication, it is recommended for people who need shorter-acting bronchodilators such as Alupent and Ventolin on a frequent, regular basis.

Serevent is available in an aerosol inhaler and as Serevent Diskus (Acculhaler) inhalation powder. The aerosol inhaler is also used to treat the airway constriction that marks such chronic lung diseases as emphysema and chronic bronchitis. Both forms of Serevent can be used with or without inhaled or oral steroid therapy.

Most important fact about this drug

Serevent is intended only for long-term prevention of symptoms, and should not be used more than twice a day. Do not use it to treat acute asthma attacks, and do not attempt to relieve worsening asthma by increasing the frequency of your doses. (Your doctor will prescribe a short-acting bronchodilator to relieve acute attacks.)

Seriously worsening asthma is a dangerous-even life-threatening-condition that needs immediate medical attention. Alert your doctor if your short-acting bronchodilator is becoming less effective or you need more inhalations than usual. Also consider it a warning sign if you need 4 or more inhalations daily for 2 days or more in a row, or find that you are finishing a 200-dose canister in less than 8 weeks.

How should you take this medication?

Use no more than the prescribed dose and follow package directions closely. Space your two daily doses approximately 12 hours apart, in the morning and evening. To be effective, the drug must be used regularly every day.

Serevent aerosol inhaler must be shaken thoroughly before each use. Test-spray the inhaler 4 times before the first use and whenever 4 weeks have passed since the last use. Avoid spraying in the eyes.

Serevent Diskus should never be used with a spacer. Always activate the Diskus device in a level, horizontal position. Never exhale into the Diskus device, and always keep it dry. Do not wash the mouthpiece or any other part of the device.

—If you miss a dose…

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never double your dose.

—Storage instructions…

Store the Serevent aerosol inhaler and Serevent Diskus at room temperature away from direct sunlight and freezing temperatures. Leave the aerosol inhaler canister with the nozzle end down. Throw away the Diskus inhalation device after every blister has been used (when the dose indicator reads "0") or 2 months after the blisters have been removed from their foil pouch.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using Serevent.

More common side effects may include:

• Asthma
• back pain
• bronchitis
• chest congestion
• cough
• diarrhea
• headache
• nasal inflammation
• pallor
• respiratory tract infection
• sinus headache
• sinus infection
• sinus problems
• sore throat
• stomachache
• tremor

Less common side effects may include

• abdominal pain
• arm pain
• chest discomfort
• constipation
• dental pain
• difficulty breathing
• dry mouth
• earache
• eczema
• fatigue
• feeling of illness
• fever
• heartburn
• hives
• indigestion
• insomnia
• irritation of the mouth and throat
• joint pain
• laryngitis
• leg cramps
• mouth infection
• mouth problems
• muscle aches or cramps
• nasal congestion
• nausea
• neck pain
• nervousness
• nosebleed
• painful menstruation
• pneumonia
• rapid heartbeat
• rash
• shortness of breath
• shoulder pain
• skin tingling
• sneezing
• stomach pain
• urinary tract infection
• vomiting
• wheezing

Why should this drug not be prescribed?

If Serevent gives you an allergic reaction, you cannot continue using it.

Special warnings about this medication

Serevent is not for the treatment of seriously worsening asthma, and should not be started if your asthma is deteriorating.

If you are taking inhaled or oral steroid medications for your asthma, continue using them along with Serevent. This drug does not replace them.

If you develop an allergic reaction (throat irritation, choking, hives, face and throat swelling, rash, and wheezing) after using Serevent, call your doctor immediately. likewise, if symptoms of asthma or chronic lung disease get worse after inhaling Serevent, stop using it and check with your doctor at once.

Although such effects are rare, Serevent can cause an increase in blood pressure and heart rate. Use this medication carefully if you have high blood pressure, heart disease, or an irregular heartbeat. Caution is also advised if you have a seizure disorder or an overactive thyroid.

Serevent aerosol inhaler can be given to children 12 years of age and older. The Diskus inhalation powder can be given to children 4 and older.

Possible food and drug interactions when taking this medication

If Serevent is taken with certain other drugs, the effects of either drug could be increased, decreased, or altered. It is especially important to check with your doctor before combining Serevent with the following:

• Airway-opening medications such as Alupent, Proventil, and Ventolin
• Blood pressure medications known as beta blockers, including Inderal, Lopressor, and Tenormin
• MAO inhibitors such as the antidepressants Marplan, Nardil, and Parnate
• Tricyclic antidepressants such as Elavil and Tofranil
• Water pills (diuretics) such as furosemide (Lasix) and hydrochlorothiazide (HydroDIURIL)

Special information if you are pregnant or breastfeeding

Serevent has not been adequately tested in pregnant women. Check with your doctor immediately if you are pregnant or are planning a pregnancy. Serevent's effects during breastfeeding are also unknown. You and your doctor should decide whether to discontinue nursing or give up Serevent.

Recommended dosage

SEREVENT AEROSOL INHALER
Asthma and chronic lung disease
The usual dose is 2 inhalations (42 micrograms) twice a day (morning and evening) 12 hours apart.

Prevention of exercise-induced asthma
Take 2 inhalations at least 30 to 60 minutes before exercise. Do not take another dose for 12 hours. (If you are on a twice daily dosage schedule, do NOT take additional Serevent before exercise.)

SEREVENT DISKUS INHALATION POWDER
Asthma
The usual dose is 1 inhalation (50 micrograms) twice a day (morning and evening).

Prevention of exercise-induced asthma
Take 1 inhalation at least 30 minutes before exercise. Do not take another dose for 12 hours. (If you are on a twice daily dosage schedule, do NOT take additional Serevent before exercise.)

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

Symptoms of Serevent overdose may include:

• Angina (chest pain)
• dizziness
• dry mouth
• fatigue
• flu-like symptoms
• headache
• heart irregularities
• high or low blood pressure
• high blood sugar
• insomnia, muscle cramps
• nausea
• nervousness
• rapid heartbeat
• seizures
• tremor