Serevent

Ser·e·vent (sr-vnt)

A trademark for the drug salmeterol xinafoate.

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salmeterol xinafoate

Serevent (UK), Serevent Diskus

Pharmacologic class: Beta₂-adrenergic receptor agonist (long-acting)

Therapeutic class: Bronchodilator

Pregnancy risk category C

FDA Boxed Warning

• Drug may increase risk of asthma-related death. When treating asthmatic patients, use only as additional therapy for those not adequately controlled on other asthma-controller medications or whose disease severity clearly warrants treatment with two maintenance therapies (including salmeterol).

Action

Stimulates intracellular adenylate cyclase, an enzyme that catalyzes conversion of adenosine triphosphate to cyclic-3', 5'-adenosine monophosphate (cAMP). Increased cAMP levels relax bronchial smooth muscle and inhibit release of mediators of immediate hypersensitivity (especially from mast cells).

Availability

Powder for inhalation using Diskus delivery system: 50 mcg/blister (60 blisters)

⊘Indications and dosages

➣ Maintenance treatment of asthma; prevention of bronchospasm in patients with reversible obstructive airway disease; maintenance treatment of bronchospasm in patients with chronic obstructive pulmonary disease (COPD)

Adults and children older than age 4: 50 mcg (one inhalation) b.i.d. approximately 12 hours apart

➣ Prevention of exercise-induced bronchospasm

Adults and children older than age 4: 50 mcg (one inhalation) 30 to 60 minutes before exercise. Withhold additional doses for at least 12 hours.

Off-label uses

• Cystic fibrosis
• High-altitude pulmonary edema
• Atopic asthma

Contraindications

• Hypersensitivity to drug or its components
• Acute asthma attack

Precautions

Use cautiously in:
• cardiovascular disease, diabetes mellitus, hyperthyroidism
• concurrent use of MAO inhibitors or tricyclic antidepressants (extreme caution required)
• pregnant or breastfeeding patients
• children younger than age 4.

Administration

• To use Serevent Diskus, activate device and hold in horizontal position.
• Make sure patient doesn't exhale into device.
• Preferably, give doses 12 hours apart in morning and evening.

Route	Onset	Peak	Duration
Inhalation	10-25 min	3-4 hr	12 hr

Adverse reactions

CNS: headache, nervousness, dizziness, tremor

CV: palpitations, hypertension, tachycardia, arrhythmias

GI: nausea, diarrhea, abdominal pain

Metabolic: hyperglycemia, hypokalemia

Musculoskeletal: muscle cramps and soreness

Respiratory: paradoxical bronchospasm

Skin: urticaria, angioedema, rash

Other: hypersensitivity reaction

Interactions

Drug-drug. Beta-adrenergic blockers: decreased salmeterol efficacy, increased risk of severe bronchospasm in patients with asthma or COPD

Diuretics (except potassium-sparing): increased risk of hypokalemia and ECG changes

MAO inhibitors, tricyclic antidepressants: potentiation of salmeterol's cardiovascular actions

Drug-diagnostic tests. Glucose: increased level

Potassium: decreased level

Drug-food. Caffeine-containing foods and beverages: increased stimulant effect

Urine-acidifying foods: increased drug blood level

Drug-herbs. Caffeine-containing herbs (such as cola nut, yerba maté), ephedra (ma huang): increased stimulant effect

Patient monitoring

• Assess pulmonary status and vital signs.
☞ Stay alert for signs and symptoms of hypersensitivity reaction, particularly rash, urticaria, angioedema, and paradoxical bronchospasm.

Patient teaching

• Remind patient that drug isn't a rescue bronchodilator and won't give immediate relief in emergency.
• Teach patient proper technique for using inhaler or Diskus. Instruct him not to exhale into device or use a spacer with Diskus.
• Advise patient to keep Diskus dry. Tell him not to rinse, wash, or take it apart.
• Instruct patient to take regular doses 12 hours apart. Tell him to take doses for exercise-induced bronchospasm 30 to 60 minutes before exercising.
• Advise patient to take drug exactly as prescribed and not to exceed one inhalation twice daily.
• Tell patient to consult prescriber if he needs more inhalations than usual.
• Caution patient not to stop taking drug without consulting prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.