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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 Box Warning

• Drug may increase risk of asthma-related death. Currently available data are inadequate to determine whether concurrent use of inhaled corticosteroids or other long-term asthma control drugs mitigates the increased risk of asthma-related death from long-acting beta2-adrenergic agonists. Because of this risk, use of salmeterol xinafoate for the treatment of asthma without a concomitant long-term asthma control medication such as an inhaled corticosteroid is contraindicated. 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). Once asthma control is achieved and maintained, assess patient at regular intervals and step down therapy (for example, discontinue salmeterol xinafoate), if possible, without loss of asthma control and maintain patient on a long-term asthma-control medication such as an inhaled corticosteroid. Don't use salmeterol for patients whose asthma is adequately controlled on low-or medium-dose inhaled corticosteroids

• Available data from controlled clinical trials suggest that long-acting beta2-adrenergic agonists increase risk of asthma-related hospitalization in children and adolescents. For children and adolescents with asthma who require addition of a long-acting beta2-adrenergic agonist to an inhaled corticosteroid, a fixed-dose combination product containing both an inhaled corticosteroid and a long-acting beta2-adrenergic agonist should ordinarily be used to ensure adherence with both drugs. In cases in which use of a separate long-term asthma-control medication (for example, inhaled corticosteroid) and a long-acting beta2-adrenergic agonist is clinically indicated, take appropriate steps to ensure adherence with both treatment components. If adherence can't be assured, a fixed-dose combination product containing both an inhaled corticosteroid and a long-acting beta2-adrenergic agonist is recommended.


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).


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


• Hypersensitivity to drug or its components

• Acute asthma attack


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.


• 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.

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


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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


A trademark for the drug salmeterol xinafoate.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.
References in periodicals archive ?
A mutually agreed upon contract stipulated that Tracy increase her weekly Serevent use by at least one dose over the previous week, or use Serevent twice daily for seven consecutive days.
Food and Drug Administration (FDA) in 1998 and 2004 respectively, Serevent and Flovent HFA are commonly used, making it likely that many COPD patients may already benefit from the protective effect seen in the study.
(With these patients, drugs on Class 1, 2 and 4 should also be avoided) amiodarone, biaxin chloral hydrate, cocaine as local chloroquine, indapamide, lithium, anaesthetic, dexatrine, chlorpromazine serevent, ventolin, dobutamine, dopamine, cisaprid, zithromax ephedrine, epinephrine, clarithromycin, levophed, appetite disopyramide, suppressant phentermine, domperidone, haldol, dexatrim[R], acutrim[R], mellaril, methadone, sibutramine, ritilin, procainamide, ventolin sotalol Class 1: Drugs that Class 4: Drugs that are weakly are accepted by associated with TdPand/or QT authorities to have prolongation but are unlikely to be a risk of prolonging a risk for TdP when used in usual QT interval and TdP recommended dosages and in patients without other risk factors *.
In 2004, GSK sued the IRS, claiming it had erred in increasing GSK's income by $7.8 billion ($4.5 billion for cost of goods sold, $1.9 billion for royalties, and $1.4 billion for interest income) for intercompany transactions involving Zantac, Ventolin, Ceftin, Zonfran, Imitrex, and Serevent. GSK later added a claim for a $1 billion refund based on a charge of discriminatory practices in the APA process.
years Granules: 4mg /packet 12mo-23mo LABA Salmeterol Serevent Diskus [greater than or 50mcg/puff equal to] 4 years LABA Formoterol Foradil Aerolizer (DPI) [greater than or 12mcg/puff equal to] 5 years LABA/ Fluti- Advair Diskus [greater than or ICS casone/ 100-50mcg/puff equal to] 4 years Salmeterol 250-50mcg/puff
The drugs giant said they disagreed with the FDA, which claimed both Advair and Glaxo's Serevent treatment may make asthma more severe.
The drugs giant, which employs 2,200 people at Barnard Castle in County Durham and Ulverston in Cumbria, said it disagreed with the FDA, which claimed both Advair and Glaxo's Serevent treatment may make asthma more severe and should not be used as first treatments.
The examinees, who are aged 40 or older and in a stable period, were divided into two groups: the one who were administered with Hokunalin Tape and the other with Serevent (salmeterol), COPD drug currently marketed by GlaxoSmithKline.
Not to be started in Serevent Diskus Prescription the midst of an attack.
The patient was started on Serevent (GlaxoSmithKline, Research Triangle Park, NC), Flovent (GlaxoSmithKline), and Proventil (Schering, Kenilworth, NJ) inhalers and returned to work with the recommendation that he use a surgical mask while at work.
Advair Diskus[R] (fluticasone propionate plus salmeterol), Foradil Aerolizer[R] (formoterol), and Serevent Siskus[R] salmeterol), were all found to have the potential to reduce the number of asthma episodes while increasing their severity.
Examples of DPI devices are the Serevent Diskus[R] and Advair Diskus[R].