Home Drug Guide Salmeterol Xinafoate

Drug Guide

Generic Name

Salmeterol Xinafoate

Brand Names Serevent

Classification

Therapeutic: Bronchodilator (long-acting beta2-adrenergic agonist)

Pharmacological: Beta2-adrenergic receptor agonist

FDA Approved Indications

  • Chronic obstructive pulmonary disease (COPD)
  • Asthma (as adjunct therapy)

Mechanism of Action

Salmeterol binds to beta2-adrenergic receptors on airway smooth muscle, activating adenyl cyclase, which increases cyclic AMP levels, leading to bronchodilation.

Dosage and Administration

Adult: Usually 50 mcg twice daily via Diskus inhaler or 25 mcg twice daily via AccuNeb nebulizer, as directed by a physician.

Pediatric: Use in children aged 4 years and older as prescribed; dosing depends on formulation and age.

Geriatric: No specific dosage adjustment required, but monitor for development of adverse effects.

Renal Impairment: No specific adjustment recommended.

Hepatic Impairment: Use with caution; no specific dosing guidelines established.

Pharmacokinetics

Absorption: Rapid absorption from lungs.

Distribution: Widely distributed in tissues; protein binding approximately 64%.

Metabolism: Extensively metabolized by hepatic CYP3A4 enzyme.

Excretion: Excreted primarily in feces; minimal renal excretion.

Half Life: Approximately 3.5 hours in plasma.

Contraindications

  • Hypersensitivity to salmeterol or any component.
  • Concurrent use with other long-acting beta2-adrenergic agonists in some circumstances.

Precautions

  • Use with caution in patients with cardiac arrhythmias, hypertension, or seizure disorders.
  • Not for use as a rescue inhaler; risks of asthma-related death noted in some studies.
  • Can precipitate hypokalemia, monitor potassium levels during therapy.

Adverse Reactions - Common

  • Headache (Common)
  • Throat irritation (Common)
  • Musculoskeletal pain (Common)

Adverse Reactions - Serious

  • Severe allergic reactions (rash, itching, swelling, difficulty breathing) (Rare)
  • Cardiac arrhythmias (Rare)
  • Hypokalemia (Uncommon)

Drug-Drug Interactions

  • Other sympathomimetics, MAO inhibitors, tricyclic antidepressants, corticosteroids (risk of hypokalemia and cardiac effects)

Drug-Food Interactions

  • No significant interactions reported

Drug-Herb Interactions

  • No well-established interactions.

Nursing Implications

Assessment: Monitor respiratory status, heart rate, blood pressure, and potassium levels.

Diagnoses:

  • Ineffective airway clearance,
  • Risk for adverse cardiac events

Implementation: Administer via inhaler/systemic as prescribed, educate patient on correct inhaler technique, monitor for side effects.

Evaluation: Assess improvement in breathing, reduction in symptoms, and monitor for adverse effects.

Patient/Family Teaching

  • Use inhaler exactly as prescribed.
  • Report any signs of worsening symptoms or adverse reactions.
  • Ensure understanding that this is not a rescue medication.
  • Wash mouth after inhalation to prevent oral candidiasis.

Special Considerations

Black Box Warnings:

  • Severe asthma-related events and death have been reported with LABA use; should not be used without an inhaled corticosteroid in asthma.
  • Risk of asthma-related death appears increased when used as monotherapy in asthma.

Genetic Factors: Limited data; pharmacogenomic testing not routinely required.

Lab Test Interference: No significant interference reported with laboratory tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, headache, tachycardia, hypokalemia.

Treatment: Discontinue salmeterol, provide supportive care, monitor vital signs and serum potassium, administer potassium as needed, and provide cardiovascular support if indicated.

Storage and Handling

Storage: Store at room temperature away from moisture, heat, and direct sunlight.

Stability: Stable under recommended storage conditions until the expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.