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Clinical References

Pharmacology

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Learning Center/Pharmacology/Salmeterol

bronchodilator laba

Salmeterol

Serevent Diskus

Route: inhaled (dry powder Diskus)
Onset: 10–20 minutes
Duration: 12 hours

Mechanism of action

Long-acting selective beta-2 adrenergic agonist. Long lipophilic side chain anchors it to cell membrane near receptor, allowing sustained receptor activation. Increases cAMP → bronchial smooth muscle relaxation.

Dosing

Adult: Diskus: 50 mcg (1 inhalation) q12h. Not to be used more frequently.
Pediatric: ≥4 years: 50 mcg q12h

Indications

COPD maintenance therapy
Asthma maintenance (always with ICS — NEVER monotherapy)
Prevention of exercise-induced bronchospasm
Nocturnal asthma symptoms

Contraindications

Monotherapy in asthma (black box warning — increased asthma-related death)
Acute bronchospasm (not a rescue drug)
Hypersensitivity to salmeterol

Side effects

Tachycardia
Tremor
Hypokalemia
Headache
Throat irritation (dry powder)

Monitoring parameters

Heart rate
Asthma control — must be used with ICS
Peak flow / spirometry
Serum potassium

Drug interactions

Beta-blockers (antagonism)
MAOIs (cardiovascular potentiation)
Non-potassium-sparing diuretics (hypokalemia)
QT-prolonging drugs (additive risk)

NBRC high-yield

LABA — 12-hour duration, NOT a rescue inhaler
Black box warning: NEVER use as monotherapy in asthma
Must always be combined with ICS in asthma patients
Available as Advair when combined with fluticasone
Safe for COPD as monotherapy or with ICS

Clinical pearls

BLACK BOX WARNING: increased risk of asthma-related death when used without ICS
Always prescribed with inhaled corticosteroid in asthma
NOT for acute rescue — onset is 10–20 minutes, used for maintenance only
Combined with fluticasone in Advair (most commonly prescribed LABA/ICS combo)
Duration (12 hr) allows BID dosing

Mnemonic

Salmeterol: Slow Starter, 12-hour Maintenance — never Solo in asthma

Salmeterol (Serevent Diskus) — Respiratory Pharmacology