Common Drug Q&A » Arthritis » Salmeterol

Salmeterol

A: What an insightful question.

While salmeterol has reduced medical withdrawals due to asthma control compared with SABA’s, it has also been associated with a higher risk for death among patients with severe asthma.

In the most current study of salmeterol vs placebo, salmeterol was associated with slightly higher rates of asthma-related death, respiratory-related death, and the combination of asthma-related deaths, intubation, or mechanical ventilation. This difference largely was confined to African American patients.

Whether this risk is due to factors including but not limited to a physiologic treatment effect, genetic factors, or patient behaviors leading to poor outcomes remains unknown and that is where we are at with this drug.

I guess one would think that the only thing that can be done is a concerted effort to have it withdrawn. But, there is a huge popiulation that this drug is very effective with. So maybe there needs to be a strong re-evaluation to which patient poplation to prescribe the drug to.

Q: Is anyone on Salmeterol xinafoate? for asthma?
What is meant to do? and how have you found it? any side effects? and whats your dosage?

A: Hi Gemma,

Salmeterol is a long-acting beta2-adrenergic receptor agonist drug , which is basically like the ventolin, blue inhaler, but longer lasting.

These are usually taken as prescribed by your doctor, should be accompanying a steroid inhaler.

I was on this inhaler, along with Qvar steroid inhaler and I was taking the salmeterol 2x puff, twice daily. I found the salmeterol inhaler helped, but I got terrible shakes and I found I could not sleep at night, because I felt so on edge. They consequently reduced the dose and then eventually I was removed entirely from this drug and I am now taking Symbicort 200/6, which is basically a long lasting inhaler and a steroid inhaler in one.

I have found that with asthma medications, what might work for one person, might not work for another and some might never experience any side effects, where others might. Just see how it goes, if you’re not happy go back to your GP. There are other asthma inhalers out there.

Good luck -x-

Q: what is the best way to cure asthma?want to know other alternative herbal med for my kids asthma.?
my kid is 4yrs old and every month, he will be given antibiotics because he has colds eventually leads to cough and asthma. he has maintenance med, (salmeterol+fluticasone propionate, cetirizine) still he cough. I give him also nebulization (combivent). how can he be asthma free? are there herbal med? or natural asthma prevention? my kid is obese. at 4yrs old he is 29kg. and i find it hard to let him on diet because he cant understand what diet is.how can i let him reduce his weight?

A: don’t mess with asthma! Trying a bunch of natural nonsense drugs may get him into a life and death situation. Look at your house, see what is causing his problems, smoking, paint fumes, animal dander, dust etc. eliminate it from your environment and pray for him to outgrow it. a number of kids do. As for the weight, you caused it by overfeeding him, you have to take steps to help him eat healthy foods. Keep him away from jusk food, no soda, no cookies , no crackers….teach him to eat good food and he will lost the weight.

Q: Salmeterol(serevent) Possible overdose? ……Please advise?
Hi I had an asthma attack this morning and forgot my blue inhaler and only had serevent with me I used that, at least 20 puffs at 25mcg each a total of 500 mcg. I didn’t realize that it would not help an attack ,fortunately my friend was there and he ran and got his. I am now ok but I am shaking , almost tingling all over and have a sore head. Please advise. Thanks to all who answer

A: Yes, call the poison control center in your area. If not that then go to the ER. Salmeterol overdose can cause rapid heart rate, hypertension, agitation, etc….
They may need to monitor your vital signs for the next few hours, and administer beta blockers in a controlled setting if necessary. Also, make sure you understand which inhalers are for rescue and which are for maintenance. Maintenance inhalers aren’t useful for acute attacks and only lead to overdose as a patient keeps trying to get them to work quickly.
Salmeterol is long-acting by design so the effect are going to be there for a number of hours. So, don’t ignore it.

Q: Anyone on salmeterol (SEREVENT) had side effects from it?
I should add my son had heart palpitations after starting that medication, his dr. says it’s a very rare reaction, I’m trying to figure out how rare it is, really.

A: It is a long acting B agonist. The blue inhaler ventolin is for more immediate treatment of symptoms. The salmeterol works over a longer time. The side effects are the same as ventolin….fine tremor, mild anxiety, fast heart rate. The dose of drug is very small because it is inhaled. These side effects are negligable compared to the panic and tight chest of an asthma attack.

Q: seretide……. Salmeterol xinafoate?
what is the classification of the drug Seretide?

A: Salmeterol (Serevent) is a long-acting Beta2-specific bronchodilator. Flovent (Fluticasone) is an inhaled steroid. Seretide is a combination inhaled steroid/long-acting bronchodilator.

Q: Which of the following drugs is classified as a topical steriod?
Albuterol (ventolin, Proventil)
Salmeterol (Serevent)
Fluocinolone (Synalar)
Prednisone (Deltasone)

A: Marie,
These details could have been researched personally using your library or the internet. I presume that this method involves less work for you. Your answer should be Fluocinolone (Synalar) which is a topical steroid. Prednisone (Deltasone) is a Corticosteroid, which is a medication that is chemically similar to natural steroids and duplicates their actions. Salmeterol (Serevent) is a long-acting beta2-adrenergic receptor agonist drug that is currently prescribed for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Albuterol (ventolin, Proventil) is a bronchodilator used for asthma and emphysema and other lung conditions.

ALL ANSWERS SHOULD BE THOROUGHLY RESEARCHED, IN ANY FORUM AND ESPECIALLY IN THIS ONE. – MANY ANSWERS ARE FLAWED.

It is extremely important to obtain an accurate diagnosis before trying to find a cure. Many diseases and conditions share common symptoms.

The information provided here should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.

Hope this helps
matador 89

Q: Hayfever causing Asthma?
Hi, I suffer from hayfever which I can bear for the 2 or so early months of the yr I get it, however more concerning this yr is the onset of what feels like shortness of breath and lung capacity, more so when I exercise and sometimes at night. I’ve been prescribed a puffer Salmeterol to ‘prevent’ wheezing’.
Anyone any experieince of this and how to overcome the onset of this type of condition..main worry is the dibilitating effect of not being able to exercise freely without the shortness of breath ?

A: OK, first of all Salmeterol (or any LABA) should NEVER be prescribed on it’s own without a corticosteroid inhaler. It really sounds like your prescriber does not have current up to date information regarding prescribing.

It’s actually dangerous to prescribe Salmeterol without a corticosteroid. I suggest you see your Doctor again or ask to be referred to an Asthma specialist. If you have exercise induced Asthma and find your current management is not working, having a corticosteroid inhaler might do the trick. Singulair as an add on is very effective too, however 20% of people do not respond to Singulair.

Either way, your current management is in urgent need of reviewing.

Q: Please save me from acnes.?
i’m a 18yr old boy. they are all over my cheeks and my forehead. i have tried antiseptic lotions but they don’t really help. is there anyway of controlling them? btw i have asthma and hence have to take steroids daily(salmeterol and fluticasone combination) i also have a general allergic tendency and often take cetrizine and use only mild soaps (dove). are they responsible?

A: A friend of mine got a book about getting rid of acne a while back. He followed the infor in it and it cleared up the acne on his face, shoulders and back almost completely.

Heres their website: http://www.yourlifestyle.info/acnefree

Q: Cipro with other medications??
My doctor just prescribed me cipro because my surgery area might be infected. anybody know if i can continue taking my pain med Ultram 50mg, or ibuprofen 600mg. i also take wellbutrin for cigarette smoking and albuterol inhaler. i also take salmeterol.

A: eat em all…..like a trail mix

Q: How does SYMBICORT increase the risk of asthma related death?
I dont understand fully what this mean can anyone explain.My dr. prescribed me this but Iam afraid to try it.

WARNING: Long-acting beta2-adrenergic agonists may increase the risk of asthma-related death. SYMBICORT should only be used for patients with asthma not adequately controlled on other asthma-controller medications (eg, low- to medium- dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with two maintenance therapies. Data from a large placebo-controlled US study that compared the safety of another long-acting beta2-adrenergic agonist (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol may apply to formoterol (a long-acting beta2-adrenergic agonist), one of the active ingredients in SYMBICORT

A: Miss Kitty Cat, you are making this more difficult than it needs to be.
I do understand your apprehension. But, read the bottle of Tylenol, Ibuprofen, and Cough medicines. It will not give you any comfort.

My over riding concern is that if you really need this drug, by not taking it … you are setting yourself up for what you are scared of … death.

That said …. the research that lead to these warnings …. which are many …. AGAIN … refer mostly to the subset population of African -Americans …. whether this risk is due to factors including but not limited to a physiologic treatment effect, genetic factors, or patient behaviors leading to poor outcomes remains unknown … so I really look at this information with much speculation …

These patients that passed away were poorly controlled asthmatics that were really sick ….

Studies have shown that long acting bronchodilators (such as that found in symbicort) produced better results in terms decreasing the severity of asthma …

Among patients with severe asthma, salmeterol was associated with a higher number of asthma-related events, including hospitalizations and death … the KEY word here is severe asthma …. we have always had death realted to severe asthma … even before the LBA class of drugs came unto the scene …. and these death rates are insignificant … that is why the drug has not been pulled … they cannot soley pin these deaths on these class of drugs … they just have seen deaths in these patients that have happened to take this drug ….

And I no way mean to diminish these deaths by saying they are insignificant … by insignificant … I mean statistically ….

If you are determined not to take the drug, the worst thing you can do is not talk with your physician. You need to go back to them and talk to them about your concerns. You do not need to SELF TREAT …. I have known to many asthmatics who thought they new better … and sadly to say, they are no longer with us ….

Please be wise and at least voice your concerns with your physician … if you have any questions … please feel free to discuss them with me …. my email is available …

I wish you the best of health

Q: Advair 250/50 question?
OK maybe I’m just being paranoid. But I was prescribed advair. And I was reading the info about it and it kinda scared the crap outta me. It says, “Advair contains salmeterol which may increase the chance of asthma-related deaths.” What does this mean to you? I take it as it just might not work at preventing an asthma attack. But my husband thinks it means the inhalor itself could cause something and kill you. Does anyone have any good ideas? Thanx!

A: A large placebo-controlled safety study of Serevent referred to as Salmeterol Multi-center Asthma Research Trial (SMART) was started in July 1996, after the FDA received reports of several asthma deaths associated with the use of Serevent Inhalation Aerosol, and after studies raised concern about the regular use of short-acting and long-acting beta-agonists. In early 2003, GlaxoSmithKline announced that it was stopping the SMART study after an interim analysis revealed an increased risk of asthma-related deaths and life threatening episodes among patients given the drug (13 deaths out of 13,176 patients treated for 28 weeks versus, 3 of 13,179 for those on placebo). The FDA says that further analysis of the data suggests that the risk might be greater in African-Americans. A previous study has reported that 36 patients who used Serevent died or suffered serious but not fatal asthma attacks.

The deaths were related to the use of severent. The warning is on Serevent, Advair, Symbicort and Fordil inhalers. The FDA concluded that benefits were greater then the risk so the medications were not pulled.

Q: Asthma related question about ADVAIR?
I have what is called “mild” asthma, and I have only taken Ventolin for it…throughout my life I’ve only had to an inhaler when I was littler and once for a short period as an adult. I have recently been having some difficulty with my breathing because my brother moved in and brought his dog and I am allergic to dogs.
My doctor prescribed ADVAIR along with ventolin…but upon reading the instructions I was somewhat alarmed by the “Warnings and Precautions” section that read:

“A large US clinical trail showed an increased risk of asthma-related death and other serious respiratory-related outcomes in patients who used salmeterol (AVAIR) in addition to their usual asthma therapy (ventolin)”

I feel very frustrated and am not sure what I should do. I just go the inhalers today and am not sure whether I should take them. I called my doctor and he said it was fine, even after I told him what it said.
Does anyone know anything about this who could help me?
I don’t want to increase the risk of my asthma getting worse by taking this…also, it seems scary that people have died as a result of taking it.

A: Yeah am I nurse in the hospital field and field questions like this all time. The drug companies have to release information like this in the interest of full disclosure. This is a medication and the results of something going wrong are there. In the reality it’s like a 1 in million or so chance that something can happen to you, but with even that slim margin and the lawyers we have to do they want to tell you up front. It’s like a blood transfusion at the hospital. Yes there is a small, very small, chance that you could contract aids, hepatitis, or even die from the transfusion. But on the other hand the is a very good chance that you will die if you don’t get the transfusion. Medicine is almost the same way.
While yes there is a small, very small, chance that you could suffer from a serious respiratory illness. It’s a much greater chance that with out you will also suffer a respiratory illness.

It’s like my blood pressure medication. Yeah there is a small chance it could make me bottom my blood pressure. But there is a much greater chance of my having a stroke without it.

I have given Advair several times and have not seen any of the adverse reactions that they list in the papers.

Q: Asthma nurse changing my medication? Is she allowed?
I live in the U.K. and have had chronic asthma for as long as I can remember (I am now 38). I have ALWAYS had salbutamol inhalers (usually ventolin). Anyway my docs surgery rings me every few months and asks that I make an appointment to see the asthma nurse, which I do. She asked me if I still use my becotide inhalers (steroidal 2 puffs morning and night) and I answered honestly that i didnt all the time because sometimes I forget. So she took it upon herself to change my medication and now i get seretide 125 which is ’salmeterol/fluticasone propionate’ (instead of salbutomol and becotide). I was told to take this 2 times in morn and 2 times at night. I CANNOT now get my salbutomol inhalers because the surgery says I have these new inhalers instead. BUT being chronic asthmatic I get tight chest throughout the day so I have to use the new seretide 125 inhalers more than 10 times a day (luckily they have same effect of stopping my breathlesness). I usually get 2 inhalers on repeat prescription (salbutomol has 200 metered doses *2) but the new inhalers have only 120 metered doses each so effectivelly the nurse has almost halved the amount of medication I get with each scrip. I ask for a repeat scrip when im on my last inhaler and now the surgery is saying im ordering my scrips too early and yesterday only prescribed me 1.

Thanks for reading and here come the questions;
Is the nurse allowed to change my medication?
Have I overdosed on my new medication?
Do you think the nurse or doctor has made an error?

I have made an appointment to see the doc (10am tomorrow) and what do u think the chances are that he will be honest and say hes made a mistake? These inhalers are very important as without them I WOULD die!!
Any answers from asthma nurses would be grately appreciated. Thank you.

A: There is a worrying collection of problems in your long question, I will try and give some simple, general answers.

Firstly if you GP gives his nurse the OK, she can change medication, ideally in line with protocols he has constructed, BUT he must sign the prescriptions and he retains overall responsibility for her actions.

Secondly, there is a move to put increasing numbers of symptomatic asthmatics on combi steroid/long acting beta 2 inhalers to improve control and compliance. ( I prefer Symbicort to Seretide.) There is also a licence for Symbicort, rather than Seretide to be used twice daily and if required if the patient is symptomatic. I am unhappy about this arrangement as it allows rather uncontrolled use of quite potent steroids. ( Particularly Fluticasone, which in high dose, has even been associated with death due to adrenal suppression!) Also there is no reason why a patient on a combi inhaler cannot also be on a reliever such as Ventolin/salbutamol as well.

Q: Spotting 10 days after period finished….?
Hi,

I started bleeding again today, I finished my last period 10 days ago. I have been on birth control for 4 months now, I actually am on meds right now cause I have pneonmnia (spelling sorry!) so i’m on a puffer called salmeterol xinafoate and just started biaxin yesterday….could it be because of my meds????

I’m 26 years old, heathy except the above mentioned. I had sex with my fiancee 2 weekends ago when my period was basically almost finished…

any thoughts????
I have never had trouble with spotting because of the pill. I was on it years ago for about 2 years but stopped. Went back on it again cause I didn’t want to get pregnant before my wedding in May!!!

A: It could actually be many things. It could very well in fact be your pill, because they do cause spotting in between periods…and although they say it’s usually only within the first one to three months of use, it can actually happen at any time (I’ve known people that this has happened to….and one happens to be myself).

However, on the other side of things, it very well could also be implantation bleeding. Your best bet is to wait until you have your “period” (aka the week’s break between pill packs) and see what happens and/or take a pregnancy test.

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