Salmeterol Metered Dose Inhaler: Asthma Dosing

Therapeutic action

Long-acting beta-2 agonist bronchodilator.

Indications

Long-term treatment of moderate and severe persistent asthma as maintenance treatment, in combination with an inhaled corticosteroid such as beclometasone.

Forms and strengths

Solution or suspension for inhalation in pressurised metered dose inhaler, delivering 25 micrograms of salmeterol per puff.

Dosage

Start at the step most appropriate to initial severity. Always try to administer the lowest effective dose.

• Child 6 to 11 years: 2 puffs (50 micrograms) 2 times daily, maximum 4 puffs or 100 micrograms daily.
• Child 12 years and over and adult: 2 to 4 puffs (50 to 100 micrograms) 2 times daily, maximum 8 puffs or 200 micrograms daily.

Duration

Treatment should be given as long as required. Re-evaluate after 2 to 3 months to determine whether doses are adequate or need to be increased or decreased.

Administration technique

• Shake the inhaler and remove the mouthpiece cover.
• Breathe in and breathe out as completely as possible, then place the lips tightly around the mouthpiece.
• Inhale deeply while activating the inhaler, then hold breath for 10 seconds before exhaling.
• If hand-breath coordination is difficult, use a spacer to facilitate administration and improve treatment efficacy.

Contra-indications, adverse effects, precautions

• May cause headache, tremor, tachycardia, hyperglycaemia, and hypokalaemia after high doses.
• Pregnancy and breast-feeding: no contra-indication.
• Salmeterol must always be used with an inhaled corticosteroid. It should not be used for symptomatic relief of acute asthma.
• Relief of symptoms may require several days or weeks of continuous therapy.
• Clean the mouthpiece before and after each use.
• Do not pierce or incinerate used aerosol containers because of explosion risk.