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Salmeterol inhalation

Updated 2 Feb 2023 | Long acting beta agonists


Inhalation formulations of salmeterol

Drugs List

  • NEOVENT 25microgram inhaler cfc-free
  • salmeterol 25microgram inhaler cfc-free
  • salmeterol 50microgram dry powder inhaler
  • SEREVENT 50microgram ACCUHALER
  • SEREVENT EVOHALER 25microgram inhaler cfc-free
  • SOLTEL 25microgram inhaler cfc-free
  • Therapeutic Indications


    Chronic obstructive pulmonary disease
    Preventive treatment of bronchial asthma due to exercise
    Symptom relief of broncho-obstruction in asthma when steroids insufficient


    The full benefits of treatment will be apparent after several doses of the drug.

    The dosage or frequency of administration should only be increased on medical advice.


    50 micrograms twice daily, increasing to 100 micrograms twice daily if required.

    Chronic Obstructive Pulmonary Disease:
    50 micrograms twice daily.


    50 micrograms twice daily, increasing to 100 micrograms twice daily if required.

    Chronic Obstructive Pulmonary Disease:
    50 micrograms twice daily.


    Not all available brands are licensed for children under 12 years.


    Children 4 years and over:
    50 micrograms twice daily.


    Children under 4 years
    Long QT syndrome
    Torsade de pointes

    Precautions and Warnings

    Children aged 4 to 12 years
    Family history of long QT syndrome
    Predisposition to hypokalaemia
    Cardiac arrhythmias
    Cardiovascular disorder
    Diabetes mellitus
    Electrolyte imbalance
    Glucose-galactose malabsorption syndrome
    History of torsade de pointes
    Lactose intolerance

    Correct electrolyte disorders before treatment
    May decrease glucose tolerance in patients with diabetes mellitus
    Advise patient dizziness may affect ability to drive or operate machinery
    Do not substitute for steroid therapy
    Ensure patient has a fast acting bronchodilator available
    Not all available brands are licensed for use in children under 12 years
    Not to be used as the sole or main treatment for severe or unstable asthma
    Some formulations contain lactose
    Some formulations may contain alcohol
    Some products may contain soya or soya derivative
    Consider use of a spacer device for suitable patients and formulations
    Check patient is using correct inhaler technique
    Consider monitoring ECG in patients at risk of QT prolongation
    Monitor serum electrolytes
    Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
    Monitor serum potassium regularly in patients with severe asthma
    Advise patient to seek medical advice if asthma seems to be worsening
    CSM (CHM) requests reporting of adverse reactions to cfc-free inhalers
    May reduce serum potassium levels
    Do not withdraw this drug suddenly
    Discontinue if paradoxical bronchospasm occurs
    Maintain treatment at the lowest effective dose
    Advise patient not to reduce steroid therapy without medical advice
    Advise patient not to use for relief of acute attacks
    Advise patient to continue taking corticosteroid therapy
    Use regularly to maintain freedom from symptoms

    Pregnancy and Lactation


    Use salmeterol with caution in pregnancy.

    There are no adequate data available on the use of salmeterol in human pregnancy to assess the possible harmful effects. The limited data that has been published identified no congenital malformations. However the study lacked the sensitivity to identify minor anomalies.

    Animal studies in selected species of rabbits using doses well in excess of normal human doses have shown foetal toxicity secondary to beta adrenoreceptor stimulation. Extensive experience with other beta-2 agonists has provided no evidence that such effects are relevant for women receiving clinical doses of salmeterol.

    It is not known if salmeterol crosses the placenta to the foetus. However, plasma levels of salmeterol after inhaled therapeutic doses are negligible which would suggest that the risk to the foetus is probably minimal.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use salmeterol with caution in breastfeeding.

    It is not known whether salmeterol passes into human breast milk. In rats, small amounts of salmeterol have been detected in maternal milk following oral dosing.

    Plasma levels of salmeterol after inhaled therapeutic doses are negligible which would suggest that it is unlikely that clinically significant amounts would be found in human breast milk.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Anaphylactic reaction
    Anaphylactic shock
    Atrial fibrillation
    Bronchospasm (paradoxical)
    Cardiac arrhythmias
    Chest pain
    Hypersensitivity reactions
    Increased blood pressure
    Muscular cramps
    Oropharyngeal irritation
    Supraventricular tachycardia


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: February 2017

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 8 February 2017.

    Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

    Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications Accessed on 8 February 2017.

    Summary of Product Characteristics: NeoventTM CFC-free Inhaler 25 micrograms/actuation. Fannin (UK) Ltd. Revised March 2016.

    Summary of Product Characteristics: Serevent Accuhaler. Glaxo Wellcome UK Ltd. Revised March 2014.

    Summary of Product Characteristics: Serevent Evohaler. Glaxo Wellcome UK Ltd. Revised July 2014.

    Summary of Product Characteristics: Soltel CFC-free Inhaler 25 micrograms/actuation. Cipla (EU) Limited. Revised July 2014.

    Summary of Product Characteristics: Vertine CFC-free Inhaler 25 micrograms/actuation. Teva UK Limited. Revised March 2012.

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