Dosing & Uses
Dosage Forms & Strengths
powder
- 50mcg/inhalation
Asthma Prevention and Maintenance
Administer as additional therapy for patients currently taking but inadequately controlled on an inhaled corticosteroid (ICS); not for patients whose asthma is adequately controlled on low-or medium-dose ICS
1 inhalation (50 mcg) twice daily; not to exceed twice daily administration
COPD Maintenance
1 inhalation (50 mcg) twice daily; not to exceed twice daily administration
Prevention of Exercise-Induced Asthma
Use as a single agent for the prevention of EIB may be clinically indicated in patients who do not have persistent asthma
1 inhalation 30 minutes before exercise; a second dose not to be administered for another 12 hr; not for use in individuals receiving twice-daily therapy of salmeterol
Dosing considerations
- In patients with persistent asthma, use for prevention of EIB may be clinically indicated, but treatment of asthma should include an ICS; one inhalation at least 30 minutes before exercise has been shown to protect patients against EIB
- When used intermittently as needed for prevention of EIB, protection may last up to 9 hr in adults and adolescents and up to 12 hours in patients aged 4-11 years
- Additional doses should not be used for 12 hours after administration of this drug; patients who are receiving treatment twice daily should not use additional salmeterol for prevention of EIB
Dosage Forms & Strengths
powder
- 50mcg/inhalation
Asthma Prevention and Maintenance
Administer as additional therapy for patients currently taking but inadequately controlled on an inhaled corticosteroid (ICS); not for patients whose asthma is adequately controlled on low-or medium-dose ICS
< 4 years
- Safety and efficacy not established
> 4 years
- 1 inhalation (50 mcg) twice daily; not to exceed twice daily administration
Dosing considerations
- For patients <18 years who require addition of a LABA to an ICS, a fixed-dose combination product containing both an ICS and a LABA should ordinarily be used to ensure adherence with both drugs
- In cases where use of separate ICS and a LABA is clinically indicated, take appropriate steps to ensure adherence with both treatment components; if adherence cannot be assured, a fixed-dose combination product containing both an ICS and a LABA is recommended
Prevention of Exercise-Induced Asthma
Use as a single agent for the prevention of EIB may be clinically indicated in patients who do not have persistent asthma
< 4 years
- Safety and efficacy not established
> 4 years
- 1 inhalation (50 mcg) twice daily; not to exceed twice-daily administration
Dosing considerations
- In patients with persistent asthma, use for prevention of EIB may be clinically indicated, but treatment of asthma should include an ICS; one inhalation at least 30 minutes before exercise has been shown to protect patients against EIB
- When used intermittently as needed for prevention of EIB, protection may last up to 9 hr in adults and adolescents and up to 12 hours in patients aged 4-11 years
- Additional doses should not be used for 12 hours after administration of this drug; patients who are receiving treatment twice daily should not use additional salmeterol for prevention of EIB
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (7)
- darunavir
darunavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .
- fosamprenavir
fosamprenavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .
- indinavir
indinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .
- lefamulin
lefamulin will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.
- lopinavir
lopinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity.
- nelfinavir
nelfinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. .
- ritonavir
ritonavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity.
Serious - Use Alternative (39)
- abametapir
abametapir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
- amisulpride
amisulpride and salmeterol both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- amitriptyline
amitriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- amoxapine
amoxapine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- apalutamide
apalutamide will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- ceritinib
ceritinib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- chloroquine
chloroquine and salmeterol both increase QTc interval. Avoid or Use Alternate Drug.
- clomipramine
clomipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- cobicistat
cobicistat increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration not recommended; may result in increased cardiovascular effects associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.
- desipramine
desipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- doxepin
doxepin, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- fexinidazole
fexinidazole and salmeterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
fexinidazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates. - idelalisib
idelalisib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- imipramine
imipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- isocarboxazid
isocarboxazid increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- itraconazole
itraconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
itraconazole and salmeterol both increase QTc interval. Avoid or Use Alternate Drug. - ivosidenib
ivosidenib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- ketoconazole
ketoconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- levoketoconazole
levoketoconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- linezolid
linezolid increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- lofepramine
lofepramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- lonafarnib
lonafarnib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
- maprotiline
maprotiline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- mefloquine
mefloquine increases toxicity of salmeterol by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- nefazodone
nefazodone will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nirmatrelvir
nirmatrelvir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration may increase risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.
- nirmatrelvir/ritonavir
nirmatrelvir/ritonavir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration may increase risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia.
- nortriptyline
nortriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of salmeterol by decreasing metabolism. Avoid or Use Alternate Drug. Concurrent administration of Viekira Pak and salmeterol is not recommended; coadministration may result in increased risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations and sinus tachycardia
- panobinostat
salmeterol and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.
- phenelzine
phenelzine increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- protriptyline
protriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- tipranavir
tipranavir will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tranylcypromine
tranylcypromine increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- trazodone
trazodone, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- trimipramine
trimipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- tucatinib
tucatinib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- voriconazole
voriconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- voxelotor
voxelotor will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
Monitor Closely (270)
- acebutolol
acebutolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
acebutolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - aceclofenac
aceclofenac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- acemetacin
acemetacin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- albuterol
albuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
albuterol and salmeterol both decrease sedation. Use Caution/Monitor.
albuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - alfentanil
alfentanil increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfuzosin
alfuzosin and salmeterol both increase QTc interval. Use Caution/Monitor.
- alprazolam
alprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amiloride
amiloride increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- amitriptyline
amitriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amobarbital
amobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amoxapine
amoxapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- arformoterol
arformoterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
arformoterol and salmeterol both decrease sedation. Use Caution/Monitor.
arformoterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - aripiprazole
aripiprazole increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- armodafinil
salmeterol and armodafinil both decrease sedation. Use Caution/Monitor.
- aspirin
aspirin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aspirin rectal
aspirin rectal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atazanavir
atazanavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of systemic effects.
- atenolol
atenolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
atenolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - atomoxetine
salmeterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .
- azelastine
azelastine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- belladonna and opium
belladonna and opium increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bendroflumethiazide
salmeterol and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.
- benperidol
benperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benzphetamine
salmeterol and benzphetamine both decrease sedation. Use Caution/Monitor.
salmeterol and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - betaxolol
betaxolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
betaxolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - bisoprolol
bisoprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
bisoprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - brompheniramine
brompheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bumetanide
salmeterol and bumetanide both decrease serum potassium. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butabarbital
butabarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butalbital
butalbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butorphanol
butorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- caffeine
salmeterol and caffeine both decrease sedation. Use Caution/Monitor.
- carbenoxolone
salmeterol and carbenoxolone both decrease serum potassium. Use Caution/Monitor.
- carbinoxamine
carbinoxamine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carvedilol
carvedilol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
carvedilol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - celecoxib
celecoxib increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- celiprolol
celiprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
celiprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - cenobamate
cenobamate will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- chloral hydrate
chloral hydrate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorothiazide
salmeterol and chlorothiazide both decrease serum potassium. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpromazine
chlorpromazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorthalidone
salmeterol and chlorthalidone both decrease serum potassium. Use Caution/Monitor.
- choline magnesium trisalicylate
choline magnesium trisalicylate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- cinnarizine
cinnarizine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- citalopram
citalopram and salmeterol both increase QTc interval. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
clarithromycin and salmeterol both increase QTc interval. Use Caution/Monitor. - clemastine
clemastine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clomipramine
clomipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clonazepam
clonazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clorazepate
clorazepate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clozapine
clozapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
clozapine and salmeterol both increase QTc interval. Use Caution/Monitor. - codeine
codeine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- conivaptan
conivaptan will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- crizotinib
crizotinib and salmeterol both increase QTc interval. Use Caution/Monitor.
- cyclizine
cyclizine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclopenthiazide
salmeterol and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.
- cyproheptadine
cyproheptadine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dabrafenib
dabrafenib will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- dasatinib
dasatinib and salmeterol both increase QTc interval. Use Caution/Monitor.
- deflazacort
salmeterol and deflazacort both decrease serum potassium. Use Caution/Monitor.
- degarelix
degarelix and salmeterol both increase QTc interval. Use Caution/Monitor.
- desipramine
desipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- deutetrabenazine
deutetrabenazine and salmeterol both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- dexchlorpheniramine
dexchlorpheniramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexfenfluramine
salmeterol and dexfenfluramine both decrease sedation. Use Caution/Monitor.
salmeterol and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dexmedetomidine
dexmedetomidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmethylphenidate
salmeterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
salmeterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextroamphetamine
salmeterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.
salmeterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextromoramide
dextromoramide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diamorphine
diamorphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dichlorphenamide
dichlorphenamide and salmeterol both decrease serum potassium. Use Caution/Monitor.
- diclofenac
diclofenac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diethylpropion
salmeterol and diethylpropion both decrease sedation. Use Caution/Monitor.
salmeterol and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - difenoxin hcl
difenoxin hcl increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diflunisal
diflunisal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- digoxin
digoxin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenhydramine
diphenhydramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dipipanone
dipipanone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dobutamine
dobutamine and salmeterol both decrease serum potassium. Use Caution/Monitor.
dobutamine and salmeterol both decrease sedation. Use Caution/Monitor.
dobutamine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dolasetron
dolasetron and salmeterol both increase QTc interval. Use Caution/Monitor.
- donepezil
donepezil and salmeterol both increase QTc interval. Use Caution/Monitor.
- dopamine
salmeterol and dopamine both decrease sedation. Use Caution/Monitor.
salmeterol and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopexamine
dopexamine and salmeterol both decrease serum potassium. Use Caution/Monitor.
dopexamine and salmeterol both decrease sedation. Use Caution/Monitor.
dopexamine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
dopexamine, salmeterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. - doxepin
doxepin increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
doxepin and salmeterol both increase QTc interval. Use Caution/Monitor. - droperidol
droperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- drospirenone
drospirenone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- duvelisib
duvelisib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
- efavirenz
efavirenz and salmeterol both increase QTc interval. Use Caution/Monitor.
- elagolix
elagolix decreases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- encorafenib
encorafenib, salmeterol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
encorafenib and salmeterol both increase QTc interval. Use Caution/Monitor. - entrectinib
entrectinib and salmeterol both increase QTc interval. Use Caution/Monitor.
- ephedrine
ephedrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
ephedrine and salmeterol both decrease sedation. Use Caution/Monitor.
ephedrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - epinephrine
epinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
epinephrine and salmeterol both decrease sedation. Use Caution/Monitor.
epinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - epinephrine racemic
epinephrine racemic and salmeterol both decrease serum potassium. Use Caution/Monitor.
epinephrine racemic and salmeterol both decrease sedation. Use Caution/Monitor.
epinephrine racemic and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - eribulin
eribulin and salmeterol both increase QTc interval. Use Caution/Monitor.
- esmolol
esmolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - estazolam
estazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ethacrynic acid
salmeterol and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.
- ethanol
ethanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- etodolac
etodolac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- fenfluramine
salmeterol and fenfluramine both decrease sedation. Use Caution/Monitor.
salmeterol and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - fenoprofen
fenoprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fingolimod
fingolimod and salmeterol both increase QTc interval. Use Caution/Monitor.
- fluoxetine
fluoxetine and salmeterol both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system
- fluphenazine
fluphenazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flurazepam
flurazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flurbiprofen
flurbiprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- formoterol
formoterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
formoterol and salmeterol both decrease sedation. Use Caution/Monitor.
formoterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - fostemsavir
salmeterol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- furosemide
salmeterol and furosemide both decrease serum potassium. Use Caution/Monitor.
- gemifloxacin
gemifloxacin and salmeterol both increase QTc interval. Use Caution/Monitor.
- gentamicin
salmeterol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- gilteritinib
gilteritinib and salmeterol both increase QTc interval. Use Caution/Monitor.
- green tea
green tea increases effects of salmeterol by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.
- haloperidol
haloperidol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrochlorothiazide
salmeterol and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.
- hydromorphone
hydromorphone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydroxyzine
hydroxyzine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen
ibuprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen IV
ibuprofen IV increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- iloperidone
iloperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
iloperidone increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. - imipramine
imipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- indapamide
salmeterol and indapamide both decrease serum potassium. Use Caution/Monitor.
- indomethacin
indomethacin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- isoproterenol
isoproterenol and salmeterol both decrease serum potassium. Use Caution/Monitor.
isoproterenol and salmeterol both decrease sedation. Use Caution/Monitor.
isoproterenol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - istradefylline
istradefylline will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- ketoprofen
ketoprofen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketorolac
ketorolac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketorolac intranasal
ketorolac intranasal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- ketotifen, ophthalmic
ketotifen, ophthalmic increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- labetalol
labetalol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
labetalol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - lenvatinib
salmeterol and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- letermovir
letermovir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levalbuterol
levalbuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
levalbuterol and salmeterol both decrease sedation. Use Caution/Monitor.
levalbuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - levorphanol
levorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lisdexamfetamine
salmeterol and lisdexamfetamine both decrease sedation. Use Caution/Monitor.
salmeterol and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - lofepramine
lofepramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofexidine
lofexidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loprazolam
loprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lorazepam
lorazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lormetazepam
lormetazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lornoxicam
lornoxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine
loxapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- maprotiline
maprotiline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- marijuana
marijuana increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meclofenamate
meclofenamate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mefenamic acid
mefenamic acid increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- melatonin
melatonin increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meloxicam
meloxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meperidine
meperidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meprobamate
meprobamate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaproterenol
metaproterenol and salmeterol both decrease serum potassium. Use Caution/Monitor.
metaproterenol and salmeterol both decrease sedation. Use Caution/Monitor.
metaproterenol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methadone
methadone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methamphetamine
salmeterol and methamphetamine both decrease sedation. Use Caution/Monitor.
salmeterol and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methyclothiazide
salmeterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.
- methylenedioxymethamphetamine
salmeterol and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.
salmeterol and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methylphenidate
salmeterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- metolazone
salmeterol and metolazone both decrease serum potassium. Use Caution/Monitor.
- metoprolol
metoprolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
metoprolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - midazolam
midazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midodrine
salmeterol and midodrine both decrease sedation. Use Caution/Monitor.
salmeterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - mifepristone
mifepristone will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- mirtazapine
mirtazapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mitotane
mitotane decreases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- modafinil
salmeterol and modafinil both decrease sedation. Use Caution/Monitor.
- morphine
morphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- motherwort
motherwort increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moxonidine
moxonidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabilone
nabilone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabumetone
nabumetone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nadolol
nadolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nadolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - nalbuphine
nalbuphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- naproxen
naproxen increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nebivolol
nebivolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nebivolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - norepinephrine
norepinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
norepinephrine and salmeterol both decrease sedation. Use Caution/Monitor.
norepinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - nortriptyline
nortriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olanzapine
olanzapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olodaterol inhaled
salmeterol and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects
- opium tincture
opium tincture increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- osilodrostat
osilodrostat and salmeterol both increase QTc interval. Use Caution/Monitor.
- oxaprozin
oxaprozin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxazepam
oxazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxycodone
oxycodone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxymorphone
oxymorphone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- paliperidone
paliperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- papaveretum
papaveretum increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- parecoxib
parecoxib increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- penbutolol
penbutolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - pentazocine
pentazocine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pentobarbital
pentobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- perphenazine
perphenazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phendimetrazine
salmeterol and phendimetrazine both decrease sedation. Use Caution/Monitor.
salmeterol and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenobarbital
phenobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenoxybenzamine
phenoxybenzamine, salmeterol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.
- phentermine
salmeterol and phentermine both decrease sedation. Use Caution/Monitor.
salmeterol and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine
salmeterol and phenylephrine both decrease sedation. Use Caution/Monitor.
salmeterol and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine PO
salmeterol and phenylephrine PO both decrease sedation. Use Caution/Monitor.
salmeterol and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - pholcodine
pholcodine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pimozide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pindolol
pindolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
pindolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - pirbuterol
pirbuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.
pirbuterol and salmeterol both decrease sedation. Use Caution/Monitor.
pirbuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - piroxicam
piroxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- posaconazole
posaconazole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- potassium acid phosphate
potassium acid phosphate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- potassium chloride
potassium chloride increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- potassium citrate
potassium citrate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- primidone
primidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- procarbazine
procarbazine increases effects of salmeterol by pharmacodynamic synergism. Use Caution/Monitor.
- prochlorperazine
prochlorperazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- promethazine
promethazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- propranolol
propranolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
propranolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - propylhexedrine
salmeterol and propylhexedrine both decrease sedation. Use Caution/Monitor.
salmeterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - protriptyline
protriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pseudoephedrine
salmeterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- quazepam
quazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quetiapine
quetiapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- risperidone
risperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rucaparib
rucaparib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- sacubitril/valsartan
sacubitril/valsartan increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salicylates (non-asa)
salicylates (non-asa) increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salsalate
salsalate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- saquinavir
saquinavir increases levels of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of QT prolongation and cardiac arrhythmias.
- scullcap
scullcap increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- secobarbital
secobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- serdexmethylphenidate/dexmethylphenidate
salmeterol and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- shepherd's purse
shepherd's purse increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
salmeterol and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.
- solriamfetol
salmeterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- sotalol
sotalol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
sotalol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - spironolactone
spironolactone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- stiripentol
stiripentol, salmeterol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
- succinylcholine
succinylcholine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sufentanil
sufentanil increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sulfasalazine
sulfasalazine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sulindac
sulindac increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tapentadol
tapentadol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- temazepam
temazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- terbutaline
salmeterol and terbutaline both decrease serum potassium. Use Caution/Monitor.
salmeterol and terbutaline both decrease sedation. Use Caution/Monitor.
salmeterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - thioridazine
thioridazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thiothixene
thiothixene increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- timolol
timolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
timolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - tolfenamic acid
tolfenamic acid increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolmetin
tolmetin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolvaptan
tolvaptan increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- topiramate
topiramate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- torsemide
salmeterol and torsemide both decrease serum potassium. Use Caution/Monitor.
- tramadol
tramadol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trazodone
trazodone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triamterene
triamterene increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- triazolam
triazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triclofos
triclofos increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trifluoperazine
trifluoperazine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trimipramine
trimipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triprolidine
triprolidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- valbenazine
valbenazine and salmeterol both increase QTc interval. Use Caution/Monitor.
- xylometazoline
salmeterol and xylometazoline both decrease sedation. Use Caution/Monitor.
salmeterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - yohimbine
salmeterol and yohimbine both decrease sedation. Use Caution/Monitor.
salmeterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ziconotide
ziconotide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziprasidone
ziprasidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
Minor (20)
- acetazolamide
acetazolamide will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- bendroflumethiazide
salmeterol, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- bumetanide
salmeterol, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- chlorothiazide
salmeterol, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- chlorthalidone
salmeterol, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- cyclopenthiazide
salmeterol, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- cyclophosphamide
cyclophosphamide will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ethacrynic acid
salmeterol, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- eucalyptus
eucalyptus increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- furosemide
salmeterol, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- hydrochlorothiazide
salmeterol, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- indapamide
salmeterol, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- larotrectinib
larotrectinib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- methyclothiazide
salmeterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- metolazone
salmeterol, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- noni juice
noni juice increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- ribociclib
ribociclib will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sage
sage increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- torsemide
salmeterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
Adverse Effects
>10%
Headache (13-17%)
Pain (1-12%)
1-10%
Nasal congestion (9%)
Hypertension (4%)
Edema (1-3%)
Dizziness (4%)
Sleep disturbance (1-3%)
Migraine (1-3%)
Contact dermatitis (1-3%)
Urticaria (3%)
Hyperglycemia (1-3%)
Articular rheumatism (1-3%)
Paresthesia (1-3%)
Muscular stiffness (1-3%)
Photodermatitis (1-2%)
Bronchitis (7%)
Influenza (5%)
Rigidity (1-3%)
hinitis (5%)
Asthma (3%)
Frequency Not Defined
Conjunctivitis
Hyperglycemia
Keratitis
Oral candidiasis
Chest tightness
Cataracts
Hypokalemia
Myositis
Warnings
Black Box Warnings
Long-acting beta2-adrenergic agonists (LABA), as monotherapy (without inhaled corticosteroids [ICS]) increase risk of asthma-related death; data from a large placebo-controlled U.S. trial showed an increase in asthma-related deaths in subjects receiving salmeterol alone; use of background ICS was not required in this study; when LABA are used in fixed-dose combination with ICS, data from large clinical trials do not show a significant increase in risk of serious asthma-related events (hospitalizations, intubations, death) compared with ICS alone
Use of drug for the treatment of asthma as monotherapy without a concomitant ICS is contraindicated; use only as additional therapy for patients with asthma who are currently taking but are inadequately controlled on an ICS; do not use drug for patients whose asthma is adequately controlled on low-or medium-dose ICS
Pediatric and Adolescent Patients
- Available data from controlled clinical trials suggest that LABA as monotherapy increase risk of asthma-related hospitalization in pediatric and adolescent patients
- For pediatric and adolescent patients with asthma who require addition of a LABA to an ICS, a fixed-dose combination product containing both an ICS and a LABA should ordinarily be used to ensure adherence with both drugs
- In cases where use of an ICS and a LABA is clinically indicated, appropriate steps must be taken to ensure adherence with both treatment components; if adherence cannot be assured, a fixed-dose combination product containing both an ICS and a LABA recommended
Contraindications
Severe hypersensitivity to milk proteins or demonstrated hypersensitivity to drug or excipients
Primary treatment of status asthmaticus or other acute episodes of asthma or COPD where intensive measures are required
Treatment of asthma without a concomitant long-term asthma control medication, such as an inhaled corticosteroid
Cautions
Use with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension; therapy can produce a clinically significant cardiovascular effect in some patients as measured by pulse rate, blood pressure, and/or symptoms; although such effects are uncommon after administration of salmeterol at recommended doses, if they occur, the drug may need to be discontinued
Drug should not be used more often than recommended, at higher doses than recommended, or in conjunction with other medicines containing LABA, as an overdose may result; clinically significant cardiovascular effects and fatalities reported in association with excessive use of inhaled sympathomimetic drugs; patients should not use another medicine containing a LABA (e.g., formoterol fumarate, arformoterol tartrate, indacaterol) for any reason
Use caution in diabetes mellitus and ketoacidosis; clinically significant and dose-related changes in blood glucose and/or serum potassium seen infrequently during clinical trials at recommended doses
Not for acute asthma; for acute asthma exacerbations, use short-acting beta-agonists (eg, albuterol)
Not for acute episodes of COPD
May increase risk of severe, potentially fatal asthma attacks; small but significant increase in asthma-related deaths for patients using salmeterol vs placebo, with greater risk in African-Americans
Therapy may produce significant hypokalemia in some patients, possibly through intracellular shunting, which has potential to produce adverse cardiovascular effects; decrease in serum potassium is usually transient, not requiring supplementation
Use caution in patients with hypokalemia, hepatic impairment, seizure disorders, and hyperthyroidism
Paradoxical bronchospasm may occur with therapy; if it occurs it should be treated immediately with an inhaled, short-acting bronchodilator; treatment should be discontinued immediately and alternative therapy instituted; upper airway symptoms of laryngeal spasm, irritation, or swelling, such as stridor and choking, have been reported in patients receiving therapy
When initiating and throughout treatment in patients receiving oral or ICS for treatment of asthma, patients must continue taking a suitable dosage of corticosteroids to maintain clinical stability even if they feel better as a result of initiating salmeterol; any change in corticosteroid dosage should be made only after clinical evaluation
Use Serevent Diskus only as additional therapy for patients with asthma who are currently taking but are inadequately controlled on an ICS; do not use Serevent Diskus for patients whose asthma is adequately controlled on low- or medium-dose ICS
Immediate hypersensitivity reactions (eg, urticaria, angioedema, rash, bronchospasm, hypotension), including anaphylaxis, may occur with therapy; anaphylactic reactions in patients with severe milk protein allergy after inhalation of powder products containing lactose reported
Use only for shortest duration of time
Deterioration of disease
- Not for use in patients during rapidly deteriorating or potentially life-threatening episodes of asthma or COPD, including patients with significantly increased symptoms
- Worsening or acutely deteriorating asthma is associated with increase in need for inhaled, short-acting beta2-agonists; decreasing response to usual medications; increasing need for systemic corticosteroids; recent emergency room visits; deteriorating lung function
- Increasing use of inhaled, short-acting beta2-agonists is a marker of deteriorating asthma; in this situation, the patient requires immediate reevaluation with reassessment of treatment regimen, giving special consideration to possible need for adding additional ICS or initiating systemic corticosteroids; patients should not use drug more than 1 inhalation twice daily
Drug interaction overview
- Use of strong cytochrome P450 3A4 (CYP3A4) inhibitors (eg, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, ketoconazole, telithromycin) not recommended because increased cardiovascular adverse effects may occur
Pregnancy & Lactation
Pregnancy
Available data from published epidemiological studies and case reports in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes
Beta-agonists may interfere with uterine contractility
There are clinical considerations in pregnant women with asthma
In women with poorly or moderately controlled asthma, there is increased risk of pre-eclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate
Severe asthma during pregnancy has been associated with maternal mortality, fetal mortality, or both
Pregnant women with asthma should be closely monitored and medication adjusted as necessary to maintain optimal asthma control
Animal data
- Oral administration of salmeterol to pregnant rabbits caused teratogenicity characteristic of beta-adrenoceptor stimulation at maternal doses approximately 50 times maximum recommended human daily inhaled dose (MRHDID) on an AUC basis
Labor and delivery
- There are no adequate and well-controlled human studies that have evaluated effects of therapy during labor and delivery; because of potential for beta-agonist interference with uterine contractility, use during labor should be restricted to those patients in whom the benefits clearly outweigh the risks
Lactation
There is no information regarding presence of salmeterol in human milk, effects on breastfed child, or on milk production
Drug is detected in rat milk; drug concentrations in human plasma after inhaled therapeutic doses are low and therefore concentrations in human breast milk are likely to be low
The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed child from treatment or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Long-acting beta-2 agonist; action on beta-2 receptors relaxes bronchial smooth muscle with little effect on heart rate
50 times more selective than albuterol
Pharmacokinetics
Peak serum time: 20 min
Half-Life: 5.5 hr
Onset: 30-48 min (asthma); 2 hr (COPD)
Duration: 12 hr
Absorption: Minimal (undetectable)
Protein Bound: 96%
Metabolism: Liver
Excretion: Feces (60%); urine (25%)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Serevent Diskus inhalation - | 50 mcg/dose aerosol |  | |
| Serevent Diskus inhalation - | 50 mcg/dose aerosol |  |
Copyright © 2010 First DataBank, Inc.
Formulary
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