Generic name: Salmeterol Oral Inhalation

Why is this medication prescribed?
Salmeterol is used to treat wheezing, shortness of breath, and troubled breathing caused by asthma and chronic obstructive pulmonary disease (COPD), a group of lung diseases that includes chronic bronchitis and emphysema. It also is used to prevent bronchospasm (breathing difficulties) during exercise. Salmeterol is in a class of medications called long-acting beta agonists. It works by relaxing and opening air passages in the lungs, making it easier to breathe.

How should this medicine be used?
Salmeterol comes as a dry powder to inhale by mouth using a special inhaler. It is usually used twice a day, in the morning and evening, about 12 hours apart. To help you remember to use salmeterol, use it around the same times every day. To prevent breathing difficulties during exercise, it is usually used 30 minutes before exercise, not more often than once every 12 hours. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use salmeterol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Do not use salmeterol during an attack of asthma or COPD. Your doctor will prescribe a short-acting inhaler to use during attacks. If you are using salmeterol twice a day, do not use another dose before exercising.

Salmeterol controls symptoms of asthma and other lung diseases but does not cure them. Do not stop using salmeterol without talking to your doctor. If you suddenly stop using salmeterol, your symptoms may worsen. Also do not stop taking your other inhaled or oral medications for asthma without talking to your doctor.

Before you use the salmeterol inhaler the first time, read the written instructions that come with it. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler while he or she watches.

To use the inhaler, follow these steps:

• Hold the inhalation device in one hand, and put the thumb of your other hand on the thumbgrip. Push your thumb away from you as far as it will go until the mouthpiece appears and snaps into position.
• Hold the inhalation device in a horizontal position with the mouthpiece toward you. Slide the lever away from you as far as it will go until it clicks.
• Every time the lever is pushed back, a dose is ready to inhale. You will see the number in the dose counter go down. Do not waste doses by closing the device, playing with the lever, or advancing the lever more than once.
• Hold the inhalation device level and away from your mouth, and breathe out as far as you comfortably can.
• Put the mouthpiece to your lips. Breathe in quickly and deeply though the inhalation device, not through your nose.
• Remove the inhalation device from your mouth, and hold your breath for 10 seconds or as long as you comfortably can. Breathe out slowly.
• You will probably taste or feel the salmeterol powder released by the inhaler. Even if you do not, do not take another dose. If you are not sure you are getting your dose of salmeterol, call your doctor or pharmacist.
• Put your thumb on the thumbgrip and slide it back toward you as far as it will go. The device will click shut.

Never exhale into the inhalation device, take the device apart, or wash the mouthpiece or any part of the device. Keep the device dry. Do not use the device with a spacer.

Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?
Before using salmeterol,

• tell your doctor and pharmacist if you are allergic to salmeterol, any other medications, or milk protein.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); diuretics ('water pills'); and other medications for asthma or COPD. Also tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past 2 weeks: antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); and monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate). Your doctor may need to change thedoses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had irregular heartbeat, high blood pressure, hyperthyroidism (overactive thyroid), diabetes, seizures, or liver or heart disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using salmeterol, call your doctor.
• if you have been using a short-acting beta-agonist inhaler such as albuterol (Proventil, Ventolin) on a regular basis (for example, four times a day), your doctor will probably tell you to stop using it regularly when you start using salmeterol. Keep your other inhaler to use during an attack of asthma or COPD.

What should I do if I forget a dose?
Inhale the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not inhale a double dose to make up for a missed one.

What side effects can this medication cause?
Salmeterol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• shaking hands that you cannot control
• headache
• nervousness
• dizziness
• cough
• stuffed nose
• runny nose
• ear pain
• pale skin
• muscle pain or cramps
• sore throat
• throat irritation

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• increased difficulty breathing
• fast or pounding heartbeat
• unusual excitement
• chest pain
• skin rash
• hives
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• choking or difficulty swallowing
• loud, high-pitched breathing

What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away the inhalation device 6 weeks after you remove it from the foil overwrap or after every blister has been used (when the dose indicator reads 0), whichever comes first. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose
In case of overdose, call your local poison controlcenter at 1-800-222-1222. If the victim has collapsedor is not breathing, call local emergency services at911.

Symptoms of overdose may include:

• seizures
• chest pain
• dizziness
• fainting
• blurred vision
• fast, pounding, or irregular heartbeat
• nervousness
• headache
• shaking hands that you cannot control
• muscle cramps or weakness
• dry mouth
• upset stomach
• dizziness
• excessive tiredness
• lack of energy
• difficulty falling asleep or staying asleep
• thirst
• flushing
• dry skin
• frequent urination
• loss of appetite
• trouble breathing

What other information should I know?
Keep all appointments with your doctor.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.