Serevent (salmeterol)

How does it work?

Serevent evohalers, diskhalers and accuhalers all contain the active ingredient salmeterol, which is a type of medicine called a long-acting beta 2 agonist.

Salmeterol works by acting on receptors in the lungs called beta 2 receptors. When salmeterol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open.

In conditions where there is narrowing of the airways, such as asthma or chronic obstructive pulmonary disease (COPD, eg emphysema and chronic bronchitis), it is difficult for air to get in and out of the lungs. By opening the airways, salmeterol makes it easier to breathe. Salmeterol doesn't open the airways as quickly as short-acting beta 2 agonists such as salbutamol or terbutaline, however, it does keep the airways open for much longer. The effects of salmeterol last for about 12 hours, whereas those of salbutamol or terbutaline last for about 3 to 5 hours. This means salmeterol is used to prevent asthma attacks, wheezing, chest tightness or shortness of breath, rather than to relieve them.

In people whose asthma or airways disease is not controlled with short-acting bronchodilators (eg salbutamol) and regular inhaled anti-inflammatories, such as corticosteroids, salmeterol is used as an additional regular inhaler to help keep the airways open. It is particularly useful for preventing shortness of breath caused by exercise, and for taking before bed to prevent shortness of breath that is worse at night.

Salmeterol is taken using an inhaler device. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it were taken by mouth. Serevent is available as three different types of inhaler device; the standard metered dose inhaler, which is now CFC-free and known as the evohaler, the breath-actuated accuhaler, and the diskhaler.

The evohaler is used by inhaling through the mouthpiece at the same time as pushing down the canister. Some people may find this hard to coordinate and the accuhaler or diskhaler may be easier for these people to use. You can ask your pharmacist, asthma nurse or doctor to check your inhaler technique to make sure you are using your inhaler device correctly.

What is it used for?

Asthma

Chronic obstructive pulmonary disease.

Warning!

Serevent CFC-containing inhaler was been discontinued in January 2006. It has been replaced by Serevent evohaler, which is exactly the same as the old inhaler in terms of dose, efficacy, safety, price, size, shape and colour, however, it doesn't contain CFCs. If you have been transfered from Serevent inhaler to Serevent evohaler you may notice that the evohaler tastes, sounds or feels different to your old inhaler. This is normal and expected and does not mean that the new evohaler is any different to your old inhaler. Talk to your doctor or pharmacist if you are concerned.

This inhaler should not be used to relieve sudden asthma attacks, as it won't work quickly enough. You should keep your reliever inhaler (short-acting bronchodilator, eg salbutamol or terbutaline) with you at all times in case you need to relieve wheezing or shortness of breath.

Do not exceed the dose of salmeterol that your doctor has prescribed you to use.

If this inhaler does not seem to prevent wheezing or chest tightness as well as usual, or for as long as usual, or if you find you need to use your reliever inhaler (eg salbutamol or terbutaline) more often than normal, you should consult your doctor as soon as possible. It may be that your asthma or COPD is getting worse and your doctor might need to give you another medicine.

Your symptoms are likely to improve once you have started using this medicine regularly, however you should not reduce your dose of anti-inflammatory medicine (eg corticosteroids or sodium cromoglicate), as this will make your symptoms worsen again.

Inhalers may cause an unexpected increase in wheezing (paradoxical bronchospasm) straight after using them. If this happens, stop using the inhaler immediately and consult your doctor. The medicine should be stopped and an alternative treatment found.

People with severe asthma should have regular blood tests to monitor the amount of potassium in their blood. This is because low oxygen levels in the blood (hypoxia) and various asthma medicines, including this one, can lower blood potassium levels.

Use with caution in

Diabetes

Thyrotoxicosis

Heart disease

High blood pressure

Irregular heart beats (arrhythmias).

Not to be used in

Known sensitivity or allergy to any ingredient.

Serevent is not recommended for children under four years of age.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

It is important that asthma is well controlled in pregnant women. Wherever possible, asthma medications should be taken by inhaler, as this minimises the amount of medicine that enters the bloodstream and crosses the placenta. This medicine should be used with caution during pregnancy. Seek medical advice from your doctor.

This medicine should be used with caution by breastfeeding mothers. However, in general, asthma inhalers can be used as normal during breastfeeding, because the amount of medicine that passes into the breast milk after using an inhaler is negligable and unlikely to harm the baby. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Shaking, usually of the hands (tremor)

Awareness of your heart beat (heart palpitations)

Headache

Faster than normal heart beat (tachycardia)

Abnormal heart beats (arrhythmias)

Low blood potassium level (hypokalaemia)

Difficulty in sleeping (insomnia)

Nausea

Muscle cramps

Unexpected narrowing of the airways (paradoxical bronchospasm)

Dizziness

Nervousness

Severe swelling of lips, face or tongue (angioedema)

Chest pain

Irritation of the back of the mouth and throat

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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