.not be used for the relief of exercise-induced asthma
symptoms unless regular inhaled corticosteroids are
also used;
.be reviewed as clinically appropriate: stepping down
therapy should be considered when good long-term
asthma control has been achieved.lCAUTIONSHigh doses of beta 2 agonists can be dangerous
in some children
lINTERACTIONS→Appendix 1 : beta 2 agonists
lSIDE-EFFECTS
▶Common or very commonMuscle cramps
▶UncommonAngina pectoris.skin reactions.sleep disorder
.taste altered
▶Rare or very rareAnxiety.QT interval prolongation
lPREGNANCYInhaled drugs for asthma can be taken as
normal during pregnancy.
lBREAST FEEDINGInhaled drugs for asthma can be taken as
normal during breast-feeding.
lPATIENT AND CARER ADVICEAdvise patients not to exceed
prescribed dose, and to follow manufacturer’s directions; if
a previously effective dose of inhaled formoterol fails to
provide adequate relief, a doctor’s advice should be
obtained as soon as possible. Patients should be advised to
report any deterioration in symptoms following initiation
of treatment with a long-acting beta 2 agonist. Patient or
carer should be given advice on how to administer
formoterol fumarate inhalers.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Inhalation powder
▶Easyhaler (formoterol)(Orion Pharma (UK) Ltd)
Formoterol fumarate dihydrate 12 microgram per
1 doseFormoterol Easyhaler 12 micrograms/dose dry powder inhaler
| 120 doseP£ 23. 75 DT = £ 23. 75
▶Foradil(Novartis Pharmaceuticals UK Ltd)
Formoterol fumarate dihydrate 12 microgramForadil
12 microgram inhalation powder capsules with device|
60 capsuleP£ 28. 06 DT = £ 28. 06
▶Oxis Turbohaler(AstraZeneca UK Ltd)
Formoterol fumarate dihydrate 6 microgram per 1 doseOxis 6
Turbohaler| 60 doseP£ 24. 80 DT = £ 24. 80
Formoterol fumarate dihydrate 12 microgram per 1 doseOxis 12
Turbohaler| 60 doseP£ 24. 80 DT = £ 24. 80
Pressurised inhalation
▶Atimos Modulite(Chiesi Ltd)
Formoterol fumarate dihydrate 12 microgram per 1 doseAtimos
Modulite 12 micrograms/dose inhaler| 100 doseP£ 30. 06 DT =
£ 30. 06
Combinations available:Budesonide with formoterol,p. 161.
Fluticasone with formoterol,p. 163
eiiiiF 154Salmeterol
lINDICATIONS AND DOSE
Reversible airways obstruction in patients requiring long-
term regular bronchodilator therapy|Nocturnal asthma
in patients requiring long-term regular bronchodilator
therapy|Prevention of exercise-induced bronchospasm
in patients requiring long-term regular bronchodilator
therapy|Chronic asthma only in patients who regularly
use an inhaled corticosteroid (not for immediate relief of
acute asthma)
▶BY INHALATION OF AEROSOL, OR BY INHALATION OF POWDER
▶Child 5–11 years: 50 micrograms twice daily
▶Child 12–17 years: 50 micrograms twice daily, dose may
be increased in more severe airway obstruction;
increased to 100 micrograms twice dailyPHARMACOKINETICS
▶At recommended inhaled doses, the duration of action
of salmeterol is about 12 hours.lUNLICENSED USENeovent®not licensed for use in children
under 12 years.IMPORTANT SAFETY INFORMATION
CHM ADVICE
To ensure safe use, the CHM has advised that for the
management of chronic asthma, long-acting beta 2
agonist (salmeterol) should:
.be added only if regular use of standard-dose inhaled
corticosteroids has failed to control asthma
adequately;
.not be initiated in patients with rapidly deteriorating
asthma;
.be introduced at a low dose and the effect properly
monitored before considering dose increase;
.be discontinued in the absence of benefit;
.not be used for the relief of exercise-induced asthma
symptoms unless regular inhaled corticosteroids are
also used;
.be reviewed as clinically appropriate: stepping down
therapy should be considered when good long-term
asthma control has been achieved.lCAUTIONSHigh doses of beta 2 agonists can be dangerous
in some children
lINTERACTIONS→Appendix 1 :beta 2 agonists
lSIDE-EFFECTS
▶Common or very commonMuscle cramps
▶UncommonNervousness.skin reactions
▶Rare or very rareArthralgia.chest pain.insomnia.
oedema.oropharyngeal irritation
lPREGNANCYInhaled drugs for asthma can be taken as
normal during pregnancy.
lBREAST FEEDINGInhaled drugs for asthma can be taken as
normal during breast-feeding.
lPATIENT AND CARER ADVICEAdvise patients that
salmeterol shouldnotbe used for relief of acute attacks,
not to exceed prescribed dose, and to follow
manufacturer’s directions; if a previously effective dose of
inhaled salmeterol fails to provide adequate relief, a
doctor’s advice should be obtained as soon as possible.
Patients should be advised to report any deterioration in
symptoms following initiation of treatment with a long-
acting beta 2 agonist.
Medicines for Children leaflet: Salmeterol inhaler for asthma
prevention (prophylaxis)www.medicinesforchildren.org.uk/
salmeterol-inhaler-for-asthma-preventionlMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Inhalation powder
▶Serevent Accuhaler(GlaxoSmithKline UK Ltd)
Salmeterol (as Salmeterol xinafoate) 50 microgram per
1 doseSerevent 50 micrograms/dose Accuhaler| 60 doseP
£ 35. 11 DT = £ 35. 11
Pressurised inhalation
▶Salmeterol (Non-proprietary)
Salmeterol (as Salmeterol xinafoate) 25 microgram per
1 doseSalmeterol 25 micrograms/dose inhaler CFC free|
120 doseP£ 29. 26 DT = £ 29. 26
▶Neovent(Kent Pharmaceuticals Ltd)
Salmeterol (as Salmeterol xinafoate) 25 microgram per
1 doseNeovent 25 micrograms/dose inhaler CFC free|
120 doseP£ 29. 26 DT = £ 29. 26
▶Serevent Evohaler(GlaxoSmithKline UK Ltd)
Salmeterol (as Salmeterol xinafoate) 25 microgram per
1 doseSerevent 25 micrograms/dose Evohaler| 120 doseP
£ 29. 26 DT = £ 29. 26BNFC 2018 – 2019 Airways disease, obstructive 155
Respiratory system3