Maintenance treatment of asthma in patients not adequately controlled on other asthma-controller medications (eg, inhaled corticosteroid) or whose disease severity warrants initiation of 2 maintenance therapies.
Allow approximately 12hrs between doses. Asthma: ≥12yrs: not previously on inhaled steroid: 1 inh of 100/50 or 250/50 twice daily; already on inhaled steroid: see literature. If insufficient response after 2wks, use next higher strength. Max 1 inh of 500/50 twice daily. COPD: 1 inh of 250/50 twice daily. Rinse mouth after use.
<4yrs: not recommended. Allow approximately 12hrs between doses. Asthma: 4–11yrs: 1 inh of 100/50 twice daily. Rinse mouth after use.
Steroid + long-acting beta-2 agonist.
Primary treatment of status asthmaticus or other acute episodes of asthma or COPD requiring intensive measures. Concomitant with other forms of salmeterol or formoterol. Severe milk protein hypersensitivity.
Increased risk of asthma-related deaths and hospitalizations. Do not initiate in rapidly or acutely deteriorating asthma. Not for relief of acute bronchospasm. Not for use with other long-acting β2-agonists or for transferring from systemic steroids. Reevaluate periodically. Do not exceed recommended dose. Cardiovascular disease (esp. coronary insufficiency, arrhythmias, hypertension). Convulsive disorders. Thyrotoxicosis. Hyperresponsiveness to sympathomimetics. Diabetes. Ketoacidosis. Hypokalemia. Hyperglycemia. Hepatic impairment (monitor). Tuberculosis. Untreated infections. Ocular herpes simplex. Eosinophilic conditions. Immunosuppressed. If exposed to chickenpox or measles, consider immune globulin prophylactic therapy. If adrenal insufficiency exists following systemic corticosteroid therapy, replacement with inhaled corticosteroids may exacerbate symptoms of adrenal insufficiency (eg, lassitude). Prescribe a short-acting, inhaled β2-agonist for acute symptoms; monitor for increased need. Monitor potassium, intraocular pressure; bone mineral density if other osteoporosis risk factors exist; and for growth suppression in children; hypercorticism and HPA axis suppression (if occurs, discontinue gradually). Do not use with spacers. Labor & delivery. Pregnancy (Cat.C). Nursing mothers: not recommended.
See Contraindications. Concomitant strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, ritonavir, atazanavir, clarithromycin, indinavir, nefazodone, nelfinavir, saquinavir, telithromycin): not recommended. Caution with other sympathomimetics (except short-acting bronchodilators), during or within 2 weeks of MAOIs, tricyclic antidepressants (increased cardiac effects), K+–depleting diuretics. Antagonized by β-blockers.
Upper respiratory tract infection or inflammation, pharyngitis, pneumonia, laryngeal spasm or swelling, headache, dizziness, hoarseness, dysphonia, sinusitis, pain, GI upset, oral candidiasis, bronchitis, cough, paradoxical bronchospasm (discontinue if occurs), musculoskeletal pain; rarely: serious asthma episode, asthma-related death. Children: also epistaxis.
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