Serevent

Serevent is a long-acting beta-2 agonist (LABA) from GlaxoSmithKline containing the active ingredient salmeterol. It is used as an add-on to inhaled corticosteroids in asthma and for maintenance therapy in COPD.

Salmeterol works for 12 hours and must therefore be inhaled 2x daily. Unlike formoterol, its effect only begins after 10-20 minutes, which is why Serevent is not suitable as a rescue medication.

Serevent is available as a Diskus (dry powder inhaler) and as a metered-dose inhaler. The same active ingredient is also contained in the combination inhalers Seretide and Viani.

Salmeterol activates the beta-2 receptors for a prolonged period:

Mechanism of action:

• Binds to beta-2 adrenoceptors in the bronchial muscles
• High lipophilicity: anchors itself laterally in the cell membrane
• Repeated interaction with the active site of the receptor
• This results in long-lasting bronchodilation (12 hours)

Time course:

• Onset of action: 10-20 minutes
• Maximum effect: 2-4 hours
• Duration of action: 12 hours

Important difference from salbutamol: Salmeterol is a partial agonist with a slow onset of action – therefore not suitable for acute situations!

Serevent is suitable for:

• Maintenance therapy of asthma (always together with ICS!)
• Long-term treatment of COPD
• Prophylaxis of nocturnal asthma
• Prophylaxis of exercise-induced asthma (long-term)

Safety note: Serevent must NEVER be used alone for asthma! Always in combination with an inhaled corticosteroid.

Not suitable:

• As a rescue medication (onset of action too slow)
• As the sole asthma therapy
• For the MART approach (unlike formoterol)

Serevent Diskus:

• 50 µg per single dose
• 1 inhalation 2x daily

Serevent metered-dose inhaler:

• 25 µg per puff
• 2 puffs 2x daily

Dosage:

• For more severe symptoms, the doctor can increase the dose for adults to 2 inhalations 2x daily (Diskus) or 4 puffs 2x daily (metered-dose inhaler)
• Adults: no more than 200 µg per day (4 Diskus inhalations or 8 puffs of the metered-dose inhaler)
• Children aged 4 years and over: no more than 100 µg per day (2 Diskus inhalations or 4 puffs of the metered-dose inhaler)
• Always at the same time of day (morning and evening)

Diskus: 1. Hold the Diskus in one hand, use the thumb grip 2. Open it until it clicks 3. Push the lever back (the dose is loaded) 4. Breathe out deeply (not into the Diskus) 5. Close your lips firmly around the mouthpiece 6. Breathe in steadily and deeply 7. Hold your breath for 10 seconds 8. Close the Diskus

Important notes:

• Use regularly, even when you have no symptoms
• Always keep a rescue inhaler (e.g. salbutamol) on hand as well
• Do not use as an as-needed medication

Do not use in case of:

• Hypersensitivity to salmeterol or lactose
• As sole therapy for asthma

Caution in case of:

• Severe cardiovascular diseases
• Hyperthyroidism
• QT prolongation
• Hypokalemia
• Diabetes mellitus

Pregnancy: Only if clearly indicated. Uncontrolled asthma is more dangerous.

Breastfeeding: Use is possible after weighing the benefits and risks.

Common (1-10%):

• Tremor
• Headache
• Palpitations
• Muscle cramps

Uncommon:

• Nervousness
• Skin rash

Rare:

• Dizziness
• Hypokalemia

Very rare:

• Cardiac arrhythmias
• Paradoxical bronchospasm
• Angioedema
• Joint pain

Note: With regular use, tremor and palpitations often decrease after a few days.

Interactions:

• Beta blockers – can cancel out the effect of salmeterol
• QT-prolonging medications
• MAO inhibitors, tricyclic antidepressants
• CYP3A4 inhibitors (ketoconazole) – increased salmeterol levels

Not recommended:

• Other LABAs at the same time (duplication)
• Non-selective beta blockers in asthma