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Salmeterol Disease Interactions

There are 5 disease interactions with salmeterol:

Moderate

Beta- 2 Adrenergic Bronchodilators (Includes Salmeterol) ↔ Cardiovascular

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperthyroidism, Heart Disease, Hypertension

Adrenergic bronchodilators can stimulate cardiovascular beta- 1 and beta- 2 receptors, resulting in adverse effects such as tachycardia, palpitation, peripheral vasodilation, blood pressure changes, and ECG changes (e.g., flattening of the T wave; prolongation of the QT interval; ST segment depression). Direct stimulation of cardiac tissues is mediated by beta- 1 receptors and thus less likely to occur with beta-2-selective agents such as albuterol. However, beta-2-selectivity is not absolute and can be lost with larger doses. High dosages of these agents have been associated with precipitation or aggravation of angina, myocardial ischemia, and cardiac arrhythmias. Therapy with adrenergic bronchodilators should be administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, and/or underlying cardiovascular disorders such as coronary insufficiency, cardiac arrhythmias, or hypertension. The recommended dosages should not be exceeded.

References

  1. Tranfa CME, Pelaia G, Grembiale RD, Naty S, Durante S, Borrello G "Short-term cardiovascular effects of salmeterol." Chest 113 (1998): 1272-6
  2. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  3. Chodosh S, Crooks LA, Tuck J "Comparative effects of pirbuterol acetate, metaproterenol, and placebo aerosols on pulmonary function and incidence of cardiac ectopy." J Asthma 26 (1989): 309-15
  4. Finch JS "Cardiovascular toxicity: clinical evaluation of albuterol, isoproterenol and placebo in rising dose tolerance trial." Ann Allergy 47 (1981): 402-4
  5. Maguire GP, Emirgil C "Bronchodilator and side effects of different modes of administration of metaproterenol: inhaled, oral, and in combination." Am J Med Sci 291 (1986): 168-74
  6. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
  7. Richards DM, Brogden RN "Pirbuterol. A preliminary review of its pharmacological properties and therapeutic efficacy in reversible bronchospastic disease." Drugs 30 (1985): 6-21
  8. Maconochie JG, Forster JK "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol 33 (1992): 342-5
  9. Hibbard JU "Chronic terbutaline therapy and peripartum cardiomyopathy: a case-control study." Hypertens Pregnancy 15 (1996): 183-91
  10. Spitzer WO, Suissa S, Ernst P, Horwitz RI, Habbick B, Cockcroft D, Boivin JF, McNutt M, Buist AS, Rebuck AS "The use of beta-agonists and the risk of death and near death from asthma." N Engl J Med 326 (1992): 501-6
  11. "Product Information. Severent (salmeterol)." Glaxo Wellcome, Research Triangle Park, NC.
  12. Bierman CW, Kemp JP, Nathan RA "Efficacy and safety of inhaled bitolterol mesylate via metered-dose inhaler in children with asthma." Ann Allergy Asthma Immunol 76 (1996): 27-35
  13. "Product Information. Tornalate Metered Dose (bitolterol)." Dura Pharmaceuticals, San Diego, CA.
  14. Larsson S "Long-term treatment with beta2-adrenostimulants in asthma. Side effects, selectivity, tolerance, and routes of administration." Acta Med Scand Suppl 608 (1977): 1-40
  15. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet 336 (1990): 1396-9
  16. Suissa S, Hemmelgarn B, Blais L, Ernst P "Bronchodilators and acute cardiac death." Am J Respir Crit Care Med 154 (1996): 1598-602
  17. Ence TJ, Tashkin DP, Ho D, Child JS "Acute bronchial and cardiovascular effects of oral pirbuterol and metaproterenol." Ann Allergy 43 (1979): 229-36
  18. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  19. Godfrey S "Worldwide experience with albuterol (salbutamol)." Ann Allergy 47 (1981): 423-6
  20. Wagner JM, Morton MJ, Johnson KA, O'Grady JP, Speroff L "Terbutaline and maternal cardiac function." JAMA 246 (1981): 2697-701
  21. Wolfe JD, Yamate M, Biedermann AA, Chu TJ "Comparison of the acute cardiopulmonary effects of oral albuterol, metaproterenol, and terbutaline in asthmatics." JAMA 253 (1985): 2068-72
  22. Al-Hillawi AH, Hayward R, Johnson NM "Incidence of cardiac arrhythmias in patients taking slow release salbutamol and slow release terbutaline for asthma." Br Med J (Clin Res Ed) 288 (1984): 367
  23. "Adverse effects and complications of treatment with beta-adrenergic agonist drugs. Committee on drugs, the American Academy of Allergy and Immunology." J Allergy Clin Immunol 75 (1985): 443-9
  24. Vathenen AS, Britton JR, Ebden P, Cookson JB, Wharrad HJ, Tattersfield AE "High-dose inhaled albuterol in severe chronic airflow limitation." Am Rev Respir Dis 138 (1988): 850-5
  25. Kinney EL, Trautlein JJ, Harbaugh CV, Lambert D, Zelis RF "Ventricular tachycardia after terbutaline." JAMA 240 (1978): 2247
  26. Brogden RN, Faulds D "Salmeterol xinafoate. A review of its pharmacological properties and therapeutic potential in reversible obstructive airways disease." Drugs 42 (1991): 895-912
  27. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
  28. Lampert MB, Hibbard J, Weinert L, Briller J, Lindheimer M, Lang RM "Peripartum heart failure associated with prolonged tocolytic therapy." Am J Obstet Gynecol 168 (1993): 493-5
  29. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
  30. Chazan R, Droszcz W, Maruchin JE "Pharmacodynamics of salbutamol in humans." Int J Clin Pharmacol Ther Toxicol 26 (1988): 385-7
  31. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  32. Sanders JP, Potter DE, Ellis S, Bee DE, Grant JA "Metabolic and cardiovascular effects of carbuterol and metaproterenol." J Allergy Clin Immunol 60 (1977): 174-9
  33. Larsson S, Svedmyr N "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis 116 (1977): 861-9
  34. Breeden CC, Safirstein BH "Albuterol and spacer-induced atrial fibrillation." Chest 98 (1990): 762-3
  35. Braden GL, Germain MJ, Mulhern JG, Hafer JG, Bria WF "Hemodynamic, cardiac, and electrolyte effects of low-dose aerosolized terbutaline sulfate in asthmatic patients." Chest 114 (1998): 380-7
  36. Jenne JW "Can oral beta(2) agonists cause heart failure?" Lancet 352 (1998): 1081-2
  37. "Product Information. Xopenex (levalbuterol)." Sepracor, Marlborough, MA.
  38. Littner MR, Tashkin DP, Calvarese B, Bautista M "Acute bronchial and cardiovascular effects of increasing doses of pirbuterol acetate aerosol in asthma." Ann Allergy 48 (1982): 14-20
  39. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  40. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
  41. Neville E, Corris PA, Vivian J, Nariman S, Gibson GJ "Nebulised salbutamol and angina." Br Med J (Clin Res Ed) 285 (1982): 796-7
  42. Trautlein J, Allegra J, Gillin M "Aerosolized terbutaline sulfate--an evalution of efficacy and side effects in patients with reversible airway disease." J Clin Pharmacol 17 (1977): 76-80
  43. Shovlin CL, Tam FW "Salbutamol nebuliser and precipitation of critical cardiac ischaemia." Lancet 336 (1990): 1258
  44. Mettauer B, Rouleau JL, Burgess JH "Detrimental arrhythmogenic and sustained beneficial hemodynamic effects of oral salbutamol in patients with chronic congestive heart failure." Am Heart J 109 (1985): 840-7
  45. Katz M, Robertson PA, Creasy RK "Cardiovascular complications associated with terbutaline treatment for preterm labor." Am J Obstet Gynecol 139 (1981): 605-8
  46. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS "The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients." J Allerg Clin Immunol 103 (1999): 615-21
  47. Whitsett TL, Manion CV, Wilson MF "Cardiac, pulmonary and neuromuscular effects of clenbuterol and terbutaline compared with placebo." Br J Clin Pharmacol 12 (1981): 195-200
  48. Nathan RA, Bronsky EA, Dockhorn RJ, Kemp JP "Multicenter dose-ranging study of bitolterol mesylate solution for nebulization in children with asthma." Ann Allergy 72 (1994): 209-16
  49. Brogden RN, Speight TM, Avery GS "Terbutaline: a preliminary report of its pharmacological properties and therapeutic efficacy in asthma." Drugs 6 (1973): 324-32
  50. Pinnas JL, Bhatt BD, Campbell SC, Kemp JP, Tinkelman DG "Dose-response study of nebulized bitolterol mesylate solution in asthmatic patients." Chest 91 (1987): 533-9
View all 50 references
Moderate

Beta- 2 Adrenergic Bronchodilators (Includes Salmeterol) ↔ Diabetes

Moderate Potential Hazard, Low plausibility

Applies to: Diabetes Mellitus

Adrenergic bronchodilators may cause increases in blood glucose concentrations. These effects are usually transient and slight, but may be significant with dosages higher than those normally recommended. Large doses of IV albuterol (not commercially available in the U.S.) and terbutaline sulfate have been reported to cause exacerbation of preexisting diabetes mellitus and ketoacidosis. Therapy with adrenergic bronchodilators should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate. Systemic adverse effects are minimized, but not abolished, by administration of these agents via oral inhalation.

References

  1. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS "The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients." J Allerg Clin Immunol 103 (1999): 615-21
  3. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  4. "Product Information. Xopenex (levalbuterol)." Sepracor, Marlborough, MA.
  5. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  6. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
  7. Maconochie JG, Forster JK "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol 33 (1992): 342-5
  8. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  9. Chazan R, Droszcz W, Maruchin JE "Pharmacodynamics of salbutamol in humans." Int J Clin Pharmacol Ther Toxicol 26 (1988): 385-7
  10. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
  11. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
  12. "Product Information. Tornalate Metered Dose (bitolterol)." Dura Pharmaceuticals, San Diego, CA.
  13. "Product Information. Severent (salmeterol)." Glaxo Wellcome, Research Triangle Park, NC.
  14. Hastwell G, Lambert BE "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol 85 (1978): 767-9
  15. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
View all 15 references
Moderate

Beta- 2 Adrenergic Bronchodilators (Includes Salmeterol) ↔ Hypokalemia

Moderate Potential Hazard, Low plausibility

Applies to: Hypokalemia

Adrenergic bronchodilators may cause decreases in serum potassium concentrations, primarily when given by nebulization or intravenous administration. Although this effect is usually transient and does not require supplementation, clinically significant hypokalemia may occur in some patients, with the potential to induce cardiovascular adverse effects. The relevance of these observations to oral or oral aerosol/powder for inhalation therapy is unknown. Therapy with adrenergic bronchodilators should be administered cautiously in patients with or predisposed to hypokalemia.

References

  1. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet 336 (1990): 1396-9
  2. Allon M, Dunlay R, Copkney C "Nebulized albuterol for acute hyperkalemia in patients on hemodialysis." Ann Intern Med 110 (1989): 426-9
  3. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
  4. Gelmont DM, Balmes JR, Yee A "Hypokalemia induced by inhaled bronchodilators." Chest 94 (1988): 763-6
  5. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
  6. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  7. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS "The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients." J Allerg Clin Immunol 103 (1999): 615-21
  8. Whyte KF, Addis GJ, Whitesmith R, Reid JL "The mechanism of salbutamol-induced hypokalaemia." Br J Clin Pharmacol 23 (1987): 65-71
  9. Sanders JP, Potter DE, Ellis S, Bee DE, Grant JA "Metabolic and cardiovascular effects of carbuterol and metaproterenol." J Allergy Clin Immunol 60 (1977): 174-9
  10. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
  11. Windom H, Grainger J, Burgess C, Crane J, Pearce N, Beasley R "A comparison of the haemodynamic and hypokalaemic effects of inhaled pirbuterol and salbutamol." N Z Med J 103 (1990): 259-61
  12. "Hypokalaemia due to salbutamol overdosage." Br Med J (Clin Res Ed) 283 (1981): 500-1
  13. Hastwell G, Lambert BE "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol 85 (1978): 767-9
  14. Kantola I, Tarssanen L "Hypokalemia from usual salbutamol dosage ." Chest 89 (1986): 619-20
  15. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  16. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
  17. Braden GL, vonOeyen PT, Germain MJ, Watson DJ, Haag BL "Ritodrine- and terbutaline-induced hypokalemia in preterm labor: Mechanisms and consequences." Kidney Int 51 (1997): 1867-75
  18. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  19. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K "Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta(2)-adrenergic stimulation with terbutaline in healthy subjects." Chest 106 (1994): 1654-9
  20. "Product Information. Xopenex (levalbuterol)." Sepracor, Marlborough, MA.
  21. Rakhmanina NY, Kearns GL, Farrar HC "Hypokalemia in an asthmatic child from abuse of albuterol metered dose inhaler." Pediatr Emerg Care 14 (1998): 145-7
  22. "Product Information. Tornalate Metered Dose (bitolterol)." Dura Pharmaceuticals, San Diego, CA.
  23. Larsson S, Svedmyr N "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis 116 (1977): 861-9
  24. Montoliu J, Almirall J, Ponz E, Campistol JM, Revert L "Treatment of hyperkalaemia in renal failure with salbutamol inhalation." J Intern Med 228 (1990): 35-7
  25. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  26. "Product Information. Severent (salmeterol)." Glaxo Wellcome, Research Triangle Park, NC.
  27. Maconochie JG, Forster JK "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol 33 (1992): 342-5
  28. Hurlbert BJ, Edelman JD, David K "Serum potassium levels during and after terbutaline." Anesth Analg 60 (1981): 723-5
  29. Gross TL, Sokol RJ "Severe hypokalemia and acidosis: a potential complication of beta- adrenergic treatment." Am J Obstet Gynecol 138 (1980): 1225-6
View all 29 references
Moderate

Beta- 2 Adrenergic Bronchodilators (Includes Salmeterol) ↔ Seizures

Moderate Potential Hazard, Low plausibility

Applies to: Seizures

Adrenergic bronchodilators may cause CNS stimulation. Therapy with adrenergic bronchodilators should be administered cautiously in patients with seizure disorders. Systemic adverse effects are minimized, but not abolished, by administration of these agents via oral inhalation.

References

  1. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
  2. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
  3. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  4. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
  5. Larsson S, Svedmyr N "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis 116 (1977): 861-9
  6. "Product Information. Xopenex (levalbuterol)." Sepracor, Marlborough, MA.
  7. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  8. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
  9. "Product Information. Severent (salmeterol)." Glaxo Wellcome, Research Triangle Park, NC.
  10. "Product Information. Tornalate Metered Dose (bitolterol)." Dura Pharmaceuticals, San Diego, CA.
View all 10 references
Moderate

Salmeterol (Includes Salmeterol) ↔ Hepatic Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Salmeterol is predominantly cleared by hepatic metabolism and liver dysfunction might lead to accumulation of salmeterol in plasma. Patients with hepatic disease should be closely monitored.

salmeterol drug Interactions

There are 750 drug interactions with salmeterol

salmeterol alcohol/food Interactions

There is 1 alcohol/food interaction with salmeterol

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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