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Salmeterol Side Effects

In Summary

More frequently reported side effects include: skin rash, pharyngitis, influenza, and ear sign or symptom. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to salmeterol: inhalation aerosol powder, inhalation disk, inhalation powder

As well as its needed effects, salmeterol may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking salmeterol, check with your doctor immediately:

More common:
  • Cough producing mucus
  • difficulty with breathing
  • headache
  • irritation of the throat
  • runny nose
  • shortness of breath
  • sneezing
  • stuffy nose
  • tightness in the chest
  • wheezing
Less common:
  • Abdominal or stomach pain
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chills
  • colds
  • cough or hoarseness
  • diarrhea
  • difficulty breathing
  • dizziness
  • dry mouth
  • fever
  • flu-like symptoms
  • flushed, dry skin
  • fruit-like breath odor
  • general feeling of discomfort or illness
  • increased hunger
  • increased thirst
  • increased urination
  • joint pain
  • loss of appetite
  • muscle aches and pains
  • nausea
  • nervousness
  • noisy breathing
  • pain
  • pain or tenderness around the eyes and cheekbones
  • pounding in the ears
  • shivering
  • slow or fast heartbeat
  • sore mouth or tongue
  • sore throat
  • sweating
  • swelling
  • trouble with sleeping
  • troubled breathing
  • unexplained weight loss
  • unusual tiredness or weakness
  • vomiting
  • white patches in the mouth or on the tongue

If any of the following symptoms of overdose occur while taking salmeterol, get emergency help immediately:

Symptoms of overdose:
  • Arm, back, or jaw pain
  • confusion
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • fainting
  • fast or irregular heartbeat
  • fast, slow, pounding, or irregular heartbeat or pulse
  • seizures
  • shakiness in the legs, arms, hands, or feet
  • sleeplessness
  • trembling or shaking of the hands or feet
  • unable to sleep

Minor Side Effects

Some salmeterol side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Less common:
  • Acid or sour stomach
  • anxiety
  • belching
  • blistering, burning, crusting, dryness, or flaking of the skin
  • bone pain
  • burning, dry, or itching eyes
  • difficulty with moving
  • discharge or excessive tearing
  • eye redness, irritation, or pain
  • headache, severe and throbbing
  • heartburn
  • hives or welts
  • indigestion
  • itching, scaling, severe redness, soreness, or swelling of the skin
  • mouth or tooth pain
  • muscle cramps and spasm
  • muscle stiffness or tightness
  • redness of the skin
  • redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
  • skin rash
  • skin rash, encrusted, scaly and oozing
  • stomach discomfort, upset, or pain

For Healthcare Professionals

Applies to salmeterol: inhalation aerosol, inhalation aerosol with adapter, inhalation powder


Salmeterol is usually well-tolerated and adverse effects seen are consistent with its pharmacological action. In general, the severity of these adverse effects are dependent on dose. Tolerance to the adverse effects of salmeterol can occur.[Ref]


The cardiovascular system side effects have included palpitations and peripheral vasodilation, commonly resulting in reflex tachycardia. Blood pressure has increased and decreased. Higher doses have rarely aggravated angina, myocardial ischemia, or caused atrial or ventricular arrhythmias.[Ref]

Changes in heart rate of approximately 8 to 16 beats per minute may be produced by 0.2 mg of salmeterol given by MDI. At an inhaled dose of 0.4 mg, two subjects have experienced nonspecific T-wave changes, and one subject experienced QT prolongation. Higher doses of salmeterol should be used with caution in patients with cardiac disease, arrhythmias, or hypertension. All of these effects are dose-related and lower doses may be tolerated.[Ref]


Musculoskeletal side effects have included tremors, especially at higher doses. Tolerance has developed to the tremorogenic effects. Severe muscle cramping is rarely reported.[Ref]


Metabolic side effects have included hypokalemia, and less commonly hyperglycemia.[Ref]

Following a 400-mcg dose of salmeterol via MDI, a decrease in plasma potassium concentrations of 0.45 mEq/L has been reported. Salmeterol may stimulate sodium-potassium ATPase resulting in an intracellular shift of potassium.[Ref]

Nervous system

One patient has reported episodes of vertigo lasting 36 hours each following inhalation of salmeterol. These episodes occurred several months apart during separate attempts to reinstitute therapy.[Ref]

The nervous system side effects have included headache, restlessness, anxiety, nervousness, irritability, and insomnia.[Ref]


Respiratory side effects have included cough, paradoxical bronchospasm, and oropharyngeal irritation.[Ref]


Gastrointestinal side effects have included nausea and diarrhea.[Ref]


Hypersensitivity reactions have included rash or urticaria.[Ref]


Concern over the development of tachyphylaxis to the bronchodilating and bronchoprotective effects of beta-agonists has been expressed. Although conflicting data exist, the development of complete tolerance has not been reported.[Ref]


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21. Svedmyr N, Lofdahl CG "The use of beta(2)-adrenoceptor agonists in the treatment of bronchial asthma." Pharmacol Toxicol 78 (1996): 3-11

It is possible that some side effects of salmeterol may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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