Salmeterol xinafoate is indicated for the treatment of reversible airway obstruction, including nocturnal asthma and prevention of exercise-induced bronchospasm, in patients who require long-term regular bronchodilator therapy.

Each metered dose (puff) contains Salmeterol 25 mcg as Salmeterol xinafoate.

Stimulation of beta-2 adrenoceptors leads to relaxation of bronchial smooth muscle, resulting in bronchodilation and improved airflow. Salmeterol is believed to act through binding to two distinct sites on the beta-2 adrenoceptor. The saligenin portion binds to the active site of the receptor, while the hydrophilic side chain attaches to leucine residues at an exo-site, leading to a prolonged and almost irreversible interaction. This explains its long duration of action. An alternative hypothesis suggests that the lipophilic nature of salmeterol allows it to diffuse into the lipid bilayer of smooth muscle cell membranes, creating a drug reservoir that gradually releases the drug over time, sustaining its effect.

Adults: 50 micrograms (two puffs) twice daily.
More severe cases: 100 micrograms (four puffs) twice daily.
Children 5-12 years: 50 micrograms (two puffs) twice daily. Or, as directed by the registered physician.

Using an Inhaler seems simple, but most patients do not know how to use it in the right way. If the Inhaler is used in the wrong way, less medicine can reach the lungs. Correct and regular use of the Inhaler will prevent or lessen the severity of asthma attacks.
Following simple steps can help to use Inhaler effectively (According to "National Asthma Guidelines for Medical Practitioners" published by Asthma Association):

• Take off the cap.
• Shake the inhaler (at least six times) vigorously before each use.
• If the inhaler is new or if it has not been used for a week or more, shake it well and release one puff into the air to make sure that it works.
• Breathe out as full as comfortably possible & hold the inhaler upright.
• Place the actuator into mouth between the teeth and close lips around the mouthpiece.
• While breathing deeply and slowly through the mouth, press down firmly and fully on the canister to release medicine.
• Remove the inhaler from mouth. Continue holding breath for at least for 10 seconds or as long as it is comfortable.
• If doctor has prescribed more than one inhalation per treatment, wait 1 minute between puffs (inhalations).
• Shake the inhaler well and repeat steps 4 to 7.
• After use, replace the cap on the mouthpiece. After each treatment, rinse mouth with water.
• Check your technique in front of a mirror from time to time, if you see a white mist during the inhalation, you may not have closed your lips properly around mouthpiece, or you may not be breathing in as you press the can. This indicates failure of technique. If this happens, repeat the procedure from step 4 carefully.

Instructions for Cleaning Inhaler: Clean your Inhaler at least once a week. Remove canister and rinse the plastic actuator and cap in warm water but do not put the metal canister into water. Dry the actuator and cap thoroughly and gently replace the metal canister into the actuator with a twisting motion. Put the cap on the mouthpiece.

Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants should be used with caution, as they may enhance the effects of salmeterol.

This medicine is contraindicated in patients with known hypersensitivity to salmeterol or any component of the formulation.

Adverse effects associated with salmeterol include dose-related tremor, palpitations, and headache, which are usually mild and temporary. Muscle pain, stiffness, chest pain, and skin rash have also been reported.

Salmeterol should be used during pregnancy only when no suitable alternative is available and when the expected benefit justifies the potential risk to the fetus. There are no sufficient data regarding its excretion in human breast milk. A decision should be made either to discontinue breastfeeding or discontinue the drug, considering the importance of treatment for the mother.

Inhalation of salmeterol may be associated with paradoxical bronchospasm. It should not be used in patients who are not also receiving an inhaled corticosteroid. Salmeterol is not intended for the relief of acute asthma symptoms.

Long-acting selective β-adrenoceptor stimulants

Store at 20–25°C. Protect from heat and direct sunlight. Keep out of reach of children.