Long-acting β2-agonist (LABA) Pregnancy: As a precautionary measure, preferable to avoid use during pregnancy. Breast-feeding: a risk to the suckling child cannot be excluded (§4.6).

Salmeterol

Brand names: Serevent

Salmeterol is a long-acting beta-2 agonist (LABA) for maintenance bronchodilation in asthma and COPD; in asthma it must always be used with an inhaled corticosteroid, never alone.

Adult dose

Dose: One inhalation (50 micrograms) twice daily, increasing to two inhalations (2 x 50 micrograms) twice daily if required (reversible airways obstruction / asthma)

Route: Inhalation (Accuhaler)

Frequency: Twice daily

SPC (Serevent Accuhaler): In COPD — one inhalation (50 micrograms) twice daily (do not increase). Should be used regularly; full benefit apparent after several doses. Not for acute asthma symptoms — a fast, short-acting bronchodilator is required for these. For maintenance asthma, must be given with inhaled or oral corticosteroids and not as sole/main treatment. Dose or frequency should only be increased on medical advice. Paediatric (asthma): children 4 years and over — one inhalation (50 micrograms) twice daily; insufficient data to recommend use under 4 years. COPD: not appropriate in children.

Dose adjustments

Renal

No need to adjust the dose in patients with impaired renal function.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to salmeterol xinafoate or to any of the excipients

Side effects

Headache (common)
Tremor (common)
Palpitations (common)
Muscle cramps (common)
Tachycardia (uncommon)

Clinical monograph

How it works

It is a long-acting β2-adrenoceptor agonist relaxing airway smooth muscle for around 12 hours, with a slower onset than salbutamol.

Prescribing in practice

In asthma, LABA monotherapy is unsafe — always give it with an inhaled corticosteroid (usually a combination inhaler).
It is a maintenance treatment, not a reliever for acute symptoms.
Tremor, palpitations and (at high doses) hypokalaemia can occur.

Monitoring

Review asthma/COPD control, inhaler technique and reliever use.

Counselling the patient

It is a regular preventer, not for sudden breathlessness — keep your reliever for that.
In asthma, never use it without your steroid inhaler.
It works more slowly than your blue reliever.

Evidence & guidelines

LABAs are add-on maintenance therapy in asthma (always with an ICS) and in COPD per NICE NG80/NG115.

Reference: NICE NG80/NG115; BTS/SIGN; MHRA; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways