General
When initiating salmeterol alone or in fixed combination with fluticasone, discontinue regular use of short-acting, oral or inhaled β2-agonists;     use a short-acting, inhaled β2-agonist, not salmeterol (alone or in fixed combination with fluticasone), to relieve acute symptoms such as shortness of breath.    
Increasing use of short-acting, inhaled β2-agonists is a marker of deteriorating asthma and failure to respond to a previously effective dosage is often a sign of asthma destabilization.         Extra/increased doses of salmeterol alone or in fixed combination with fluticasone are not recommended.         (See Deterioration of Disease and Acute Episodes under Cautions.) Consult clinician.  
Administration
Oral Inhalation
Administer by oral inhalation using a special oral inhaler (Diskus device) that delivers powdered salmeterol xinafoate alone (Serevent Diskus) or in fixed combination with fluticasone (Advair Diskus, AirDuo RespiClick) or using an inhalation aerosol containing salmeterol in fixed combination with fluticasone (Advair HFA) via an oral aerosol inhaler with hydrofluoroalkane (HFA) propellant.   
Administer twice daily, approximately every 12 hours.    
Inhalation Powder
Hold the Diskus device in one hand, put the thumb of the other hand on the thumbgrip, and push the thumbgrip until the mouthpiece appears and snaps into position.   
To release powdered drug into the exit port, hold the inhaler in a level, horizontal position and depress the lever on the Diskus in a direction away from the patient.   
To avoid releasing and wasting additional doses of the drug, do not close the Diskus device, play with the lever, or advance the lever more than once.   A dose counter will advance each time the lever is depressed.   
Exhale completely, place the mouthpiece of the inhaler between the lips, and inhale deeply and rapidly through the inhaler with a steady, even breath.     Remove the inhaler from the mouth and hold the breath for 10 seconds before slowly exhaling.   
Do not exhale into the Diskus device.     
Do not use another dose from the Diskus device if the patient does not feel or taste the drug. 
Close the inhalation device and reset for the next dose by sliding the thumbgrip toward the patient as far as it will go.    Do not wash the inhaler.    Do not take inhaler apart.     
Discard the inhaler when every blister of salmeterol alone or in fixed combination with fluticasone has been used.     Alternatively, discard the inhaler 6 or 4 weeks after removal of salmeterol alone or in fixed combination with fluticasone, respectively, from its foil overwrap pouch.    
Consult manufacturer’s labeling for instructions on use of the AirDuo RespiClick oral inhaler.
Spacer devices not recommended with the Serevent or Advair Diskus inhaler.    Spacer devices or volume holding chambers not recommended with the AirDuo RespiClick inhaler.
Rinse the mouth without swallowing after inhalation of salmeterol in fixed combination with fluticasone propionate.   
Salmeterol/Fluticasone Inhalation Aerosol
Use the inhalation aerosol only with the actuator supplied with the product.
Shake the oral aerosol inhaler well for 5 seconds before each inhalation.  Test spray inhaler 4 times into the air (away from face) before initial use, and shake well for 5 seconds before each spray.  If inhaler not used for >4 weeks or if inhaler was dropped, test spray inhaler twice into the air (away from face) and shake well for 5 seconds before each spray. 
Remove cap covering mouthpiece of the aerosol inhaler. Look for foreign objects inside inhaler prior to use and check to see that canister is fully seated within actuator.
After exhaling as completely as possible, place mouthpiece of inhaler well into mouth and close lips firmly around it. Inhale deeply through mouth while actuating inhaler. Remove mouthpiece from mouth and hold breath for as long as possible (up to 10 seconds) and exhale slowly. It is recommended that 30 seconds elapse between inhalations. After inhalation, rinse mouth and spit out water. 
Clean the aerosol inhaler by wiping the opening where medicine sprays out of metal canister and mouthpiece with a dry cotton swab and dampened tissue, respectively, at least once a week after evening dose.  Allow actuator to air-dry overnight.
When dose counter on the aerosol inhaler reads “020,” recommend that the patient contact the pharmacy for a refill or consult clinician to determine need for a refill. Discard inhaler when the dose counter reads “000.” Never alter or remove dose counter from canister.
Dosage
Available as salmeterol xinafoate; dosage expressed in terms of salmeterol.
Each blister in the Serevent Diskus device contains 50 mcg of salmeterol inhalation powder; however, precise amount of drug delivered to lungs with each activation of the device depends on factors such as patient’s inspiratory flow.
Each blister in the Advair Diskus device contains 50 mcg of salmeterol and 100, 250, or 500 mcg of fluticasone propionate; however, precise amount of each drug delivered to lungs with each activation of device depends on factors such as patient’s inspiratory flow.
Each actuation of the AirDuo RespiClick device contains 14 mcg of salmeterol and 55, 113, or 232 mcg of fluticasone propionate; however, precise amount of each drug delivered to the lungs with each actuation of the device depends on factors such as the patient’s inspiratory flow.
Commercially available AirDuo RespiClick oral inhaler delivers 60 actuations.
Each actuation of the Advair HFA oral aerosol inhaler delivers 25 mcg of salmeterol and 50, 125, or 250 mcg of fluticasone propionate from the valve. Dosages in the fixed-combination inhalation aerosol are expressed in terms of drug delivered from the mouthpiece; each actuation of the inhaler delivers 21 mcg of salmeterol and 45, 115, or 230 mcg of fluticasone propionate from the mouthpiece.
Commercially available Advair HFA inhalation aerosol delivers 60 or 120 metered sprays per 8- or 12-g canister, respectively.
Pediatric Patients
Asthma
Salmeterol
Children ≥4 years of age: 50 mcg (1 inhalation) twice daily.
Salmeterol/Fluticasone Fixed Combination
Children ≥12 years of age: 42 mcg of salmeterol and 90, 230, or 460 mcg of fluticasone propionate (2 inhalations of Advair HFA) twice daily;   recommended initial dosage is based on patient’s asthma severity and current asthma therapy, including dosage of inhaled corticosteroids, as well as patient’s current control of asthma symptoms and risk of future exacerbations.
If control of asthma is inadequate after 2 weeks of therapy at the initial dosage, replacing the current strength of the fixed combination with a higher strength (higher strengths contain higher dosages of fluticasone only) may provide additional asthma control.
Children 4–11 years of age: 50 mcg of salmeterol and 100 mcg of fluticasone propionate (1 inhalation of Advair Diskus) twice daily in those inadequately controlled on an inhaled corticosteroid.
Children ≥12 years of age: 50 mcg of salmeterol and 100, 250, or 500 mcg of fluticasone propionate (1 inhalation of Advair Diskus) twice daily;   recommended initial dosage is based on patient’s asthma severity and current asthma therapy, including dosage of inhaled corticosteroids, as well as patient’s current control of asthma symptoms and risk of future exacerbations.
Children ≥12 years of age: 14 mcg of salmeterol and 55, 113, or 232 mcg of fluticasone propionate (1 inhalation of AirDuo RespiClick) twice daily at approximately the same time every day; recommended initial dosage is based on patient’s current asthma therapy and asthma severity. Usual recommended initial dosage is 14 mcg of salmeterol and 55 mcg of fluticasone propionate (1 inhalation) twice daily in patients not previously receiving inhaled corticosteroid therapy.
Administration of the inhalation powder of salmeterol in fixed combination with fluticasone more frequently than twice daily or exceeding 1 inhalation twice daily is not recommended. 
If control of asthma is inadequate after 2 weeks of therapy at the initial dosage, replacing the current strength of the fixed combination with a higher strength (higher strengths contain higher dosages of fluticasone only) may provide additional asthma control.  
Exercise-induced Bronchospasm
Salmeterol
Children ≥4 years of age: 50 mcg (1 inhalation) administered at least 30 minutes before exercise.
Adults
Asthma
Salmeterol
50 mcg (1 inhalation) twice daily.
Salmeterol/Fluticasone Fixed Combination
42 mcg of salmeterol and 90, 230, or 460 mcg of fluticasone propionate (2 inhalations) twice daily;    recommended initial dosage is based on patient’s asthma severity and current asthma therapy, including dosage of inhaled corticosteroids, as well as patient’s current control of asthma symptoms and risk of future exacerbations.
If control of asthma is inadequate after 2 weeks of therapy at the initial dosage, replacing the current strength of the fixed combination with a higher strength (higher strengths contain higher dosages of fluticasone only) may provide additional asthma control.
50 mcg of salmeterol and 100, 250, or 500 mcg of fluticasone propionate (1 inhalation of Advair Diskus) twice daily;  recommended initial dosage is based on patient’s asthma severity and current asthma therapy, including dosage of inhaled corticosteroids, as well as patient’s current control of asthma symptoms and risk of future exacerbations.
14 mcg of salmeterol and 55, 113, or 232 mcg of fluticasone propionate (1 inhalation of AirDuo RespiClick) twice daily at approximately the same time every day; recommended initial dosage is based on patient’s current asthma therapy and asthma severity. Usual recommended initial dosage is 14 mcg of salmeterol and 55 mcg of fluticasone propionate (1 inhalation) twice daily in patients not previously receiving inhaled corticosteroid therapy.
Administration of the inhalation powder of salmeterol in fixed combination with fluticasone more frequently than twice daily or exceeding 1 inhalation twice daily is not recommended. 
If control of asthma is inadequate after 2 weeks of therapy at the initial dosage, replacing the current strength of the fixed combination with a higher strength (higher strengths contain higher dosages of fluticasone only) may provide additional asthma control. 
Exercise-induced Bronchospasm
Salmeterol
50 mcg (1 inhalation) administered at least 30 minutes before exercise.
COPD
Salmeterol
50 mcg (1 inhalation) twice daily.
Salmeterol/Fluticasone Fixed Combination
50 mcg of salmeterol and 250 mcg of fluticasone propionate (1 inhalation of Advair Diskus) twice daily.
Use of higher dosages or administration more frequently than twice daily not recommended.
Prescribing Limits
Pediatric Patients
Asthma
Salmeterol
Children ≥4 years of age: Maximum 50 mcg (1 inhalation) twice daily.
Salmeterol/Fluticasone Fixed Combination
Children or adolescents ≥12 years of age: Maximum 42 mcg of salmeterol and 460 mcg of fluticasone propionate (2 inhalations of Advair HFA) twice daily.
Children 4–11 years of age: Maximum 50 mcg of salmeterol and 100 mcg of fluticasone propionate (1 inhalation of Advair Diskus) twice daily.
Children or adolescents ≥12 years of age: Maximum 50 mcg of salmeterol and 500 mcg of fluticasone propionate (1 inhalation of Advair Diskus) twice daily.
Children or adolescents ≥12 years of age: Maximum 14 mcg of salmeterol and 232 mcg of fluticasone propionate (1 inhalation of AirDuo RespiClick) twice daily.
Exercise-induced Bronchospasm
Salmeterol
Children ≥4 years of age: Maximum 50 mcg (1 inhalation) twice daily (every 12 hours).
Adults
Asthma
Salmeterol
Maximum 50 mcg (1 inhalation) twice daily.
Salmeterol/Fluticasone Fixed Combination
Maximum 42 mcg of salmeterol and 460 mcg of fluticasone propionate (2 inhalations) twice daily.
Maximum 50 mcg of salmeterol and 500 mcg of fluticasone propionate (1 inhalation of Advair Diskus) twice daily.
Maximum 14 mcg of salmeterol and 232 mcg of fluticasone propionate (1 inhalation of AirDuo RespiClick) twice daily.
Exercise-induced Bronchospasm
Salmeterol
Maximum 50 mcg (1 inhalation) twice daily (every 12 hours).
COPD
Salmeterol
Maximum 50 mcg (1 inhalation) twice daily.
Salmeterol/Fluticasone Fixed Combination
Maximum 50 mcg of salmeterol and 250 mcg of fluticasone propionate (1 inhalation) twice daily.
Special Populations
The following information addresses dosage of salmeterol in special populations. When salmeterol is used in fixed combination with fluticasone propionate, dosage requirements for fluticasone propionate should be considered.  
Hepatic Impairment
No specific dosage recommendations at this time. Monitor patients receiving salmeterol alone or in fixed combination with fluticasone for increased drug exposure and systemic corticosteroid effects.    (See Hepatic Impairment under Cautions.)
Renal Impairment
No specific dosage recommendations at this time.   
Geriatric Patients
Dosage adjustments not recommended solely because of age in geriatric patients.  
 Detailed Salmeterol dosage information
