Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Serevent Diskus (Salmeterol-inh). If you are concerned about side effects, discuss the risks and benefits of Serevent Diskus (Salmeterol-inh) with your doctor.

The following side effects have been reported by at least 1% of people taking Serevent Diskus (Salmeterol-inh). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• coughing or other bronchial irritation
• dizziness or lightheadedness
• dryness or irritation of mouth or throat
• fast heartbeat
• headache
• irritation of throat or mouth
• muscle cramps or twitching
• nausea or vomiting
• nervousness
• palpitations
• restlessness
• trembling
• trouble sleeping

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor immediately if any of the following side effects occur:

• difficulty breathing
• feeling of choking, irritation, or swelling in throat
• flushing or redness of skin
• Hives
• increased shortness of breath, tightness in chest, or wheezing
• severe dizziness
• skin rash
• swelling of face, lips, or eyelids
• tightness in chest or wheezing

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Serevent Diskus (Salmeterol-inh).

Diskhaler Disks

Each circular, double-foil blister pack contains 4 regularly distributed blisters, each containing a dry powder blend of microfine salmeterol. Each blister contains 50 µg of salmeterol. Nonmedicinal ingredient: lactose.

Diskus

Each dose of dry powder of microfine salmeterol for inhalation contains 50 µg of salmeterol. Nonmedicinal ingredient: lactose.

Do not use Serevent Diskus (Salmeterol-inh) if you:

• are allergic to salmeterol or any ingredients of Serevent Diskus (Salmeterol-inh)
• are allergic to lactose or milk protein
• are not using an inhaled corticosteroid (e.g., budesonide)
• have abnormal heart rhythms associated with fast heart rates

There may be an interaction between salmeterol and any of the following:

• Atomoxetine
• beta-blockers (e.g., Metoprolol, Propranolol)
• Digoxin
• diuretics (e.g., Hydrochlorothiazide, Furosemide)
• ketoconazole
• MAO inhibitors (e.g., Phenelzine, Tranylcypromine)
• ritonavir
• sympathomimetic medications (e.g., caffeine, ephedrine, Pseudoephedrine)
• tricyclic antidepressants (e.g., Amitriptyline, Desipramine)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Serevent Diskus (Salmeterol-inh). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Serevent Diskus (Salmeterol-inh).

Asthma flare-ups: Talk to your doctor and make sure you know what to do if you have an asthma flare-up. This is sometimes referred to as an "asthma action plan." Knowing how to adjust your medication in response to an acute worsening of asthma is an important safety measure.

Medical conditions: If you have high blood pressure, heart problems, Diabetes, Thyroid problems, or Epilepsy (seizures), discuss with your doctor how Serevent Diskus (Salmeterol-inh) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Serevent Diskus (Salmeterol-inh), and whether any special monitoring is needed.

Monitoring asthma: Talk to your doctor about ways for you to monitor your asthma at home, such as a peak flow meter. Peak flow metres measure the amount of air you can expel in a short time and can help you identify when your asthma might be flaring up even before you begin to experience symptoms.

Prevention only: Salmeterol should not be used to treat acute symptoms (as a "rescue" medication). It is meant for prevention purposes only. Salmeterol should be taken along with other medications called inhaled corticosteroids. Short-acting medications such as salbutamol, terbutaline, or fenoterol are required for relief of breathing symptoms as instructed by your doctor and should be available at all times.

Worsening symptoms: If you find you need to use your short-acting ("rescue") inhaler more often or if your condition seems to worsen, call your doctor. If you have not been given instructions beforehand, contact your doctor immediately about what to do if any of the following situations occur (they may be signs of seriously worsening asthma):

• decreased effectiveness of short-acting, inhaled bronchodilators such as salbutamol, terbutaline, or fenoterol (less than 4 hours of relief)
• need for more inhalations than usual of short-acting, inhaled bronchodilators
• peak flow meter showing results in the below-normal range

Pregnancy: Serevent Diskus (Salmeterol-inh) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Serevent Diskus (Salmeterol-inh), contact your doctor immediately.

Breast-feeding: It is not known if salmeterol passes into breast milk. If you are a breast-feeding mother and are taking Serevent Diskus (Salmeterol-inh), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using salmeterol have not been established for children younger than 4 years of age.