Salmeterol may cause fine tremor of skeletal muscle (particularly the hands), palpitations. tachycardia, nervous tensions, headaches, peripheral vasodilation, and rarely muscle cramps. Inhalation causes fewer adverse drug reaction than systemic administration, and the more selective beta-2 agonist cause fewer adverse drug reaction than less selective beta agonist. Potentially serious hypokalemia has been reported after large doses. Hypersensitivity reactions have occurred, including paradoxical bronchospasm, angioedema, urticaria. hypotension, and collapse.
Fluticasone hypersensitivity reactions may occur. Eosinophilic conditions, including Churg-Strauss syndrome have been reported rarely, in most cases following a transfer from oral corticosteroid therapy. Inhalation administration of large amounts of fluticasone propionate may produce systemic effects also. The adverse effects of corticosteroid may result from unwanted mineralocorticoid or glucocorticoid actions, or from inhibition of the hypothalamic-pituitary-adrenal axis. Despite the fact that inhaled fluticasone is generally thought to lack systemic effects at therapeutic doses, a study in 25 healthy subjects indicated that fluticasone propionate as single inhaled doses of 250, 500 and 1000 mcg did produce a reduction in plasma cortisol, indicating suppression with fluticasone particularly at high doses and the effect may be more marked with repeated than with single doses.