Adverse events which have been associated with salmeterol or fluticasone propionate are given as follows.
Includes tachycardia, palpitations, cardiac arrhythmias, precipitation of angina pectoris, CNS stimulations, dry mouth, sweating, headache, dizziness, nausea, vomiting, nervousness, anxiety and tremor.
The side-effects associated with the use of corticosteroids in the large doses often necessary to produce a therapeutic response results from excessive action on electrolyte balance, excessive action on other aspects of metabolism including gluconeogenesis, the action on tissue repair & healing, and an inhibitory effects on the secretion of corticotrophin by the anterior lobe of the pituitary gland.
Hypersensitivity reactions have occurred with corticosteroids, mainly when administered topically.
Salmeterol may cause fine tremor of skeletal muscle (particularly the hands), palpitations, tachycardia, nervous tensions, headaches, peripheral vasodilatation, and rarely muscle cramps. Inhalation causes fewer side-effects than systemic administration, and the more selective beta2-agonist cause fewer side-effect than less selective beta agonists. 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 μg 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.