Effects of salmeterol oral inhalation: A Synthesis of Findings from 13 Studies

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Original Abstract of the Article

Major Research Findings

Studies on the efficacy and safety of salmeterol oral inhalation have examined various aspects, including the immune response in HIV-infected individuals, effects on blood sugar levels, drug interactions, and neurocognitive function. 1 investigated the impact of ritonavir, an HIV-specific protease inhibitor, on the immune response of HIV-infected patients, observing significant increases in CD4 and CD8 lymphocyte counts, alterations in T cell subset distribution, and enhancements in lymphocyte function. Conversely, 5 explored the effect of ritonavir on glucose metabolism, suggesting that lopinavir/ritonavir may induce insulin resistance more readily compared to atazanavir/ritonavir. 12 compared the effects of darunavir with low-dose ritonavir (DRV/r) and atazanavir with low-dose ritonavir (ATV/r) on insulin sensitivity over 48 weeks, indicating comparable changes in metabolic parameters between the two regimens.

Benefits and Risks

Benefit Summary

Salmeterol oral inhalation has the potential to improve the immune response in HIV-infected individuals. 1 demonstrated that ritonavir treatment led to increased CD4 and CD8 lymphocyte counts, modified T cell subset distribution, and enhanced lymphocyte function. Furthermore, salmeterol oral inhalation may exhibit good tolerability when used in combination with other HIV medications. 12 showed that the changes in metabolic parameters with darunavir/ritonavir were comparable to those observed with atazanavir/ritonavir, suggesting that salmeterol oral inhalation might be relatively safe when used in combination with atazanavir/ritonavir.

Risk Summary

Salmeterol oral inhalation may influence blood sugar levels. 5 indicated that lopinavir/ritonavir might induce insulin resistance more readily compared to atazanavir/ritonavir, suggesting a potential impact on glucose metabolism. Additionally, salmeterol oral inhalation can interact with other drugs. 3 revealed that ritonavir significantly increased the plasma concentrations of rifabutin when coadministered. Therefore, these risks should be taken into consideration when contemplating the use of salmeterol oral inhalation.

Comparison Across Studies

Commonalities

These studies investigated the efficacy and safety of salmeterol oral inhalation, focusing on different aspects. A shared finding is that salmeterol oral inhalation may affect the immune response of HIV-infected individuals, blood sugar levels, and drug interactions. However, the methods, study populations, and assessment parameters employed differed across these studies, making direct comparisons challenging.

Differences

Key differences between the studies include the study population, assessment parameters, and comparator medications. 1 focused on the impact of ritonavir on the immune response of HIV-infected patients, while 5 investigated the effect of ritonavir on glucose metabolism. 12 compared the effects of darunavir/ritonavir and atazanavir/ritonavir on insulin sensitivity. 3 explored the drug interaction between ritonavir and rifabutin.

Consistency and Inconsistencies in Findings

These studies suggest that salmeterol oral inhalation might influence the immune response of HIV-infected individuals, blood sugar levels, and drug interactions. However, due to variations in methods, study populations, and assessment parameters, drawing definitive conclusions regarding the consistency or inconsistencies of findings is challenging. Future research using more standardized approaches is essential for comprehensively evaluating the efficacy and safety of salmeterol oral inhalation.

Considerations for Real-World Application

While salmeterol oral inhalation holds potential as a treatment for HIV-infected individuals, it is crucial to be aware of its potential effects on blood sugar levels and interactions with other medications. Before considering salmeterol oral inhalation, consulting a physician to discuss the suitability of this treatment option is essential. Patients should work with their healthcare provider to choose the most appropriate treatment plan based on their individual circumstances.

Limitations of Current Research

These studies are relatively small and limited in terms of the study populations. Furthermore, the duration of these studies is short, limiting the evaluation of long-term effects of salmeterol oral inhalation. Future research should involve larger-scale studies with longer follow-up periods to assess the long-term impact of salmeterol oral inhalation.

Future Research Directions

Additional research is necessary to thoroughly understand the efficacy and safety of salmeterol oral inhalation. Specifically, studies focusing on its long-term effects, impact on blood sugar levels, interactions with other medications, and effects on neurocognitive function are needed.

Conclusion

Salmeterol oral inhalation shows promise as a potential treatment for HIV-infected individuals. However, it is important to be aware of its potential effects on blood sugar levels and interactions with other medications. Consulting a physician to discuss the suitability of this treatment option is crucial before using salmeterol oral inhalation. Patients should work with their healthcare provider to choose the most appropriate treatment plan based on their individual circumstances.

Literature analysis of 13 papers
Positive Content
11
Neutral Content
0
Negative Content
2
Article Type
12
1
0
0
13
1.

Alterations in the immune response of human immunodeficiency virus (HIV)-infected subjects treated with an HIV-specific protease inhibitor, ritonavir.

Author: KelleherA D, CarrA, ZaundersJ, CooperD A

HIV-1 infection treatment
Immune system improvement

Ritonavir, an HIV-1 protease inhibitor, significantly increased CD4 and CD8 lymphocyte counts and improved immune function in 21 patients.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Clinical Trial, Phase IThe first stage of clinical trials in humans. Evaluates the safety, tolerability, and pharmacokinetics of a new drug/treatment.
Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

Multiple-dose pharmacokinetics of ritonavir in human immunodeficiency virus-infected subjects.

Author: HsuA, GrannemanG R, WittG, LockeC, DenissenJ, MollaA, ValdesJ, SmithJ, ErdmanK, LyonsN, NiuP, DecourtJ P, FourtillanJ B, GiraultJ, LeonardJ M

Increased triglyceride levels

Ritonavir, an HIV treatment, showed moderately dose-dependent pharmacokinetics with concentration-dependent autoinduction. Triglyceride levels increased with higher ritonavir doses. This data provides information about its absorption, elimination, and potential side effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Clinical Trial, Phase IThe first stage of clinical trials in humans. Evaluates the safety, tolerability, and pharmacokinetics of a new drug/treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

3.

The effect of multiple doses of ritonavir on the pharmacokinetics of rifabutin.

Author: CatoA, CavanaughJ, ShiH, HsuA, LeonardJ, GrannemanR

Increased rifabutin levels

Ritonavir significantly increases the plasma concentrations of rifabutin and its metabolite 25-O-desacetylrifabutin, suggesting that both drugs are metabolized by CYP3A.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Short-term exposure to low-dose ritonavir impairs clearance and enhances adverse effects of trazodone.

Author: GreenblattDavid J, von MoltkeLisa L, HarmatzJerold S, FogelmanSteven M, ChenGengsheng, GrafJennifer A, MertzanisPolyxane, ByronSusan, CulmKerry E, GrandaBrian W, DailyJohanna P, ShaderRichard I

Drug interactions

Ritonavir significantly reduced apparent oral clearance of trazodone, prolonged elimination half-life, and increased peak plasma concentrations (mean +/- SE). Coadministration of trazodone with ritonavir increased sedation, fatigue, and performance impairment compared to trazodone plus placebo.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

6.

Effects of first-line use of nucleoside analogues, efavirenz, and ritonavir-boosted protease inhibitors on lipid levels.

Author: HillAndrew, SawyerWill, GazzardBrian

Lipid elevation

There is a wide range of lipid elevations during 48 weeks of first-line HAART, depending on the choice of antiretrovirals used.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

7.

The benefit of simplification from tipranavir/ritonavir 500/200 bid to 500/100 bid guided by therapeutic drug monitoring.

Author: MorelloJudit, Rodríguez-NovoaSonia, BlancoFrancisco, VispoEugenia, BarreiroPablo, Gonzalez-PardoGema, Jiménez-NácherInmaculada, González-LahozJuan, SorianoVincent

HIV suppression
Reduced aminotransferases
Reduced cholesterol
Reduced triglycerides
Pill burden
Side effects

Tipranavir is a potent protease inhibitor but has a high pill burden and frequent side effects. This study found that reducing the ritonavir dose in patients taking tipranavir/ritonavir resulted in decreased liver enzymes and cholesterol levels in some patients without affecting viral suppression.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

8.

Boosting dose ritonavir does not alter peripheral insulin sensitivity in healthy HIV-seronegative volunteers.

Author: TaylorSteven A, LeeGrace A, PaoVivian Y, AnthonypillaiJayaranjan, AweekaFrancesca T, SchwarzJean-Marc, MulliganKathleen, SchambelanMorris, GrunfeldCarl

Insulin resistance

Some HIV protease inhibitors (PIs), including full-dose ritonavir (800 mg) and ritonavir-boosted lopinavir, acutely induce insulin resistance in the absence of HIV infection. The effects of boosting dose ritonavir (100-200 mg) on glucose metabolism have not been described in the absence of another PI.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

9.

Similar efficacy and tolerability of atazanavir compared with atazanavir/ritonavir, each with abacavir/lamivudine after initial suppression with abacavir/lamivudine plus ritonavir-boosted atazanavir in HIV-infected patients.

Author: SquiresKathleen E, YoungBenjamin, DejesusEdwin, BellosNicholaos, MurphyDaniel, ZhaoHenry H, PatelLisa G, RossLisa L, WannamakerPaul G, ShaeferMark S,

HIV treatment
Reduced side effects

Treatment simplification strategies involving induction with a ritonavir (RTV)-boosted protease inhibitor regimen followed by simplification without RTV may offer sustained virologic suppression while minimizing long-term adverse effects associated with RTV.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Randomized controlled study demonstrating failure of LPV/r monotherapy in HIV: the role of compartment and CD4-nadir.

Author: GutmannChristine, CusiniAlexia, GünthardHuldrych F, FuxChristoph, HirschelBernard, DecosterdLaurent-Arthur, CavassiniMatthias, YerlySabine, VernazzaPietro L,

Reduced viral load
Treatment failure

Monotherapy with ritonavir-boosted lopinavir was not recommended as a standard strategy for HIV maintenance, especially in patients with a low nadir CD4 cell count. Viral failure was observed in patients with a low nadir CD4 cell count, and further research is needed to understand the role of the central nervous system in monotherapy failure.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

11.

Early lipid changes with atazanavir/ritonavir or darunavir/ritonavir.

Author: MartinezE, Gonzalez-CordonA, FerrerE, DomingoP, NegredoE, GutierrezF, PortillaJ, CurranA, PodzamczerD, MurillasJ, BernardinoJ I, SantosI, CartonJ A, PeraireJ, PichJ, PerezI, GatellJ M,

Lipid effects
Tolerability
Hyperbilirubinaemia

This study examines the lipid effects and overall tolerability of ritonavir-boosted atazanavir and darunavir compared to ritonavir-boosted lopinavir in patients with HIV infection.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

Effects of once-daily darunavir/ritonavir versus atazanavir/ritonavir on insulin sensitivity in HIV-infected persons over 48 weeks: results of an exploratory substudy of METABOLIK, a phase 4, randomized trial.

Author: OvertonEdgar Turner, TebasPablo, CoateBruce, RyanRobert, PerniciaroAmy, DayaramYaswant K, De La RosaGuy, BaughBryan P

Darunavir with low-dose ritonavir (DRV/r) and atazanavir with low-dose ritonavir (ATV/r) are antiretroviral medications. This study assessed the effects of these agents on insulin sensitivity.

Clinical Trial, Phase IVPost-marketing surveillance. Monitors long-term safety/efficacy after approval.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Neurocognitive Function and Neuroimaging Markers in Virologically Suppressed HIV-positive Patients Randomized to Ritonavir-boosted Protease Inhibitor Monotherapy or Standard Combination ART: A Cross-sectional Substudy From the PIVOT Trial.

Author: Arenas-PintoAlejandro, StöhrWolfgang, JägerHans Rolf, HaddowLewis, ClarkeAmanda, JohnsonMargaret, ChenFabian, WinstonAlan, GodiClaudia, ThustSteffi, TrombinRita, CairnsJanet, SolankyBhavana S, GolayXavier, PatonNicholas I,

HIV treatment

This study assessed the neurocognitive function and brain imaging markers of patients on ritonavir-boosted protease inhibitor (PI) monotherapy versus standard antiretroviral therapy (ART). There was no difference in neurocognitive impairment between the two groups. However, symptomatic neurocognitive impairment was associated with higher global cortical atrophy scores.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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