Arformoterol

Arformoterol Brand Name– Brovana

What is Arformoterol

Arformoterol is a long-acting beta-2 adrenergic agonist (LABA) administered via nebulization twice daily.

The drug is the (R,R)-enantiomer of racemic formoterol.

Arformoterol is indicated for maintenance treatment of chronic obstructive pulmonary disease (COPD) in adults.

Due to the onset of effect, LABAs should not be used for relief of acute bronchospasm. As the (R,R)-enantiomer of racemic formoterol, arformoterol has a 2-fold greater binding affinity to beta-2 adrenergic receptors than the racemate, and a 1,000 times greater affinity than (S,S)-formoterol.

The drug produces post-dose bronchodilation (as measured by percent change from baseline FEV-1) similar to salmeterol.

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD, LABAs may be used as initial monotherapy in Groups A and B. In Group C patients, long-acting muscarinic antagonists (LAMAs) are preferred as initial therapy over LABAs due to effectiveness in preventing exacerbations.

In Group D patients, LABAs are used as initial therapy in combination with inhaled corticosteroids (ICS) or LAMAs. At follow-up, if the patient is still experiencing dyspnea, consider switching inhaler device and investigate for other causes of dyspnea.

If the patient has exacerbations, consider triple therapy with a LAMA, a LABA, and ICS.

The use of LABAs alone to treat asthma without an inhaled corticosteroid (ICS) to treat lung inflammation is associated with an increased risk of asthma-related death; therefore, LABAs are contraindicated in patients with asthma without the use of an asthma controller medication (i.e., an ICS).

Indications

• chronic bronchitis
• chronic obstructive pulmonary disease (COPD)
• emphysema

For the maintenance treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema

Side Effects

1. agitation
2. anaphylactoid reactions
3. angina
4. angioedema
5. arrhythmia exacerbation
6. asthenia
7. asthma-related death
8. atrial flutter
9. AV block
10. back pain
11. bronchospasm
12. chest pain (unspecified)
13. constipation
14. diarrhea
15. dizziness
16. dysphonia
17. dyspnea
18. fatigue
19. fever
20. gastritis
21. headache
22. heart failure
23. hyperglycemia
24. hyperkalemia
25. hypertension
26. hypokalemia
27. hypotension
28. infection
29. insomnia
30. leukocytosis
31. malaise
32. melena
33. metabolic acidosis
34. muscle cramps
35. myocardial infarction
36. nausea
37. oral ulceration
38. palpitations
39. paresthesias
40. peripheral edema
41. photosensitivity
42. QT prolongation
43. rash
44. sinus tachycardia
45. sinusitis
46. ST-T wave changes
47. supraventricular tachycardia (SVT)
48. tolerance
49. tremor
50. urticaria
51. vomiting
52. wheezing
53. xerostomia

Monitoring Parameters

• pulmonary function tests (PFTs)

Contraindications

• acute bronchospasm
• alcoholism
• angioedema
• asthma
• asthma-related death
• bradycardia
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• coronary artery disease
• diabetes mellitus
• females
• geriatric
• heart failure
• hepatic disease
• hypertension
• hyperthyroidism
• hypocalcemia
• hypokalemia
• hypomagnesemia
• infants
• labor
• long QT syndrome
• malnutrition
• MAOI therapy
• monotherapy treatment of asthma
• myocardial infarction
• paradoxical bronchospasm
• pheochromocytoma
• pregnancy
• QT prolongation
• seizure disorder
• seizures
• thyroid disease
• thyrotoxicosis
• urticaria

Interactions

• Abarelix
• Acebutolol
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Pseudoephedrine
• Aclidinium; Formoterol
• Acrivastine; Pseudoephedrine
• Alfuzosin
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamine; Dextroamphetamine Salts
• Anagrelide
• Apomorphine
• Aripiprazole
• Arsenic Trioxide
• Artemether; Lumefantrine
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Atenolol
• Atenolol; Chlorthalidone
• Atomoxetine
• Azithromycin
• Bedaquiline
• Bendroflumethiazide; Nadolol
• Benzphetamine
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• Betaxolol
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• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Brimonidine; Timolol
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Budesonide; Formoterol
• Bumetanide
• Buprenorphine
• Buprenorphine; Naloxone
• Caffeine
• Caffeine; Ergotamine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Carteolol
• Carvedilol
• Ceritinib
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chloroquine
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
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• Citalopram
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• Clofazimine
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• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Crizotinib
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• Dextroamphetamine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Guaifenesin; Pseudoephedrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Dichlorphenamide
• Diethylpropion
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Phenylephrine
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• Halofantrine
• Haloperidol
• Halothane
• Histrelin
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydroxychloroquine
• Hydroxyzine
• Ibuprofen; Pseudoephedrine
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• Levothyroxine; Liothyronine (Synthetic)
• Linezolid
• Liothyronine
• Lithium
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• Loop diuretics
• Loperamide
• Loperamide; Simethicone
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• Perphenazine
• Perphenazine; Amitriptyline
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• Phentermine; Topiramate
• Phenylephrine
• Phenylephrine; Promethazine
• Pimavanserin
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• Pitolisant
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• Prilocaine; Epinephrine
• Primaquine
• Procainamide
• Procarbazine
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• Propafenone
• Propranolol
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• Pseudoephedrine
• Quetiapine
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