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
  • Beta-adrenergic blockers
  • Betaxolol
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • 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
  • Ciprofloxacin
  • Cisapride
  • Citalopram
  • Clarithromycin
  • Clofazimine
  • Clomipramine
  • Clozapine
  • Cocaine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Crizotinib
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Dasatinib
  • Degarelix
  • Desipramine
  • Desloratadine; Pseudoephedrine
  • Deutetrabenazine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dextroamphetamine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Dichlorphenamide
  • Diethylpropion
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Phenylephrine
  • Disopyramide
  • Dobutamine
  • Dofetilide
  • Dolasetron
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Dopamine
  • Dorzolamide; Timolol
  • Doxepin
  • Dronedarone
  • Droperidol
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Eliglustat
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Encorafenib
  • Enflurane
  • Entrectinib
  • Ephedrine
  • Epinephrine
  • Eribulin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Escitalopram
  • Esmolol
  • Ethacrynic Acid
  • Ezogabine
  • Fexofenadine; Pseudoephedrine
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Fluvoxamine
  • Formoterol
  • Formoterol; Mometasone
  • Foscarnet
  • Furosemide
  • Gemifloxacin
  • Gemtuzumab Ozogamicin
  • Gilteritinib
  • Glasdegib
  • Glycopyrrolate; Formoterol
  • Goserelin
  • Granisetron
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
  • Guaifenesin; Pseudoephedrine
  • Halofantrine
  • Haloperidol
  • Halothane
  • Histrelin
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibuprofen; Pseudoephedrine
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Inotuzumab Ozogamicin
  • Isocarboxazid
  • Isoflurane
  • Isoproterenol
  • Itraconazole
  • Ivosidenib
  • Ketoconazole
  • Labetalol
  • Lapatinib
  • Lefamulin
  • Lenvatinib
  • Leuprolide
  • Leuprolide; Norethindrone
  • Levobetaxolol
  • Levobunolol
  • Levofloxacin
  • Levomethadyl
  • Levothyroxine
  • Levothyroxine; Liothyronine (Porcine)
  • Levothyroxine; Liothyronine (Synthetic)
  • Linezolid
  • Liothyronine
  • Lithium
  • Lofexidine
  • Lomefloxacin
  • Loop diuretics
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Loratadine; Pseudoephedrine
  • Macimorelin
  • Maprotiline
  • Mefloquine
  • Meperidine; Promethazine
  • Mesoridazine
  • Methacholine
  • Methadone
  • Methamphetamine
  • Metoprolol
  • Metronidazole
  • Midodrine
  • Midostaurin
  • Mifepristone
  • Mirtazapine
  • Monoamine oxidase inhibitors
  • Moxifloxacin
  • Nadolol
  • Naproxen; Pseudoephedrine
  • Nebivolol
  • Nebivolol; Valsartan
  • Nilotinib
  • Norepinephrine
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Ondansetron
  • Osilodrostat
  • Osimertinib
  • Oxaliplatin
  • Ozanimod
  • Paliperidone
  • Panobinostat
  • Pasireotide
  • Pazopanib
  • Penbutolol
  • Pentamidine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phendimetrazine
  • Phenelzine
  • Phentermine
  • Phentermine; Topiramate
  • Phenylephrine
  • Phenylephrine; Promethazine
  • Pimavanserin
  • Pimozide
  • Pindolol
  • Pitolisant
  • Posaconazole
  • Prilocaine; Epinephrine
  • Primaquine
  • Procainamide
  • Procarbazine
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Propranolol
  • Protriptyline
  • Pseudoephedrine
  • Quetiapine
  • Quinidine
  • Quinine
  • Racepinephrine
  • Ranolazine
  • Rasagiline
  • Ribociclib
  • Ribociclib; Letrozole
  • Rilpivirine
  • Risperidone
  • Ritonavir
  • Romidepsin
  • Saquinavir
  • Selegiline
  • Selpercatinib
  • Sertraline
  • Sevoflurane
  • Siponimod
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Telavancin
  • Telithromycin
  • Tetrabenazine
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Thioridazine
  • Thyroid hormones
  • Timolol
  • Tolterodine
  • Toremifene
  • Torsemide
  • Tranylcypromine
  • Trazodone
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Voriconazole
  • Vorinostat
  • Ziprasidone
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