Formoterol

Formoterol Brand Names- Foradil | Perforomist

What is Formoterol

Formoterol is an inhaled long-acting beta-2 receptor agonist (LABA) given twice daily via nebulizer.

Formoterol is indicated for the maintenance treatment of airflow obstruction associated with chronic obstructive pulmonary disease (COPD). Due to the onset of effect, LABAs should not be used for relief of acute bronchospasm.

Formoterol significantly improves FEV-1, lung volume, dyspnea, health-related quality of life, and exacerbation rates in COPD patients, but does not affect mortality or the rate of lung function decline.

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD, LABAs may be used as initial monotherapy in COPD patients 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.

Formoterol has been used clinically for the maintenance treatment of asthma, but should not be used as monotherapy.

The use of LABAs alone to treat asthma without an 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).

An inhalational nebulizer solution for formoterol was initially approved by the FDA in 2007.

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. abdominal pain
  2. anaphylactoid reactions
  3. angina
  4. angioedema
  5. arrhythmia exacerbation
  6. asthma-related death
  7. atrial flutter
  8. bronchial secretions
  9. bronchospasm
  10. chest pain (unspecified)
  11. diarrhea
  12. dizziness
  13. dyspepsia
  14. dysphonia
  15. dyspnea
  16. fatigue
  17. fever
  18. headache
  19. hoarseness
  20. hyperglycemia
  21. hypertension
  22. hypokalemia
  23. hypotension
  24. infection
  25. insomnia
  26. malaise
  27. metabolic acidosis
  28. muscle cramps
  29. nausea
  30. palpitations
  31. paresthesias
  32. pharyngitis
  33. photosensitivity
  34. pruritus
  35. QT prolongation
  36. rash
  37. rhinitis
  38. sinus tachycardia
  39. sinusitis
  40. ST-T wave changes
  41. tolerance
  42. tremor
  43. urticaria
  44. ventricular tachycardia
  45. vomiting
  46. wheezing
  47. xerostomia

Monitoring Parameters

  • pulmonary function tests (PFTs)

Contraindications

  • acute bronchospasm
  • apheresis
  • asthma-related death
  • AV block
  • bradycardia
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cardiomyopathy
  • celiac disease
  • children
  • coronary artery disease
  • diabetes mellitus
  • diabetic ketoacidosis
  • females
  • fever
  • geriatric
  • heart failure
  • human immunodeficiency virus (HIV) infection
  • hyperglycemia
  • hyperparathyroidism
  • hypertension
  • hyperthyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothermia
  • hypothyroidism
  • infants
  • labor
  • long QT syndrome
  • MAOI therapy
  • milk protein hypersensitivity
  • monotherapy treatment of asthma
  • myocardial infarction
  • paradoxical bronchospasm
  • pheochromocytoma
  • pregnancy
  • QT prolongation
  • rheumatoid arthritis
  • seizure disorder
  • seizures
  • sickle cell disease
  • sleep deprivation
  • stroke
  • systemic lupus erythematosus (SLE)
  • tachycardia
  • thyroid disease
  • thyrotoxicosis

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
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  • Amphetamine; Dextroamphetamine Salts
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  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
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  • Chlorpheniramine; Hydrocodone; Phenylephrine
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