Adult Dosing

Maintenance therapy in COPD

• 15 mcg (2 ml) bid by nebulization
• Max: 30 mcg/day

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

• Long term maintenance therapy of bronchoconstriction in COPD

• Hypersensitivity to any of the components of the product
• Asthma patients without use of a long-term asthma control medication
• Acutely deteriorating COPD
• Pediatric patients
• Concurrent use of other long-acting beta-2 agonists

• Long acting beta2-adrenergics may increase the risk of asthma related deaths. Data from large placebo-controlled US study showed an increase in asthma-related deaths in patients receiving salmeterol along with usual asthma therapy. These findings may apply to arformoterol. Arformoterol is contraindicated in patients with asthma without use of a long-term control medication

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

• Hepatic impairment: No dose adjustments, use with caution

• Increased risk of asthma related death [US Black Box Warning]
• Indicated in the long term maintenance treatment for bronchoconstriction in COPD, not in the treatment of acute episodes. Should not be initiated in acutely deteriorating COPD.
• Avoid treatment in patients with acutely deteriorating COPD; to treat acute symptoms of COPD, use of inhaled, short-acting beta2-agonist is recommended
• Instruct patients who have been taking inhaled, short-acting beta2-agonists on a regular basis to discontinue and use those drugs only for symptomatic relief of acute symptoms
• Can produce life-threatening paradoxical bronchospasm
• Hypersensitivity reactions like anaphylactic reactions, angioedema, bronchospasm, rash, and urticaria may occur
• Clinically significant changes in SBP and/or DBP pulse rate and electrocardiograms have occurred
• It may produce significant hypokalemia in some patients
• Long-term administration at the recommended dose may produce clinically significant changes in blood glucose and/or serum potassium
• Fatalities may occur in association with excessive use of inhaled sympathomimetic drugs

Use cautiously in

• Hypersensitivity to milk proteins
• Cardiovascular disorders
• Coronary insufficiency
• Cardiac arrhythmias
• Hypertension
• Diabetes
• Convulsive disorders
• Thyrotoxicosis
• Thyroid disorder
• Hypokalemia

Pregnancy Category:C

Breastfeeding: Safety unknown; no published data exists on the use of arformoterol during breastfeeding. However, use of inhaled bronchodilators is considered acceptable due to low bioavailability and maternal serum levels. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 29 September 2010). Manufacturer advises caution.

• Note: Increased risk of asthma related deaths [US Black Box Warning]
• RESP: Asthma related deaths, asthma exacerbation/deterioration, paradoxical bronchospasm, bronchitis, dyspnea, pulmonary/chest congestion
• EENT: Sinusitis
• CNS: Headache, asthenia, nervousness, weakness, tremor, dizziness, insomnia
• CV: Chest pain, angina, hypertension or hypotension, tachycardia, arrhythmias, peripheral edema, palpitation, heart block, QT prolongation
• GI: Vomiting, diarrhea, nausea, dry mouth
• METABOLIC: Hyperkalemia, hypokalemia, hyperglycemia, metabolic acidosis
• HEMA: Leukocytosis
• MUSC: Pain, back pain, leg cramps, muscle cramps
• MISC: Hypersensitivity reactions including anaphylaxis, angioedema, flu-syndrome, fatigue, malaise

• Long acting beta-2 agonist; stimulates intracellular adenyl cyclase, resulting in increased intracellular cyclic AMP levels causing relaxation of bronchial smooth muscle
• Some systemic absorption following inhalation
• Metabolized by liver by CYP2D6 and CYP2C19
• 63 % excreted in urine (1% unchanged) and 11% excreted in feces
• Half-life: 26 hrs

US Trade Name(s)

• Brovana

US Availability

Brovana

• SOLN for INH: 0.015 mg/2mL

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Pulmonary

Bronchodilators

Beta Agonists (Inhaled)

Allergy & Immunology

Bronchodilators

Beta Agonists (Inhaled)