formoterol

Produces accumulation of cyclic adenosine monophosphate (cAMP) at beta-adrenergic receptors, resulting in relaxation of airway smooth muscle.
Relatively specific for beta₂ (pulmonary) receptors.

Therapeutic effects:

Bronchodilation.

Pharmacokinetics ⬆ ⬇

Absorption: Following inhalation, majority of inhaled drug is swallowed and absorbed.

Distribution: Unknown.

Metabolism/Excretion: Mostly metabolized by the liver; 10–18% excreted unchanged in urine.

Half-Life: 10 hr.

Time/Action Profile ⬆ ⬇

(bronchodilation)

ROUTE	ONSET	PEAK	DURATION
Inhaln	15 min	1–3 hr	12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Asthma;
Acutely deteriorating COPD or acute respiratory symptoms.

Use Cautiously in:

Cardiovascular disease (including angina, hypertension, and arrhythmias);
Diabetes;
Seizure disorders;
Glaucoma;
Hyperthyroidism;
Pheochromocytoma;
Excessive use (may lead to tolerance and paradoxical bronchospasm);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk; may inhibit contractions during labor;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: angina, arrhythmia, hypertension, hypotension, palpitations, tachycardia

Derm: rash

F and E: hypokalemia

GI: dry mouth, nausea

Metab: hyperglycemia, metabolic acidosis

MS: muscle cramps

Neuro: dizziness, fatigue, headache, insomnia, malaise, nervousness, tremor

Resp: PARADOXICAL BRONCHOSPASM

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

MAO inhibitors, tricyclic antidepressants,, or QT interval prolonging medications may ↑ risk of arrhythmias; avoid concurrent use.
↑risk of hypokalemia with theophylline, corticosteroids, potassium-losing diuretics.
Beta blockers may ↓ therapeutic effects.
↑adrenergic effects may occur with concurrent use of adrenergics.

Route/Dosage ⬆ ⬇

Inhaln (Adults ): 20 mcg twice daily via jet nebulizer.

Availability ⬆ ⬇

(Generic available)

Inhalation solution for nebulization (Perforomist): 20 mcg/2 mL
Powder for inhalation (Oxeze Turbuhaler): 6 mcg/inhalation (60 metered doses); 12 mcg/inhalation (60 metered doses)
In combination with:
aclidinium (Duaklir Pressair); budesonide (Breyna, Symbicort); budesonide, glycopyrrolate, and formoterol (Breztri Aerosphere); glycopyrrolate (Bevespi Aerosphere); mometasone (Dulera); see Combination Drugs.

Assessment ⬆ ⬇

Assess lung sounds, BP, and HR before administration and during peak of medication.
Monitor pulmonary function tests before initiating and periodically during therapy to determine effectiveness.
Observe for paradoxical bronchospasm and hypersensitivity reaction including anaphylaxis. If symptoms occur, discontinue formoterol and treat as indicated.
Monitor ECG periodically during therapy. May cause prolonged QTc interval.

Lab Test Considerations:

May cause hyperglycemia and hypokalemia.

Implementation ⬆ ⬇

Use formoterol along with an inhaled corticosteroid, not as monotherapy.
Inhaln: For use with nebulizer: Administer via standard jet nebulizer via mouthpiece or face mask. Remove vial from foil immediately prior to use and discard vial after use. May be stored in refrigerator until expiration date and at room temperature for up to 3 mo.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to not discontinue therapy even if feeling better. If a dose is missed, omit and take next regularly scheduled dose. Do not double dose. Use a rapid-acting bronchodilator if symptoms occur before next dose is due. Caution patient not to use more than 2 times a day or <12 hr apart.
Instruct patient to notify health care professional immediately if rash, bronchospasm, shortness of breath not relieved by medication, nausea, vomiting, shakiness, headache, fast or irregular heartbeat, or sleeplessness occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications or alcohol concurrently.
Caution patient also to avoid smoking and other respiratory irritants.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇