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:

Concurrent use with MAO inhibitors,tricyclic antidepressants, or other agents that may prolong the QTc interval may result in serious arrhythmias and should be undertaken with extreme caution.
↑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/2 mL-unit-dose vial 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 (Symbicort); budesonide, glycopyrrolate, and formoterol (Breztri Aerosphere); glycopyrrolate (Bevespi Aerosphere); mometasone (Dulera); see Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess lung sounds, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced. Closely monitor patients on higher dose for adverse effects.
Monitor pulmonary function tests before initiating and periodically during therapy to determine effectiveness.
Observe for paradoxical bronchospasm (wheezing, dyspnea, tightness in chest) and hypersensitivity reaction (rash; urticaria; swelling of the face, lips, or eyelids). If condition occurs, withhold medication and notify physician or other health care professional immediately.
Monitor ECG periodically during therapy. May cause prolonged QTc interval.
Monitor patient for signs of anaphylaxis (dyspnea, rash, laryngeal edema) during therapy.

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 ⬆ ⬇

Instruct patient to take formoterol as directed. Do not discontinue therapy without discussing with health care professional, even if feeling better. If a dose is missed skip dose and take next dose at regularly scheduled time. Do not double doses. 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 less than 12 hr apart; may cause adverse effects, paradoxical bronchospasm, or loss of effectiveness of medication. Instruct patient to review Medication Guide with each Rx refill in case of changes.
Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or nausea, vomiting, shakiness, headache, fast or irregular heartbeat, or sleeplessness occur.
Advise patient to consult health care professional before taking any Rx, OTC, or herbal products or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
Rep: Advise females 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 ⬆ ⬇