formoterol (for-mo-te-role) Foradil Aerolizer, Oxeze Turbuhaler, Perforomist

 Indications

Maintenance treatment to prevent bronchospasm in

chronic obstructive pulmonary disease (COPD) including

chronic bronchitis and emphysema.

Action

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 and 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

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Acute attack

of asthma (onset of action is delayed); Patients not receiving

a long-term asthma-control medication (e.g. inhaled

corticosteroid).

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, Lactation, Pedi:

Pregnancy, lactation, or children 5 yr (may inhibit

contractions during labor; use only if potential benefits

outweigh risks; in children, a fixed-dose combination

product containing formoterol and an inhaled corticosteroid

should be strongly considered to ensure adherence).

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache, insomnia, malaise,

nervousness. Resp: ASTHMA-RELATED DEATH, PARADOXICAL

BRONCHOSPASM. CV: angina, arrhythmias, hypertension,

hypotension, palpitations, tachycardia. GI: dry

mouth, nausea. F and E: hypokalemia.Metab: hyperglycemia,

metabolic acidosis. MS: muscle cramps.

Neuro: tremor. Derm: rash. Misc: allergic 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.

qrisk of hypokalemia with theophylline, corticosteroids,

potassium-losing diuretics. Beta

blockers mayptherapeutic effects.qadrenergic 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

Dry powder capsules for inhalation (Foradil

Aerolizer): 12 mcg. Inhalation solution for

nebulization (Perforomist): 20 mcg/2 mL. Powder

for oral inhalation (Oxeze Turbuhaler): 6 mcg/

inhalation (60 metered doses), 12 mcg/inhalation

(60 metered doses). In combination with: budesonide

(Symbicort); glycopyrrolate (Bevespi Aerosphere);

mometasone (Dulera); see Appendix B.