formoterol fumarate

Action

Stimulates intracellular adenylate cyclase, relaxing bronchial smooth muscle and inhibiting release of mediators of immediate hypersensitivity

Availability

Capsules for oral inhalation (used with Aerolizer inhaler): 12 mcg

Indications and dosages

➣ Long-term maintenance of asthma; prevention or long-term maintenance of bronchospasm in patients with chronic obstructive pulmonary disease

Adults and children ages 5 and older: Contents of 1 capsule inhaled orally via Aerolizer q 12 hours

➣ Acute prevention of exercise-induced bronchospasm (on occasional, as-needed basis)

Adults and children ages 5 and older: Contents of 1 capsule inhaled orally via Aerolizer at least 15 minutes before start of exercise. Wait 12 hours after initial dose before giving repeat dose.

Contraindications

• Hypersensitivity to drug or its components

• Tachyarrhythmias

Precautions

Use cautiously in:

• acute asthma symptoms, deteriorating asthma, cardiovascular disorders, seizure disorders, thyrotoxicosis, diabetes, possible hypokalemia

• patients older than age 75

• labor

• pregnant or breastfeeding patients

• children younger than age 5.

Administration

• Be aware that drug is not intended for acute asthma attacks.

• Use capsules only with Aerolizer inhaler supplied.

• Keep capsules in blister until immediately before use.

See Make sure patient doesn't swallow capsules.

Adverse reactions

CNS: tremor, dizziness, insomnia, anxiety

CV: chest pain

EENT: sinusitis, pharyngitis, tonsillitis

GI: dry mouth

Metabolic: hypokalemia, hyperglycemia

Musculoskeletal: muscle cramps, back pain, leg cramps

Respiratory: bronchitis, chest infection, dyspnea, upper respiratory tract infection, increased sputum

Skin: pruritus, rash

Other: dysphonia, viral infection, fever

Interactions

Drug-drug. Adrenergics: potentiation of formoterol's sympathomimetic effects

Beta-adrenergic blockers: partial or total inhibition of formoterol's effects

Cardiac glycosides, methylxanthines, potassium-wasting diuretics, steroids: potentiation of formoterol's hypokalemic effects, increased risk of arrhythmias

Disopyramide, MAO inhibitors, quinidine, phenothiazines, procainamide, tricyclic antidepressants: prolonged QTc interval, increased risk of ventricular arrhythmias

Halogenated hydrocarbon anesthetics: increased risk of arrhythmias

Levodopa, levothyroxine, oxytocin: impaired cardiac tolerance of formoterol

Drug-diagnostic tests. Blood glucose: increased level

Potassium: decreased level

Drug-behaviors. Alcohol use: impaired cardiac tolerance of formoterol

Patient monitoring

• Monitor pulmonary function test results.

• Monitor potassium and glucose levels.

Patient teaching

• Teach patient how to use capsules and Aerolizer inhaler provided.

• Instruct patient to keep capsules in blisters until immediately before use.

• Caution patient not to swallow capsules.

• Tell patient not to use drug for acute asthma attacks.

See Instruct patient to contact prescriber immediately if difficulty in breathing persists after using drug or if condition worsens.

• Caution patient to take drug exactly as prescribed and not to stop therapy even if he feels better.

• Tell patient to consult prescriber if he has been taking inhaled, short-acting drugs on a regular basis.

• Advise female patient to tell prescriber if she is pregnant or breastfeeding or if she plans to become pregnant.

• Caution patient to avoid alcohol during therapy.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.