Adult: As inhalation cap: 12 mcg bid via inhaler device, may be increased up to 24 mcg bid as necessary for severe cases. As metered-dose dry powd inhaler: 6 or 12 mcg 1-2 times daily, up to 24 mcg bid in severe cases. As metered-dose aerosol: 12-24 mcg bid. Doses are given in combination w/ an inhaled corticosteroid. Child: As inhalational cap: ≥5 yr 12 mcg bid via inhaler device. As metered-dose dry powd inhaler: ≥6 yr 6-12 mcg 1-2 times daily.
Inhalation/Respiratory Prophylaxis of exercise-induced asthma
Adult: 12 mcg at least 15 min prior to exercise. Additional doses should not be taken w/in 12 hr. Child: ≥5 yr Same as adult dose.
Adult: As inhalation cap: 12 mcg bid via inhaler device. As metered-dose dry powd inhaler: 12 mcg 1-2 times daily. As metered-dose aerosol: 12 mcg bid. Additional doses may be given as required. Max: 48 mcg/day (24 mcg/dose). As soln for nebulisation: 20 mcg bid.
Contraindications
Treatment of status asthmaticus, other acute episodes of asthma or COPD. Monotherapy in asthma treatment.
Special Precautions
Patient w/ CV disease, CNS disorders, hyperthyroidism, hypokalaemia, DM, phaeochromocytoma, seizure disorder. Not intended for the relief of bronchospasm. Pregnancy and lactation.
This drug may cause dizziness and other similar effects, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor pulmonary function, BP, heart rate, CNS stimulation; serum glucose and K levels.
Overdosage
Symptoms: Nausea, vomiting, headache, tremor, somnolence, palpitations, tachycardia, ventricular arrhythmias, metabolic acidosis, hypokalaemia, hyperglycaemia, prolonged QT-interval, HTN. Management: Supportive and symptomatic treatment. May consider use of cardioselective β-blockers but w/ extreme caution. Monitor serum K levels.
Drug Interactions
Increased risk of ventricular arrhythmia w/ drugs that prolong QT-interval (e.g. quinidine, disopyramide, procainamide, phenothiazines, antihistamines, erythromycin). Increased adverse effects w/ other sympathomimetic drugs. Increased CV effects w/ MAOIs, macrolides, or TCAs. Increased risk of hypokalaemia w/ xanthine derivatives, steroids, or non K-sparing diuretics. Increased risk of arrhythmias w/ concomitant anaesth w/ halogenated hydrocarbons. Increased bronchodilating effects w/ anticholinergic drugs. Antagonistic effect w/ β-blockers.
Action
Description: Mechanism of Action: Formoterol stimulates intracellular adenyl cyclase, the enzyme that catalyses the conversion of ATP to cyclic-3', 5'-adenosine monophosphate (cAMP) resulting in relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from mast cells. Onset: Powd for inhalation: W/in 3 min. Duration: Approx 12 hr. Pharmacokinetics: Absorption: Rapidly absorbed (inhalation). Time to peak plasma concentration: 1-3 hr. Distribution: Plasma protein binding: 61-64%. Metabolism: Largely metabolised via glucuronidation and O-demethylation. Excretion: Via urine (10 %, as unchanged drug). Half-life: 10 hr.
Chemical Structure
Formoterol Source: National Center for Biotechnology Information. PubChem Database. Arformoterol, CID=3083544, https://pubchem.ncbi.nlm.nih.gov/compound/Arformoterol (accessed on Jan. 21, 2020)
Storage
Inhalation cap: Prior to dispensing: Store between 2-8°C. After dispensing: Store between 20-25°C. Soln for nebulisation: Prior to dispensing: Store between 2-8°C. After dispensing: Store between 2-25°C.
R03AC13 - formoterol ; Belongs to the class of adrenergic inhalants, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
References
Anon. Formoterol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/07/2015.Buckingham R (ed). Formoterol Fumarate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/07/2015.Foradil Capsule (Merck Sharp & Dohme Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/07/2015.Perforomist Solution (Mylan Specialty L.P.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/07/2015.
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