As an adjunct (see literature): For the maintenance treatment of asthma and in the prevention of bronchospasm in reversible obstructive airway disease (including nocturnal asthma). Maintenance treatment of COPD-associated bronchospasm. Prevention of exercise-induced bronchospasm (EIB).
<5yrs: not recommended. ≥5yrs: 1 inh (12mcg) every 12 hours; max 2 doses/day. Prevention of EIB: 1 inh at least 15 minutes before exercise (do not use additional doses for EIB if already using regular dosing for asthma).
Long-acting beta-2 agonist.
For asthma: without concomitant use of a long-term asthma control drug (eg, inhaled corticosteroid). Primary treatment of status asthmaticus or other acute episodes of asthma or COPD where intensive measures are required.
Increased risk of asthma-related deaths and hospitalizations. Prescribe for asthma only as additional therapy with an inhaled corticosteroid. Do not initiate in significantly worsening or acutely deteriorating asthma. Formoterol is not a substitute for steroids. Do not exceed recommended dose. Cardiovascular disease (esp. hypertension, coronary insufficiency, arrhythmias, aneurysm, pheochromocytoma). Convulsive disorders. Thyrotoxicosis. Hyperresponsiveness to sympathomimetics. Diabetes. Ketoacidosis. Hypokalemia. Blood glucose changes. Evaluate response before altering steroid doses (may still need an antiinflammatory). Prescribe a short-acting, inhaled β2-agonist for acute symptoms; monitor for increased need. Allergy to milk proteins. Do not use with spacers. Labor & delivery. Pregnancy (Cat.C). Nursing mothers.
Avoid MAOIs, tricyclic antidepressants, drugs that prolong QTc interval. Not for use with other long-acting β2-agonists. Hypokalemia potentiated by xanthines, steroids, or diuretics. Antagonized by β-blockers. Sympathetic effects potentiated by additional adrenergics (caution). Risk of arrhythmias with concomitant anesthesia with halogenated hydrocarbons.
Infection, bronchitis, tremor (skeletal muscle), dizziness, insomnia, dysphonia, tonsillitis, paradoxical bronchospasm (discontinue if occurs), β2-agonist effects (eg, hypo- or hypertension, angina, tachycardia, arrhythmias, nervousness, hypokalemia, hyperglycemia, metabolic acidosis); rarely: serious asthma episode, asthma-related death.
Hepatic (CYP2D6, 2C19, 2C9, 2A6).