FORMOTEROL FUMARATE

FORMOTEROL FUMARATE
(for-mo-ter'ol)
Foradil Aerolizer
Classifications: beta-adrenergic agonist; bronchodilator;
Therapeutic: bronchodilator

Prototype: Albuterol
Pregnancy Category: C

Availability

12 mcg inhalation capsules

Action

Long-acting selective beta2-adrenergic receptor agonist. Stimulates production of intracellular cyclic AMP, which causes relaxation of bronchial smooth muscle. Also inhibits release of mediators of immediate hypersensitivity (e.g., histamine and leukotrienes) from mast cells in the lung.

Therapeutic Effect

Acts locally in lung as a bronchodilator; prevents bronchoconstriction that occurs during an asthma attack.

Uses

Treatment of asthma, prevention of exercise induced asthma, prevention of bronchospasm in COPD.

Unlabeled Uses

Bronchitis.

Contraindications

Hypersensitivity to formoterol; significantly worsening or acutely deteriorating asthma; severe asthmatic attacks; paradoxical bronchospasm; pregnancy (category C); lactation; children ≤5 y.

Cautious Use

Cardiovascular disorders (especially coronary insufficiency, cardiac arrhythmias, and hypertension), QT prolongation; convulsive disorders; thyrotoxicosis; heightened responsiveness to sympathomimetic amines; diabetes mellitus.

Route & Dosage

Treatment of Asthma, COPD
Adult/Child (≥5 y): Inhaled Inhale contents of 1 capsule q12h

Prevention of Exercise-Induced Asthma
Adult/Child (≥12 y): Inhaled Inhale contents of 1 capsule at least 15 min before exercise, do not repeat for at least 12 h

Administration

Oral Inhalation
  • Remove capsule from blister IMMEDIATELY before use.
  • Avoid exposing capsules to moisture.
  • Give capsules only by the oral inhalation route and only by using the Aerolizer InhalerTM. Review use of the Aerolizer Inhaler in Patient Instructions for Use provided by manufacturer. Do not use a spacer with the Aerolizer.
  • Instruct patient not to swallow capsule and not to exhale into the Aerolizer.
  • Patients who have been taking the inhaled form, short-acting beta2-agonists regularly (e.g., 3–4 times a day) are usually instructed to use these drugs ONLY for symptomatic relief of acute asthma symptoms. Check with physician.
  • Store capsules in the blister at 20°–25° C (86°–77° F).

Adverse Effects (≥1%)

Body as a Whole: Viral infections, chest infection, chest pain, fatigue. CNS: Headache, tremor, dizziness, insomnia. GI: Abdominal pain, dyspepsia, nausea. Respiratory: Pharyngitis, bronchitis, dyspnea, tonsillitis, dysphonia, fatal exacerbation of asthma. Skin: Rash.

Interactions

Drug: Effects may be antagonized by non-selective beta blockers; xanthines, steroids; diuretics may potentiate hypokalemia.

Pharmacokinetics

Absorption: Rapidly absorbed into plasma after oral inhalation. Onset: 1–3 min. Peak: 1–3 h. Metabolism: Metabolized by glucuronidation in the liver. Elimination: 60% in urine, 33% in feces. Half-Life: 10 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor cardiovascular status with periodic ECG, BP, and HR determinations.
  • Withhold drug and notify physician immediately of S&S of bronchospasm.
  • Lab tests: Monitor serum potassium and blood glucose periodically.
  • Monitor diabetics closely for loss of glycemic control.

Patient & Family Education

  • Do not take this drug more frequently than every 12 h.
  • Use a short-acting inhaler if symptoms develop between doses of formoterol.
  • Seek medical care immediately if a previously effective dosage regimen fails to provide the usual response, or if swelling about the face and neck and difficulty breathing develop.
  • Report any of the following immediately to the physician: Rash, hives, palpitations, chest pain, rapid heart rate, tremor or nervousness.
  • Note to diabetics: Monitor blood glucose levels carefully since hyperglycemia is a possible adverse reaction.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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