Names and pronunciation
(for-moh′ter-ahl) Duaklir Genuair , Foradil Aerolizer , Oxeze , Perforomist, Symbicort , Zenhale
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Drug reference
(for-moh′ter-ahl) Duaklir Genuair , Foradil Aerolizer , Oxeze , Perforomist, Symbicort , Zenhale
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Func. class.: Bronchodilator
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Chem. class.: β-Adrenergic agonist
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Do not confuse: Formoterol/fluticasone Foradil/Toradol
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ACTION: Has β1 and β2 action; relaxes bronchial smooth muscle and dilates the trachea and main bronchi by increasing levels of cAMP, which relaxes smooth mus- cles; causes increased contractility and heart rate by acting on β-receptors in heart
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USES: Maintenance, treatment of F asthma, COPD; prevention of exercise- induced bronchospasm
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CONTRAINDICATIONS: Hyper- sensitivity to sympathomimetics, monother- apy for asthma, COPD, status asthmaticus Precautions: Pregnancy, geriatric patients, cardiac disorders, hyperthyroidism, diabe- tes mellitus, prostatic hypertrophy, hyper- tension, African descent, aneurysm
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Black Box Warning: Asthma-related death Black Box Warning: Asthma-related death, severe asthma exacerbations; if wheezing worsens and cannot be relieved during an acute asthma attack, immediate medical attention should be sought • About correct use of inhaler/nebulizer (review package insert with patient); to avoid getting aerosol in eyes • About all aspects of product; to avoid smoking, smoke-filled rooms, persons with respiratory infections; not to swallow caps
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SIDE EFFECTS CNS: Tremors, anxiety, insomnia, head- ache, dizziness, stimulation CV: Palpitations, tachycardia, hyperten- sion, chest pain GI: Nausea, vomiting, xerostomia RESP: Bronchial irritation, dryness of oropharynx, bronchospasms (overuse), infection, inflammatory reaction (child)
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INTERACTIONS Increase: serious dysrhythmias—MAOIs, tricyclics Increase: hypokalemia—loop/thiazide diuretics Increase: effects of both products—other sympathomimetics, thyroid hormones Increase: QT prolongation—class IA/III anti- arrhythmics, phenothiazines, pimozide, halo- peridol, risperiDONE, sertindole, ziprasidone, amoxapine, arsenic trioxide, chloroquine, cla rithromycin, dasatinib, dolasetron, droperidol, erythromycin, halofantrine, halogenated anesthetics, levomethadyl, maprotiline, meth- adone, some quinolones, ondansetron, pali- peridone, palonosetron, pentamidine, probu- col, ranolazine, SUNItinib, tricyclics, vorinostat Decrease: action when used with β- blockers
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TREATMENT OF OVERDOSE: Administration of β-blocker
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DOSAGE AND ROUTES COPD Adult: NEB Perforomist solution: 20 mcg BID, max 40 mcg/day; Canada: Foradil: Dry powder inhaler: 12 mcg or 24 mcg BID, max 48 mcg/day Asthma Adult: INH: Canada Foradil: Dry powder inhaler: 12 mcg q12hr; in severe cases, 24 mcg q12 hr, max 48 mcg daily; Oxeze Turbuhaler: Dry powder inhaler: 6 mcg or 12 mcg q12 hr max 48 mcg daily Available form: INH powder in cap 12 mcg (Foradol Aerolizer); nebulizer sol for INH 20 mcg/2 mL (Perforomist); powder for oral inhalation (Oxeze Tur- buhaler) 6 mcg/inh, 12 mcg/inh
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Administer: Inhalation route • Place cap in Aerolizer inhaler; cap is punctured; do not wash Aerolizer inhaler • Pull off cover, twist mouthpiece to open, push buttons in; make sure the 4 pins are visible; remove cap from blister pack, place cap in chamber; twist to close, press (a click will be heard), re- lease; patient should exhale, place in- haler in mouth, inhale rapidly • Store at room temperature; protect from heat, moisture
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Assess: • Respiratory function: B/P, pulse, lung sounds; note sputum color, character; respiratory function tests before, during treatment; be alert for bronchospasm, which may occur with this patient • Cardiac status: hypertension, palpita- tions, tachycardia; if CV reactions occur, product may need to be discontinued • For paresthesias, coldness of extremi- ties; peripheral blood flow may decrease • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; use caution in breastfeeding, excretion unknown
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Evaluate: • Therapeutic response: ease of breathing
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CLINICAL CONSIDERATIONS
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Patient and caregiver information:
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PHARMACOKINETICS Bronchodilation: Onset 15 min; peak 1-3 hr; duration 12 hr; metabolized in liver, lungs, GI tract; half-life 10 hr
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