Formoterol: clinical use

Prescribing considerations

• In asthma, use only as add-on therapy to adequate inhaled corticosteroid treatment; it is not sufficient as initial or sole therapy.
• Do not initiate during an acute severe exacerbation or significantly worsening asthma.
• Reassess control, adherence and inhaler technique if symptoms persist, deteriorate or use increases.
• Use cautiously with QT prolongation, thyrotoxicosis, phaeochromocytoma, severe hypertension, significant structural heart disease, tachyarrhythmia or severe heart failure.
• Pharmacokinetic data are unavailable in renal or hepatic impairment; exposure may rise in severe liver cirrhosis.

Contraindications and cautions

• Hypersensitivity to formoterol or an excipient.
• Because the selected powder contains lactose, it should not be used in rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.
• The selected product is not recommended below 6 years because safety and efficacy data are insufficient.

Monitoring

• Clinical response, exacerbations, nocturnal symptoms and changing reliance on bronchodilator treatment.
• Inhaler technique and continued inhaled corticosteroid use in asthma.
• Serum potassium during acute severe asthma or when hypoxia or potassium-lowering medicines increase risk.
• Blood glucose initially in people with diabetes.
• Heart rate, rhythm and relevant cardiovascular symptoms in susceptible patients.

Clinical pharmacology

Formoterol is a selective beta2-adrenoceptor agonist that rapidly relaxes bronchial smooth muscle. After inhalation it is rapidly absorbed and mainly cleared through metabolism, including glucuronidation and O-demethylation.

Formulation and product differences

• The selected product is a multidose, inspiratory-flow-driven dry-powder Turbohaler rather than a pressurised aerosol.
• It contains lactose monohydrate with small amounts of milk protein, which may cause allergic reactions.
• The small quantity of powder means patients may neither taste nor feel delivery.
• Other products include different dry-powder devices, aerosols and combination inhalers; device technique and accompanying active ingredients are not interchangeable.

Inhaled preparation

Route: Inhaled

Strengths: 12 micrograms/actuation, 12 micrograms/dose