Formoterol Fumarate
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formoterol fumarate (for moh' te rol) Foradil Aerolizer Pregnancy Category C Drug classes
Beta2 agonist Asthmatic Therapeutic actions
Long-acting agonist that binds to beta2 receptors in the lungs causing bronchodilation; may also inhibit the release of inflammatory mediators in the lung, blocking swelling and inflammation. Indications
• • •
Long-term maintenance treatment of asthma in adults and children > 5 yr Prevention of exercise-induced bronchospasm in adults and children > 12 yr when used on an occasional, as-needed basis Long-term maintenance treatment of bronchoconstriction in patients with COPD
Contraindications and cautions
• •
Contraindicated with hypersensitivity to adrenergics, amines, or to formoterol, acute asthma attack, acute airway obstruction. Use cautiously in the elderly, with pregnancy, lactation.
Available forms
Inhalation powder in capsules—12 mcg Dosages ADULTS
•
Maintenance treatment of COPD: Oral inhalation of contents of 1 capsule (12 mcg) using Aerolizer Inhaler q 12 hr. Do not exceed a total daily dose of 24 mcg.
ADULTS AND CHILDREN > 5 YR
•
Maintenance treatment of asthma: Oral inhalation of contents of 1 capsule (12 mcg) using the Aerolizer Inhaler every 12 hr. Do not exceed 1 capsule every 12 hr.
ADULTS AND CHILDREN > 12 YR
•
Prevention of exercise-induced bronchospasm: Oral inhalation of contents of 1 capsule (12 mcg) using the Aerolizer Inhaler 15 min before exercise. Use on an occasional, as-needed basis.
Pharmacokinetics Route Inhalation
Onset 1–3 min
Peak 1–3 hr
Metabolism: Hepatic; T1/2: 10–14 hr
Duration 8–20 hr
Distribution: Crosses placenta; may enter breast milk Excretion: Feces, urine Adverse effects
• • • • •
CNS: Tremor, dizziness, insomnia, dysphonia, headache, nervousness CV: Hypertension, tachycardia, chest pain GI: Nausea, dyspepsia, abdominal pain, irritation of the throat and mouth Respiratory: Bronchitis, respiratory infection, dyspnea, tonsillitis Other: Viral infection (most likely in children)
Nursing considerations CLINICAL ALERT!
Name confusion has occurred between Foradil (formoterol) and Toradol (ketorolac); use extreme caution. Assessment
• •
History: Hypersensitivity to adrenergics, amines, or formoterol, acute asthma attack, acute airway obstruction, pregnancy, lactation Physical: R, adventitious sounds, P, BP, ECG, orientation, reflexes
Interventions
• •
• • • • •
Instruct patient in the proper use of Aerolizer Inhaler. Ensure that patient does not swallow the capsule. Monitor use of inhaler. Patient should not wash the inhaler but should keep it dry; it should not be used for delivering any other medication. If a bronchodilator is needed between doses, consult with health care provider. Do not use more often than every 12 hr. Encourage patient who experiences exercise-induced asthma to use drug 15 min before activity, and to reserve this drug for occasional, as-needed use. Ensure that patient continues with appropriate use of corticosteroids or other drugs used to block bronchospasm, as appropriate. Arrange for periodic evaluation of respiratory condition during therapy. Arrange for analgesics as appropriate for headache. Establish safety precautions if tremor becomes a problem.
Teaching points
• • •
Use the Aerolizer Inhaler as instructed. This is the only inhaler that can be used with this drug. Use only twice a day. Do not wash the inhaler; keep it dry at all times. Do not use this inhaler to deliver any other drugs. Check the "use by" date on your drug and discard any capsules that have expired. If drug is to be used periodically for exercise-induced asthma, use 15 min before activity.
• • •
Arrange for periodic evaluation of your respiratory problem while using this drug; continue to use any other therapies that have been prescribed to control your asthma. These side effects may occur: Headache (appropriate analgesics may be ordered); tremors (use care in performing dangerous tasks if this occurs); fast heartbeat, palpitations (monitor activity if this occurs, rest frequently). Report severe headache, irregular heartbeat, worsening of asthma, difficulty breathing.
Adverse effects in Italic are most common; those in Bold are life-threatening.
Beta2 agonist Asthmatic Therapeutic actions
Long-acting agonist that binds to beta2 receptors in the lungs causing bronchodilation; may also inhibit the release of inflammatory mediators in the lung, blocking swelling and inflammation. Indications
• • •
Long-term maintenance treatment of asthma in adults and children > 5 yr Prevention of exercise-induced bronchospasm in adults and children > 12 yr when used on an occasional, as-needed basis Long-term maintenance treatment of bronchoconstriction in patients with COPD
Contraindications and cautions
• •
Contraindicated with hypersensitivity to adrenergics, amines, or to formoterol, acute asthma attack, acute airway obstruction. Use cautiously in the elderly, with pregnancy, lactation.
Available forms
Inhalation powder in capsules—12 mcg Dosages ADULTS
•
Maintenance treatment of COPD: Oral inhalation of contents of 1 capsule (12 mcg) using Aerolizer Inhaler q 12 hr. Do not exceed a total daily dose of 24 mcg.
ADULTS AND CHILDREN > 5 YR
•
Maintenance treatment of asthma: Oral inhalation of contents of 1 capsule (12 mcg) using the Aerolizer Inhaler every 12 hr. Do not exceed 1 capsule every 12 hr.
ADULTS AND CHILDREN > 12 YR
•
Prevention of exercise-induced bronchospasm: Oral inhalation of contents of 1 capsule (12 mcg) using the Aerolizer Inhaler 15 min before exercise. Use on an occasional, as-needed basis.
Pharmacokinetics Route Inhalation
Onset 1–3 min
Peak 1–3 hr
Metabolism: Hepatic; T1/2: 10–14 hr
Duration 8–20 hr
Distribution: Crosses placenta; may enter breast milk Excretion: Feces, urine Adverse effects
• • • • •
CNS: Tremor, dizziness, insomnia, dysphonia, headache, nervousness CV: Hypertension, tachycardia, chest pain GI: Nausea, dyspepsia, abdominal pain, irritation of the throat and mouth Respiratory: Bronchitis, respiratory infection, dyspnea, tonsillitis Other: Viral infection (most likely in children)
Nursing considerations CLINICAL ALERT!
Name confusion has occurred between Foradil (formoterol) and Toradol (ketorolac); use extreme caution. Assessment
• •
History: Hypersensitivity to adrenergics, amines, or formoterol, acute asthma attack, acute airway obstruction, pregnancy, lactation Physical: R, adventitious sounds, P, BP, ECG, orientation, reflexes
Interventions
• •
• • • • •
Instruct patient in the proper use of Aerolizer Inhaler. Ensure that patient does not swallow the capsule. Monitor use of inhaler. Patient should not wash the inhaler but should keep it dry; it should not be used for delivering any other medication. If a bronchodilator is needed between doses, consult with health care provider. Do not use more often than every 12 hr. Encourage patient who experiences exercise-induced asthma to use drug 15 min before activity, and to reserve this drug for occasional, as-needed use. Ensure that patient continues with appropriate use of corticosteroids or other drugs used to block bronchospasm, as appropriate. Arrange for periodic evaluation of respiratory condition during therapy. Arrange for analgesics as appropriate for headache. Establish safety precautions if tremor becomes a problem.
Teaching points
• • •
Use the Aerolizer Inhaler as instructed. This is the only inhaler that can be used with this drug. Use only twice a day. Do not wash the inhaler; keep it dry at all times. Do not use this inhaler to deliver any other drugs. Check the "use by" date on your drug and discard any capsules that have expired. If drug is to be used periodically for exercise-induced asthma, use 15 min before activity.
• • •
Arrange for periodic evaluation of your respiratory problem while using this drug; continue to use any other therapies that have been prescribed to control your asthma. These side effects may occur: Headache (appropriate analgesics may be ordered); tremors (use care in performing dangerous tasks if this occurs); fast heartbeat, palpitations (monitor activity if this occurs, rest frequently). Report severe headache, irregular heartbeat, worsening of asthma, difficulty breathing.
Adverse effects in Italic are most common; those in Bold are life-threatening.
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