Foradil
formoterol fumarate
Pharmacologic class: Sympathomimetic; long-acting, selective beta2-adrenergic receptor agonist
Therapeutic class: Bronchodilator
Pregnancy risk category C
Action
Stimulates intracellular adenylate cyclase, relaxing bronchial smooth muscle and inhibiting release of mediators of immediate hypersensitivity
Availability
Capsules for oral inhalation (used with Aerolizer inhaler): 12 mcg
Indications and dosages
➣ Long-term maintenance of asthma; prevention or long-term maintenance of bronchospasm in patients with chronic obstructive pulmonary disease
Adults and children ages 5 and older: Contents of 1 capsule inhaled orally via Aerolizer q 12 hours
➣ Acute prevention of exercise-induced bronchospasm (on occasional, as-needed basis)
Adults and children ages 5 and older: Contents of 1 capsule inhaled orally via Aerolizer at least 15 minutes before start of exercise. Wait 12 hours after initial dose before giving repeat dose.
Contraindications
• Hypersensitivity to drug or its components
• Tachyarrhythmias
Precautions
Use cautiously in:
• acute asthma symptoms, deteriorating asthma, cardiovascular disorders, seizure disorders, thyrotoxicosis, diabetes, possible hypokalemia
• patients older than age 75
• labor
• pregnant or breastfeeding patients
• children younger than age 5.
Administration
• Be aware that drug is not intended for acute asthma attacks.
• Use capsules only with Aerolizer inhaler supplied.
• Keep capsules in blister until immediately before use.
See Make sure patient doesn't swallow capsules.
Adverse reactions
CNS: tremor, dizziness, insomnia, anxiety
CV: chest pain
EENT: sinusitis, pharyngitis, tonsillitis
GI: dry mouth
Metabolic: hypokalemia, hyperglycemia
Musculoskeletal: muscle cramps, back pain, leg cramps
Respiratory: bronchitis, chest infection, dyspnea, upper respiratory tract infection, increased sputum
Skin: pruritus, rash
Other: dysphonia, viral infection, fever
Interactions
Drug-drug. Adrenergics: potentiation of formoterol's sympathomimetic effects
Beta-adrenergic blockers: partial or total inhibition of formoterol's effects
Cardiac glycosides, methylxanthines, potassium-wasting diuretics, steroids: potentiation of formoterol's hypokalemic effects, increased risk of arrhythmias
Disopyramide, MAO inhibitors, quinidine, phenothiazines, procainamide, tricyclic antidepressants: prolonged QTc interval, increased risk of ventricular arrhythmias
Halogenated hydrocarbon anesthetics: increased risk of arrhythmias
Levodopa, levothyroxine, oxytocin: impaired cardiac tolerance of formoterol
Drug-diagnostic tests. Blood glucose: increased level
Potassium: decreased level
Drug-behaviors. Alcohol use: impaired cardiac tolerance of formoterol
Patient monitoring
• Monitor pulmonary function test results.
• Monitor potassium and glucose levels.
Patient teaching
• Teach patient how to use capsules and Aerolizer inhaler provided.
• Instruct patient to keep capsules in blisters until immediately before use.
• Caution patient not to swallow capsules.
• Tell patient not to use drug for acute asthma attacks.
See Instruct patient to contact prescriber immediately if difficulty in breathing persists after using drug or if condition worsens.
• Caution patient to take drug exactly as prescribed and not to stop therapy even if he feels better.
• Tell patient to consult prescriber if he has been taking inhaled, short-acting drugs on a regular basis.
• Advise female patient to tell prescriber if she is pregnant or breastfeeding or if she plans to become pregnant.
• Caution patient to avoid alcohol during therapy.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.
formoterol
(for-mo-te-role) formoterol,Foradil
(trade name),Perforomist
(trade name)Classification
Therapeutic: bronchodilatorsPharmacologic: adrenergics
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (bronchodilation)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Inhaln | 15 min | 1–3 hr | 12 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- fatigue
- headache
- insomnia
- malaise
- nervousness
Respiratory
- asthma-related death (life-threatening)
- paradoxical bronchospasm (life-threatening)
Cardiovascular
- angina
- arrhythmias
- hypertension
- hypotension
- palpitations
- tachycardia
Gastrointestinal
- dry mouth
- nausea
Fluid and Electrolyte
- hypokalemia
Metabolic
- hyperglycemia
- metabolic acidosis
Musculoskeletal
- muscle cramps
Neurologic
- tremor
Dermatologic
- rash
Miscellaneous
- allergic reactions including anaphylaxis (life-threatening)
Interactions
Drug-Drug interaction
Concurrent use with MAO inhibitors, tricyclic antidepressants, or other agents that may prolong the QTc interval may result in serious arrhythmias and should be undertaken with extreme caution.↑ risk of hypokalemia with theophylline, corticosteroids, potassium-losing diuretics.Beta blockers may ↓ therapeutic effects.↑ adrenergic effects may occur with concurrent use of adrenergics.Route/Dosage
Asthma
Prevention of Exercise-Induced Bronchospasm
COPD
Availability
Nursing implications
Nursing assessment
- Assess lung sounds, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced. Closely monitor patients on higher dose for adverse effects.
- Monitor pulmonary function tests before initiating and periodically during therapy to determine effectiveness.
- Observe for paradoxical bronchospasm (wheezing, dyspnea, tightness in chest) and hypersensitivity reaction (rash; urticaria; swelling of the face, lips, or eyelids). If condition occurs, withhold medication and notify physician or other health care professional immediately.
- Monitor ECG periodically during therapy. May cause prolonged QTc interval.
- Monitor patient for signs of anaphylaxis (dyspnea, rash, laryngeal edema) throughout therapy.
- Lab Test Considerations: May cause ↑ serum glucose and decreased serum potassium.
Potential Nursing Diagnoses
Ineffective airway clearance (Indications)Implementation
- Do not confuse Foradil with Fortical (calcitonin) or Toradol (ketorolac).
- Formoterol should be used along with an inhaled corticosteroid, not as monotherapy. Patients taking formoterol twice daily should not use additional doses for exercise-induced bronchospasm.
- Inhalation: For use with inhaler: Place capsule in the well of the Aerolizer Inhaler with dry hands; do not expose to moisture. The capsule is pierced by pressing and releasing the buttons on the side of the device. Medication is dispersed into the airstream when patient inhales rapidly and deeply through mouthpiece. Capsules are only to be used with Aerolizer Inhaler and should not be taken orally. Store capsules in the blister and only remove immediately before use. Store inhaler in a level, horizontal position. Aerolizer Inhaler should never be washed and should be kept dry.
- Do not use a spacer with formoterol.
- To use, pull off the Aerolizer cover. Hold the base of the inhaler firmly, and twist mouthpiece in the direction of the arrow to open. Push the buttons in to make sure 4 pins are visible in the capsule well on each side. Remove capsule from blister pack immediately before use. Separate one blistered capsule by tearing at perforations. With foil-side up, fold back along perforation and flatten. Starting at slit, tear off corner; separate and peel foil from paper backing and remove capsule. Place capsule in the capsule chamber in the base of the Aerolizer Inhaler. Never place a capsule directly into the mouthpiece. Twist the mouthpiece back to the closed position. With the mouthpiece upright, simultaneously press both buttons only once. A click should be heard as the capsule is being pierced. Release buttons; if buttons stick in depressed position grasp wings on buttons and retract before inhalation. With patient sitting or standing in a comfortable upright position, exhale fully. Do not exhale into the device. Tilt head back slightly and breathe in rapidly but steadily. A sweet taste will be experienced and a whirring noise heard. If no whirring is heard, the capsule may be stuck. Open inhaler and loosen capsule allowing it to spin freely. Do not repeatedly press buttons to loosen capsule. Hold breath for as long as comfortably possible after removing inhaler from mouth. Open inhaler to see if any powder is still in capsule. If powder is found, repeat inhalation steps. After use, open, remove and discard empty capsule.
- Inhalation: For use with nebulizer: Administer via standard jet nebulizer via mouthpiece or face mask. Remove vial from foil immediately prior to use and discard via after use. May be stored in refrigerator for up to 3 mo.
Patient/Family Teaching
- Instruct patient to take fomoterol as directed. Do not discontinue therapy without discussing with health care professional, even if feeling better. If a dose is missed skip dose and take next dose at regularly scheduled time. Do not double doses. Use a rapid-acting bronchodilator if symptoms occur before next dose is due. Caution patient not to use more than 2 times a day or less than 12 hr apart; may cause adverse effects, paradoxical bronchospasm, or loss of effectiveness of medication. Instruct patient to review medication guide with each Rx refill.
- Advise patient to have a rapid-acting bronchodilator available for use at all times for symptomatic relief of acute asthma attacks.
- Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or nausea, vomiting, shakiness, headache, fast or irregular heartbeat, or sleeplessness occur.
- Instruct patient to notify health care professional if there is no response to the usual dose or if contents of one canister are used in less than 2 wk. Asthma and treatment regimen should be re-evaluated and corticosteroids should be considered. Need for increased use to treat symptoms indicates decrease in asthma control and need to re-evaluate patient’s therapy.
- Advise patient to consult health care professional before taking any Rx, OTC, or herbal products or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
- Advise patient to notify health care professional if pregnancy is planned or suspected, or if nursing.
- Inhaler: Instruct patient on correct technique for use of Aerolizer Inhaler. Advise patient always to use new Aerolizer Inhaler that comes with each refill. Take sticker with "use by" date written by pharmacist from the outside of the box and place it on the Aerolizer Inhaler cover. If the date is blank, count 4 mo from the date of purchase and write date on sticker. Use new inhaler and blister pack following the "use by" date.
- Inform patient that formoterol may increase the risk of asthma-related death.
- Inform patient that in rare cases capsule might break into small pieces. These pieces should be retained by the screen in the inhaler, however in rare instances tiny pieces may reach mouth or throat after inhalation. Shattering of capsule is less likely to happen if storage conditions are strictly followed, capsules removed from blister immediately before use, and capsules are only pierced once.
Evaluation/Desired Outcomes
- Prevention of bronchospasm.