Loading...
Loading...
Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Perforomist
Generic Name
Formoterol Fumarate Dihydrate
Active Ingredient
FormoterolCategory
Corticosteroid [EPC]
Salt Form
Fumarate
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 20 ug/2mL | SOLUTION | RESPIRATORY (INHALATION) | 49502-605 |
Detailed information about Perforomist
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Perforomist, you must consult a qualified healthcare professional.
Formoterol is a Long-Acting Beta2-Agonist (LABA) used for the long-term management of asthma and COPD. It works by relaxing airway smooth muscles to improve breathing and is often used in conjunction with inhaled corticosteroids.
The standard dosage of Formoterol for adults depends on the specific condition being treated and the delivery device used.
Formoterol is approved for use in children 5 years of age and older for asthma maintenance and the prevention of EIB.
Specific dosage adjustments for patients with renal impairment have not been established by the manufacturer. However, since a significant portion of the drug is excreted renally, healthcare providers may monitor these patients more closely for systemic side effects.
Formoterol is primarily metabolized in the liver. While there are no specific dose-reduction guidelines for hepatic impairment, patients with severe liver disease (Child-Pugh Class C) should be monitored for increased systemic exposure and potential cardiovascular effects.
No overall differences in safety or effectiveness have been observed between patients over 65 and younger patients. However, older adults may be more sensitive to the sympathomimetic effects (such as increased heart rate or tremors) and should be monitored accordingly.
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and return to your regular dosing schedule. Do not double the dose to catch up. Taking too much Formoterol can lead to serious cardiovascular complications.
Signs of a Formoterol overdose include extreme tremor, chest pain, rapid or irregular heartbeat (tachycardia/arrhythmia), headache, nausea, and vomiting. In severe cases, it can lead to metabolic acidosis, hypokalemia (low potassium), and seizures. If an overdose is suspected, contact a poison control center or seek emergency medical attention immediately.
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop taking the medication without medical guidance, as this could lead to a severe worsening of your respiratory condition.
Common side effects are typically related to the drug's action on the sympathetic nervous system. These may include:
> Warning: Stop taking Formoterol and call your doctor immediately if you experience any of these serious symptoms:
Prolonged use of LABAs like Formoterol can lead to a phenomenon known as 'tachyphylaxis' or tolerance, where the body becomes less responsive to the drug over time. This is why it is essential to remain on an inhaled corticosteroid to manage the underlying disease. Additionally, long-term use of high doses may have minor effects on bone mineral density, though this is much more common with corticosteroids than with LABAs.
In the past, the FDA required a Black Box Warning for all LABAs, including Formoterol, regarding an increased risk of asthma-related death when used alone. However, based on large-scale safety trials (such as the AUSTRI and VESTRI trials), the FDA removed this warning in 2017 for LABAs when used in combination with an inhaled corticosteroid (ICS).
Report any unusual symptoms to your healthcare provider. Monitoring your lung function with a peak flow meter at home may be recommended to track your progress.
Formoterol is a maintenance medication and must not be used to treat acute symptoms of asthma or COPD. You must always have a short-acting rescue inhaler (like albuterol) available for sudden breathing problems. If you find yourself needing your rescue inhaler more often than usual, or if your rescue inhaler is not working as well, contact your doctor immediately, as this may indicate a worsening of your underlying condition.
As of 2024, there is no longer a general Black Box Warning for Formoterol when used in combination with an inhaled corticosteroid. However, the FDA maintains a strict warning that Formoterol must never be used as monotherapy for asthma. Using Formoterol without an inhaled corticosteroid increases the risk of serious asthma-related events, including death. For COPD patients, this specific warning does not apply, as LABA monotherapy is a standard of care for COPD.
Your healthcare provider may perform the following tests while you are taking Formoterol:
Formoterol generally does not interfere with the ability to drive or operate machinery. However, if you experience side effects like dizziness or tremors, you should wait until these symptoms subside before engaging in activities that require focus and coordination.
There is no direct contraindication between alcohol and Formoterol. However, excessive alcohol consumption can increase heart rate and may exacerbate the cardiovascular side effects of Formoterol. It is best to discuss your alcohol intake with your doctor.
Do not stop taking Formoterol suddenly without consulting your doctor. Stopping maintenance therapy can lead to a rapid return of symptoms or a severe asthma attack. If the medication needs to be stopped, your doctor will provide a plan to transition you to other therapies.
> Important: Discuss all your medical conditions, especially heart problems or thyroid issues, with your healthcare provider before starting Formoterol.
Formoterol may affect certain laboratory values:
For each major interaction, the mechanism usually involves either pharmacodynamic antagonism (like beta-blockers) or additive sympathomimetic effects (like MAOIs). Management typically involves dose adjustment or increased monitoring of cardiac and electrolyte parameters.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, including over-the-counter cold medicines which may contain stimulants.
Formoterol must NEVER be used in the following circumstances:
Conditions requiring a careful risk-benefit analysis include:
Patients who have had an allergic reaction to other long-acting beta-agonists (such as salmeterol) or short-acting beta-agonists (such as albuterol) may be at an increased risk of a reaction to Formoterol. Additionally, some powder formulations contain milk proteins (lactose); patients with severe milk protein allergies should avoid these specific products.
> Important: Your healthcare provider will evaluate your complete medical history, including any history of heart rhythm problems or allergies, before prescribing Formoterol.
Formoterol is classified under Pregnancy Category C (based on older FDA labeling). There are no adequate and well-controlled studies of Formoterol in pregnant women. Animal studies have shown some evidence of fetal risk at very high doses.
It is not known whether Formoterol is excreted in human milk. However, because many drugs are excreted in breast milk and because of the potential for serious adverse reactions in nursing infants from Formoterol, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Clinical trials did not identify significant differences in safety or efficacy between patients 65 and older and younger patients. However, geriatric patients are more likely to have underlying cardiovascular disease, which may increase the risk of tachycardia or arrhythmias. Additionally, some elderly patients may have difficulty with the inspiratory flow required for dry powder inhalers.
The pharmacokinetics of Formoterol have not been formally studied in patients with renal impairment. However, since the drug is significantly excreted in the urine, patients with severe renal disease or those on dialysis should be monitored for signs of systemic toxicity.
Formoterol is primarily cleared by the liver. In patients with hepatic impairment, the systemic exposure to the drug may be increased. While no specific dose adjustments are provided in the labeling, caution is advised in patients with severe hepatic cirrhosis.
> Important: Special populations require individualized medical assessment. Always inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding.
Formoterol is a long-acting, selective beta2-adrenergic receptor agonist. Its primary molecular target is the beta2-adrenoceptor located on the smooth muscle cells of the bronchi. Formoterol has a high affinity for these receptors. Once bound, it stimulates the Gs-protein-coupled adenyl cyclase system, increasing the production of cyclic AMP (cAMP). High levels of cAMP lead to the relaxation of bronchial smooth muscle and inhibit the release of mediators of immediate hypersensitivity from mast cells.
Unlike salmeterol, which is a partial agonist, Formoterol is considered a full agonist at the beta2-receptor, which may contribute to its rapid onset of action (1-3 minutes) while maintaining a long duration of effect (12 hours).
The pharmacodynamic effect of Formoterol is characterized by a rapid increase in Forced Expiratory Volume in 1 second (FEV1). The dose-response relationship shows that higher doses provide greater bronchodilation, but also increase the risk of systemic sympathomimetic effects. Tolerance (tachyphylaxis) to the bronchodilatory effects can occur with chronic use, but this is typically not clinically significant when used alongside an inhaled corticosteroid.
| Parameter | Value |
|---|---|
| Bioavailability | ~15-17% (Inhaled portion) |
| Protein Binding | 61% - 64% |
| Half-life | 10 - 14 hours |
| Tmax | 5 - 10 minutes |
| Metabolism | Glucuronidation & O-demethylation (CYP2D6, 2C19) |
| Excretion | Renal 60%, Fecal 40% |
Formoterol is classified as a Long-Acting Beta2-Agonist (LABA). It is distinct from Short-Acting Beta2-Agonists (SABAs) like albuterol due to its long side-chain which allows it to remain in the receptor microenvironment for an extended period. It is also often grouped with 'Bronchodilators' and 'Adrenergic Agonists'.
Common questions about Perforomist
Formoterol is primarily used for the long-term maintenance treatment of asthma and chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis. It works by relaxing the muscles in the airways to improve airflow and prevent symptoms like wheezing and shortness of breath. In asthma patients, it must always be used in combination with an inhaled corticosteroid to ensure safety. It is also used to prevent exercise-induced bronchospasm when taken shortly before physical activity. It is not intended for the relief of sudden, acute breathing problems.
The most frequently reported side effects of Formoterol include tremors (shaking, especially of the hands), headaches, and a dry or irritated throat. Some patients may also experience dizziness, nervousness, or a mild increase in heart rate shortly after inhalation. These symptoms are typical of medications that stimulate beta-receptors and often become less noticeable as your body adjusts to the treatment. If these effects persist or become bothersome, you should consult your healthcare provider. Rare but serious side effects like chest pain or severe allergic reactions require immediate medical attention.
There is no known direct interaction between Formoterol and alcohol that would make it strictly prohibited. However, alcohol can increase your heart rate and may cause dehydration, which could potentially worsen the cardiovascular side effects of Formoterol, such as palpitations or jitteriness. For patients with underlying heart conditions, the combination might place extra strain on the cardiovascular system. It is generally recommended to consume alcohol only in moderation while on this medication. Always discuss your lifestyle habits with your doctor to ensure your treatment plan is safe.
The safety of Formoterol during pregnancy has not been established through definitive clinical trials, and it is generally classified as Category C. This means it should only be used if the potential benefit to the mother outweighs the potential risk to the fetus. Maintaining good asthma control is vital during pregnancy to ensure the fetus receives enough oxygen, so doctors often recommend continuing treatment if necessary. However, because Formoterol can interfere with uterine contractions, its use during the late stages of labor is usually avoided. Always consult your obstetrician and pulmonologist if you are pregnant or planning to conceive.
Formoterol is unique among long-acting bronchodilators because it has a very rapid onset of action, typically beginning to work within 1 to 3 minutes after inhalation. While you may feel an improvement in your breathing almost immediately, the full effect of the medication builds over several doses and lasts for at least 12 hours. Despite its fast onset, it is not approved as a rescue inhaler for acute attacks in the United States. You should continue to use your prescribed short-acting inhaler for sudden flare-ups while using Formoterol for daily maintenance.
You should not stop taking Formoterol suddenly without first speaking to your healthcare provider. Stopping a maintenance respiratory medication can lead to a 'rebound' effect where your asthma or COPD symptoms return quickly and potentially more severely than before. If your condition has improved, your doctor may decide to step down your therapy, but this should be done gradually and under medical supervision. Abrupt discontinuation increases the risk of a serious asthma attack or a COPD exacerbation. Always ensure you have a refill available so you do not run out of medication.
If you miss a dose of Formoterol, you should take it as soon as you remember. However, if it is nearly time for your next scheduled dose, skip the missed dose entirely and continue with your regular morning or evening routine. You should never take two doses at once or use more than the prescribed amount in a 24-hour period to make up for a missed one. Taking extra doses can significantly increase the risk of dangerous side effects, such as a dangerously fast heart rate or low potassium levels. Consistency is key to the effectiveness of this medication.
Weight gain is not a recognized or common side effect of Formoterol itself. Because Formoterol is a beta-agonist and not a steroid, it does not cause the metabolic changes or fluid retention typically associated with oral corticosteroids like prednisone. If you are taking Formoterol as part of a combination inhaler that includes a corticosteroid, the risk of weight gain remains very low because the steroid is inhaled and acts locally in the lungs rather than throughout the whole body. If you notice unexpected weight gain, you should discuss it with your doctor to rule out other causes.
Formoterol can interact with several types of medications, so it is important to provide your doctor with a full list of what you are taking. It should not be used with other long-acting beta-agonists (LABAs) due to the risk of overdose. Caution is required when taking it with certain antidepressants (MAOIs or TCAs), diuretics that lower potassium, or medications that affect your heart rhythm. Beta-blockers, often used for blood pressure or heart issues, can actually block the effects of Formoterol and cause breathing difficulties. Your doctor will carefully review your medications to prevent these interactions.
Yes, Formoterol is available as a generic medication in several forms, including the inhalation solution used with nebulizers. Generic versions of the dry powder inhaler capsules may also be available depending on your region and the specific brand name. Using generic Formoterol can be a cost-effective way to manage chronic respiratory conditions while receiving the same active ingredient and therapeutic benefit as the brand-name versions. You should check with your pharmacist or insurance provider to see which version is covered under your plan and ensure you are comfortable with the delivery device provided.
Other drugs with the same active ingredient (Formoterol)