BSN Tracker

formoterol

Brand: Foradil, Perforomist

⚠ BBW Prototype: salmeterol
Drug Class: bronchodilator
Drug Family: bronchodilator
Subclass: long-acting beta-2 agonist (LABA)
Organ Systems: respiratory

Mechanism of Action

LABA with faster onset than salmeterol (2-3 min vs 10-20 min); 12-hour duration; used as rescue with ICS in ICS-formoterol combination (budesonide-formoterol).

beta-2 adrenergic receptor

Indications

  • asthma maintenance (with ICS — never monotherapy)
  • COPD
  • used as rescue in ICS-formoterol combination (GINA preferred reliever)

Contraindications

  • asthma as monotherapy

Adverse Effects

Common

  • tachycardia
  • tremor
  • hypokalemia

Serious

  • paradoxical bronchospasm
  • CV events

Pharmacokinetics (ADME)

Absorption inhaled
Distribution local pulmonary
Metabolism hepatic
Excretion fecal
Half-life 10 hours
Onset 2-3 min (faster than salmeterol)
Peak 1-2 hours
Duration 12 hours
Protein Binding low
Vd local

Drug Interactions

Drug / Agent Mechanism Severity
beta-blockers antagonize bronchodilation major

Nursing Considerations

  1. ICS-formoterol (Symbicort) is the GINA-preferred reliever in mild-moderate asthma (MART strategy)
  2. Never use as monotherapy in asthma
  3. Faster onset than salmeterol makes it useful in ICS-formoterol rescue regimens

Clinical Pearls

  • GINA 2024: ICS-formoterol (Symbicort) is preferred reliever over SABA alone in Steps 1-4
  • MART strategy (Maintenance and Reliever Therapy): single ICS-formoterol inhaler for both maintenance and relief

Safety Profile

Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Asthma Maintenance (with ICS — Never Monotherapy) Bronchodilator COPD Used As Rescue In ICS-formoterol Combination (GINA Preferred Reliever)
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