Formoterol

Foradil / Perforomist / Symbicort (with budesonide)

bronchodilator labainhaled (dry powder — Aerolizer) · inhaled (SVN — Perforomist)Onset: 1–3 minutes (faster than salmeterol)Duration: 12 hours

Mechanism of Action

Long-acting selective beta-2 agonist. Faster onset than salmeterol due to partial hydrophilicity. Activates adenylyl cyclase → cAMP → airway smooth muscle relaxation.

Dosing

Adult

Foradil: 12 mcg q12h via Aerolizer. Perforomist (SVN): 20 mcg/2 mL q12h

Pediatric

≥5 years: 12 mcg q12h (asthma — with ICS)

Indications

COPD maintenance
Asthma maintenance (with ICS — NEVER monotherapy)
Prevention of exercise-induced bronchospasm

Contraindications

Monotherapy in asthma (black box warning)
Acute bronchospasm
Hypersensitivity to formoterol

Side Effects

Tachycardia
Tremor
Hypokalemia
Hyperglycemia
Prolonged QTc

Monitoring Parameters

Heart rate and QTc
Serum potassium
Blood glucose
Asthma/COPD symptom control

Drug Interactions

Beta-blockers
MAOIs
QT-prolonging drugs
Non-potassium-sparing diuretics

Clinical Pearls

Faster onset than salmeterol — may bridge rescue and maintenance
BLACK BOX WARNING in asthma: must use with ICS
Combined with budesonide in Symbicort
Available as nebulizer solution (Perforomist) — useful for patients unable to use MDI/DPI
Aerolizer capsules — must NOT be swallowed

Mnemonic

💡 Formoterol = Fast LABA (onset 1–3 min vs salmeterol's 10–20 min)

NBRC High-Yield

LABA — faster onset than salmeterol (1–3 min vs 10–20 min)
Still a maintenance drug — not recommended for acute rescue
Black box warning: monotherapy in asthma increases death risk
Available as SVN solution (Perforomist) — useful for ventilated or elderly patients
Combined with budesonide = Symbicort

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