Arformoterol

BROVANA

What it isNebulized long-acting beta-2 agonist; maintenance bronchodilation in COPD.

Why this oneAs formoterol's active enantiomer, it has not shown a consistent clinical advantage over nebulized racemic formoterol.

What limits itIt is maintenance only and never asthma monotherapy; tachycardia, tremor, and hypokalemia reflect excess beta agonism.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Long-term maintenance of bronchoconstriction in COPD (chronic bronchitis/emphysema)	adults, by nebulization	15 mcg BID	15 mcg BID	30 mcg/day

Renal No adjustment needed

Hepatic No dose adjustment; clearance prolonged — monitor closely.

Do not exceed 30 mcg/day (15 mcg BID).

Oral inhalation only via standard jet nebulizer with air compressor; do not swallow.
Do not mix with other drugs in the nebulizer.
Store refrigerated in foil pouch; use opened vial right away.
Not for acute symptoms — use a short-acting beta2-agonist as needed.
Not indicated for asthma.

LABA monotherapy increases risk of serious asthma-related events (class effect)
Do not initiate in acutely deteriorating COPD
Do not exceed dose or combine with other LABAs — clinically significant, possibly fatal cardiovascular effects
Life-threatening paradoxical bronchospasm — discontinue
Caution in cardiovascular or convulsive disorders, thyrotoxicosis, sympathomimetic sensitivity
Hypokalemia and hyperglycemia

Pregnancy No adequate studies; use only if benefit outweighs risk (animal teratogenicity at high oral exposures).

Lactation Undefined

NO BOXED WARNINGS

Principal riskNever as monotherapy in asthma

Cost, est. cash$30–$500/month

Generic entry2021

Therapeutic safety burden1 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.