Formoterol
PERFOROMIST
Pronunciation: for-MOE-ter-ol
“Formal aerosol”
What it isLong-acting beta-2 agonist with rapid onset; nebulized PERFOROMIST is twice-daily COPD maintenance, and in asthma it is used only inside an inhaled-corticosteroid combination.
Why this oneIts rapid onset lets an inhaled-corticosteroid combination serve as both maintenance and reliever.
What limits itNever use it alone in asthma. Excess exposure causes tachycardia, tremor, and hypokalemia.
Formoterol prescription history
Animated chart of estimated U.S. prescriptions per year, Asthma/COPD meds (1924–2026). Formoterol enters in 2007 (estimated).
FDA-approved for
- asthma/COPD (2001)
Principal riskNever as monotherapy in asthma
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| COPD maintenance (bronchoconstriction; chronic bronchitis, emphysema) | Adults | 20 mcg (one 2 mL unit-dose vial) nebulized q12h (morning and evening) | 20 mcg BID | 40 mcg/day (total daily dose >40 mcg not recommended) |
Renal Undefined
Hepatic Undefined
Not indicated for asthma or for acute COPD deterioration. If the usual response fails, seek medical advice immediately (sign of COPD destabilization); do not increase beyond 20 mcg BID.
Instructions
- Oral inhalation only, via standard jet nebulizer (facemask or mouthpiece) connected to an air compressor; non-compressor nebulizers not established.
- Keep vial in foil pouch until immediately before use; discard any partially used vial.
- Do not mix with other drugs in the nebulizer (compatibility not established).
- Not for acute symptoms — prescribe a short-acting beta2-agonist for rescue; stop regular SABA use when starting.
- Storage: refrigerate 2°C to 8°C before dispensing; after dispensing refrigerate, or room temperature 20°C to 25°C and discard if not used after 3 months; protect pouch from light and heat.
Available strengths
- sol 0.02 mg/2 mL
Contraindications
- Use of a LABA without an inhaled corticosteroid in patients with asthma (not indicated for asthma)
Cautions
- Serious asthma-related events (LABA monotherapy in asthma) — hospitalization, intubation, death
- Deterioration of disease and acute episodes — do not initiate in acutely deteriorating COPD; not for rescue
- Excessive use or use with other LABAs
- Paradoxical bronchospasm
- Cardiovascular effects (pulse, BP, ECG changes)
- Coexisting conditions (convulsive disorders, thyrotoxicosis, sympathomimetic sensitivity)
- Hypokalemia and hyperglycemia
- Immediate hypersensitivity reactions
Adverse reactions
- Diarrhea
- Nausea
- Nasopharyngitis
- Dry mouth
- Vomiting
- Dizziness
- Insomnia
Pregnancy Limited human data; beta-agonists may interfere with uterine contractility; oral formoterol in animals caused malformations, decreased fetal weight and neonatal mortality at large multiples of the MRHD.
Lactation Unknown whether excreted in human milk (excreted in rat milk); weigh breastfeeding benefits against maternal need.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 0.02 mg/2 mL | sol | per unit | $1.30/mL | offered |
Available combined with: budesonide / formoterol · budesonide / glycopyrrolate / formoterol
Generic entry2021
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Self-check
- Why can an ICS–formoterol combination serve as a reliever?
Formoterol has rapid onset. - May formoterol be used alone in asthma?
No.