Formoterol fumarate

How it works

It stimulates beta-2 adrenoceptors on airway smooth muscle, increasing cyclic AMP and producing prolonged bronchodilation, with a faster onset than some other long-acting agents.

Prescribing in practice

• In asthma it must always be used together with an inhaled corticosteroid and never as monotherapy, owing to the risk of asthma-related serious events with LABA monotherapy.
• It can cause dose-related tremor, palpitations and hypokalaemia, particularly with high doses or concomitant hypokalaemia-inducing drugs.
• Use with caution in patients with cardiovascular disease, arrhythmias or prolonged QT interval.

Monitoring

Monitor symptom control and for adverse effects such as tremor, tachycardia and serum potassium where high doses or risk factors are present.

Counselling the patient

• In asthma, always continue your steroid preventer inhaler alongside this medicine.
• Report worsening breathlessness or increasing need for your inhalers.
• Some shakiness or a faster heartbeat can occur and usually settles.

Evidence & guidelines

MHRA and asthma guidance require long-acting beta-2 agonists to be co-prescribed with an inhaled corticosteroid in asthma to reduce the risk of serious events.