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Asthma / COPD Pregnancy: Use with caution — LABA use in pregnancy generally acceptable for asthma control; uncontrolled asthma poses greater risk than treatment

Formoterol

Brand names: Oxis Turbohaler, Foradil, Atimos Modulite

Adult dose

Dose: 6-12 micrograms twice daily (maintenance); 6-12 mcg as-needed (MART regimen with ICS-formoterol)
Route: Inhalation
Frequency: Twice daily (maintenance); as-needed in MART regimen
Max: 48-72 micrograms/day
Long-acting beta-2 agonist (LABA). Rapid onset (1-3 min) — used as maintenance AND reliever in MART/AIR strategy with ICS-formoterol inhalers. NEVER use as monotherapy without ICS in asthma.

Paediatric dose

Route: Inhalation
Frequency: Twice daily
Max: 24 micrograms/day
Licensed from age 6 (asthma): 6-12 mcg BD. MART regimen used in children 12+ years. Always with ICS in asthma — never LABA monotherapy.

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Clinical pearls

  • Formoterol is unique among LABAs: rapid onset (1-3 min) comparable to salbutamol, making it suitable as maintenance AND reliever (MART/AIR) — salmeterol cannot be used this way (slow onset)
  • GINA 2024: preferred reliever in all steps of asthma is low-dose ICS-formoterol (not SABA) — reduces exacerbation risk vs SABA-only relief
  • SMART trial (FDA 2006): salmeterol monotherapy associated with increased asthma-related deaths — led to black box warning for all LABAs; must always use with ICS in asthma
  • In COPD: formoterol alone (Oxis/Atimos) is an option for LABA monotherapy candidates; most benefit from LABA/LAMA combinations
  • Hypokalaemia: check potassium in patients on high-dose formoterol with concurrent corticosteroids and loop diuretics — clinically significant hypokalaemia possible

Contraindications

  • LABA monotherapy in asthma without concurrent ICS (increased asthma-related death — SMART trial history)
  • Hypersensitivity to formoterol or lactose

Side effects

  • Tremor
  • Palpitations/tachycardia
  • Headache
  • Hypokalaemia (especially with high doses or combined with corticosteroids/diuretics)
  • QTc prolongation (dose-dependent)
  • Muscle cramps
  • Paradoxical bronchospasm

Interactions

  • Non-selective beta-blockers — block bronchodilator effect; avoid in asthma/COPD
  • QTc-prolonging drugs — additive risk at high doses
  • Potassium-depleting drugs (loop diuretics, corticosteroids, theophylline) — hypokalaemia risk
  • MAOIs/tricyclics — potentiate cardiovascular effects

Monitoring

  • Potassium (high-dose use or co-prescribed diuretics/corticosteroids)
  • Heart rate and rhythm
  • Inhaler technique
  • Peak flow/spirometry
  • Asthma control assessment

Reference: BNFc; BNF 90; BNFc; GINA 2024; GOLD 2024; NICE NG80 (Asthma); NICE NG115 (COPD); SPC Oxis Turbohaler. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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