Pharmacology Update
Formoterol—A New Long-acting Beta Agonist Inhaler
By William T. Elliott, MD, FACP and James Chan, PharmD, PhD
The fda recently approved formoterol inhalation powder, a long-acting, inhaled selective beta-2 adrenergic agonist. The drug is the second long-acting beta agonist on the market along with salmeterol (Serevent). Formoterol is approved for the maintenance treatment of asthma and the prevention of exercise-induced bronchospasm. Formoterol, which has been available in Europe, is marketed as Foradil by Novartis Pharmaceuticals.
Indications
Formoterol is indicated for the long-term maintenance of asthma and the prevention of bronchospasm in adults and children 5 years of age and older. It is also indicated for the acute prevention of exercise-induced bronchospasm in adults and children 12 years of age and older.1
Dosage
For the long-term maintenance of asthma, the usual dose is inhalation of the contents of 1 capsule (12 mcg) every 12 hours. The total daily dose should not exceed 2 capsules per day. For the prevention of exercise-induced bronchospasm the dose is 1 capsule (12 mcg) at least 15 minutes before exercise.
Formoterol is available as 12 mcg capsules and is administered with the Aerolizer Inhaler.
Potential Advantages
Formoterol has a faster onset of action than salmeterol.2 There have been a few case reports of patients with preferential response to formoterol compared to salmeterol.8,9
Potential Disadvantages
Some may find the inhalation of dry powder difficult, especially if they are accustomed to aerosolized inhalers. Since the delivery system is self actuated, drug delivery is sensitive to the patient’s inspiratory flow rate.4
Formoterol may have a greater potential to cause side effects such as tremors and effect on Q-T interval compared to salmeterol.3
Comments
Formoterol is the second long-acting selective beta-2 adrenergic agonist approved for the long-term treatment of asthma. It is administered as a dry powder and does not use a CFC propellant. Salmeterol is available both as an aerosol and dry powder.
These drugs appear to be comparable in improving pulmonary function in asthmatics in single-dose trials.2,3 The primary difference between formoterol and salmeterol is the faster onset of action of the formoterol which is similar to that of albuterol. With daily twice-daily dosing, the benefit of faster onset may be negligible. Despite its faster onset of action, formoterol is not recommended for rescue use as its long duration of action may mask signs of more serious asthma.2 However, the faster onset of action of formoterol may be advantageous for the prevention of exercise-induced bronchospasm. In contrast to salmeterol, formoterol has not been approved for the maintenance treatment of bronchospasm of chronic obstructive pulmonary disease but appears to be equally effective.5,6
Both drugs are priced similary with a 30-day cost of about $70.
Clinical Implications
Long-acting beta agonists such as salmeterol and formoterol are recommended as alternatives to medium- dose inhaled corticosteroids in the long-term management of moderate to persistent asthma.7 Formoterol provides a safe and effective alternative to salmeterol. Both are approved for use in adults and children, although salmeterol is approved down to the age of 4 compared to 5 for formoterol.
References
1. Foradil Product Information. Novartis Pharmaceutical, Inc. February 2001.
2. Barlow RA, RN Brogden. Drugs. 1998;55:303-322.
3. Palmqvist M, et al. Am J Respir Crit Care Med. 1999; 160:244-249.
4. Nielsen KG, et al. Eur Respir. 1997;10:2105-2109.
5. Celik G, et al. Respiration. 1999;66:434-439.
6. Cazzola M, Donner CF. Drugs. 2000;60:307-320.
7. National Institute of Health. Guidelines for the Diagnoses and Management of Asthma. Expert Panel Report 2. July 1997.
8. Noppen M, Vinckin W. Respiration. 2000;67:112-113.
9. Ulrik CS, Kok-Jensen A. Eur Respir. 1994;7:
1003-1005.
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