(al-fer-mo-te-rol) ,


(trade name)


Therapeutic: bronchodilators
Pharmacologic: adrenergics
Pregnancy Category: C


Maintenance treatment to prevent bronchospasm in chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema.


Produces accumulation of cyclic adenosine monophosphate (cAMP) at beta-adrenergic receptors, resulting in relaxation of airway smooth muscle. Relatively specific for beta2 (pulmonary) receptors.

Therapeutic effects



Absorption: Some systemic absorption occurs from pulmonary sites.
Distribution: Unknown.
Metabolism and Excretion: Mostly metabolized by the liver; 1% excreted unchanged in urine.
Half-life: 26 hr.

Time/action profile

inhalnunknown30 min12 hr


Contraindicated in: Hypersensitivity; Acutely deteriorating COPD (onset of action is delayed); Pediatric: Safety not established; Concurrent use of other long-acting beta2 agonist bronchodilators.
Use Cautiously in: Cardiovascular disorders including coronary insufficiency, arrhythmias and hypertension; Hepatic impairment; Geriatric: May be more sensitive to drug effects; Obstetric / Lactation: Safety not established; use only when maternal benefit outweighs fetal risk, may inhibit contractions during labor.

Adverse Reactions/Side Effects

Central nervous system

  • headache
  • insomnia
  • nervousness
  • weakness


  • asthma-related death (life-threatening)
  • paradoxical bronchospasm (life-threatening)


  • ECG changes
  • tachycardia


  • vomiting


  • rash

Fluid and Electrolyte

  • hypokalemia


  • leukocytosis


  • cramps


  • tremor


  • hypersensitivity reactions including anaphylaxis
  • fever


Drug-Drug interaction

Concurrent use with MAO inhibitors, tricyclic antidepressants or other agents that may prolong the QTc interval may result in serious arrhythmias and should be undertaken with extreme caution.↑ risk of hypokalemia with theophylline, corticosteroids, potassium-losing diuretics.Beta blockers may ↓ therapeutic effects.↑ adrenergic effects may occur with concurrent use of adrenergics.


Inhalation (Adults) 15 mcg twice daily via nebulization.


Inhalation solution for nebulization: 15 mcg/2 mL

Nursing implications

Nursing assessment

  • Assess lung sounds, pulse, and BP before administration and periodically during therapy.
  • Monitor pulmonary function tests before initiating therapy and periodically during therapy to determine effectiveness of medication.
  • Observe for paradoxical bronchospasm (wheezing, dyspnea, tightness in chest) and hypersensitivity reaction (rash; urticaria; swelling of the face, lips, or eyelids). If condition occurs, withhold medication and notify physician or other health care professional immediately.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)


  • Inhalation: Administer twice daily, approximately 12 hrs apart. Solution is colorless; do not administer discolored solutions. Do not administer beyond expiration date. Do not mix with other drugs in nebulizer. Administer by inhalation only; do not inject or swallow medication.

Patient/Family Teaching

  • Instruct patient on proper technique use and advise patient to take arformoterol as directed. Do not use more than the prescribed dose. If a regularly scheduled dose is missed, skip the dose and resume regular schedule. Do not double doses. If symptoms occur before next dose is due, use a rapid-acting inhaled bronchodilator (e.g. albuterol). See for nebulizer instructions.
  • Inform patient that arformoterol may increase the risk of asthma-related death.
  • Advise patients who have been taking short-acting beta2 agonists regularly to discontinue regular use and use only for symptomatic relief of acute respiratory symptoms.
  • Caution patient not to use arformoterol to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator should be kept on hand and used for relief of acute asthma attacks.
  • Advise patient to notify health care professional immediately if difficulty in breathing persists after use of arformoterol, if condition worsens, if more inhalations of rapid-acting bronchodilator than usual are needed to relieve an acute attack.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Decreased dyspnea.
  • Improved breath sounds.


a trademark for arformoterol.
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