arformoterol

arformoterol

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

Brovana

(trade name)

Classification

Therapeutic: bronchodilators
Pharmacologic: adrenergics
Pregnancy Category: C

Indications

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

Action

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

bronchodilation.

Pharmacokinetics

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

ROUTEONSETPEAKDURATION
inhalnunknown30 min12 hr

Contraindications/Precautions

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

Respiratory

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

Cardiovascular

  • ECG changes
  • tachycardia

Gastrointestinal

  • vomiting

Dermatologic

  • rash

Fluid and Electrolyte

  • hypokalemia

Hematologic

  • leukocytosis

Musculoskeletal

  • cramps

Neurologic

  • tremor

Miscellaneous

  • hypersensitivity reactions including anaphylaxis
  • fever

Interactions

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.

Route/Dosage

Inhalation (Adults) 15 mcg twice daily via nebulization.

Availability

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)

Implementation

  • 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.

arformoterol

a long-acting adrenergic beta2-agonist, sympathomimetic, and bronchodilator.
indications This drug is used to treat chronic obstructive pulmonary disease, including chronic bronchitis and emphysema.
contraindications Tachydysrhythmias, severe cardiac disease, heart block, actively deteriorating chronic obstructive pulmonary disease, and known hypersensitivity to this drug, sympathomimetics, or racemic formoterol prohibit its use.
adverse effects Adverse effects of this drug include insomnia, headache, dizziness, stimulation, hallucinations, flushing, irritability, palpitations, tachycardia, hypertension, angina, hypotension, dysrhythmias, dry nose, irritation of nose and throat, heartburn, nausea, vomiting, flushing, sweating, anorexia, bad taste/smell changes, hypokalemia, muscle cramps, cough, wheezing, dyspnea, and dry throat. Life-threatening side effects include anaphylaxis and bronchospasm. Common side effects include tremors, anxiety, and restlessness.
References in periodicals archive ?
arformoterol (for nebuliser use), and carmoterol, indacaterol, and new long-acting anticholinergics (10)
24) Although not commercially available at the time when my patients were transitioned to BIS, arformoterol tartrate inhalation solution 15 [micro]g/2 mL (Brovana[R]; Sepracor Inc, Marlborough, MA) also has been shown to be stable physically and chemically when mixed with BIS 0.
A New Drug Application (NDA) for arformoterol tartrate inhalation solution remains under review at the FDA.
At the same time, formoterol and arformoterol can approach the b receptor from the aqueous phase, giving it a rapid onset of action.
Arformoterol - Sepracor has completed more than 100 preclinical studies and 16 clinical studies for arformoterol inhalation solution as a maintenance treatment for COPD.
Currently marketed products include LUNESTA brand eszopiclone, XOPENEX brand levalbuterol HCl Inhalation Solution, XOPENEX HFA brand levalbuterol tartrate Inhalation Aerosol, BROVANA brand arformoterol tartrate Inhalation Solution, OMNARIS brand ciclesonide Nasal Spray and ALVESCO brand ciclesonide HFA Inhalation Aerosol.
Currently marketed products include LUNESTA(R) brand eszopiclone, XOPENEX brand levalbuterol HCl Inhalation Solution, XOPENEX HFA brand levalbuterol tartrate Inhalation Aerosol and BROVANA brand arformoterol tartrate Inhalation Solution.
Brovana, arformoterol tartrate, is the first long-acting bronchodilator to be developed in an inhalation solution for use with a nebulizer, which is a machine that converts liquid medication into a fine mist that is inhaled through a mouthpiece or mask.
Arformoterol -- Sepracor has completed more than 100 preclinical studies and has initiated or completed 16 clinical studies for arformoterol inhalation solution as a maintenance treatment for COPD.
Arformoterol - Sepracor has completed more than 100 preclinical studies and has initiated or completed 16 clinical studies for arformoterol inhalation solution as a maintenance treatment for COPD.
Arformoterol - Sepracor has completed more than 100 preclinical studies and has initiated or completed 15 clinical studies for arformoterol inhalation solution for the treatment of bronchospasm in patients with COPD.
Sunovion's drug development program, together with its corporate development and licensing efforts, has yielded a portfolio of pharmaceutical products including LATUDA([R])brand lurasidone HCl, LUNESTA([R]) brand eszopiclone, XOPENEX([R]) brand levalbuterol HCI Inhalation Solution, XOPENEX HFA([R]) brand levalbuterol tartrate inhalation aerosol, BROVANA([R]) brand arformoterol tartrate inhalation solution, OMNARIS([R]) brand ciclesonide nasal spray and ALVESCO([R])brand ciclesonide HFA inhalation aerosol.