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.
Absorption: Some systemic absorption occurs from pulmonary sites.
Metabolism and Excretion: Mostly metabolized by the liver; 1% excreted unchanged in urine.
Half-life: 26 hr.
|inhaln||unknown||30 min||12 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
- asthma-related death (life-threatening)
- paradoxical bronchospasm (life-threatening)
- ECG changes
Fluid and Electrolyte
- hypersensitivity reactions including anaphylaxis
Drug-Drug interactionConcurrent 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
- 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 DiagnosesIneffective 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.
- 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.
- Decreased dyspnea.
- Improved breath sounds.