glycopyrrolate inhaled/formoterol (Rx)

Brand and Other Names:Bevespi Aerosphere
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

glycopyrrolate/formoterol fumarate

inhalation aerosol

  • (9mcg/4.8mcg)/inhalation

Chronic Obstructive Pulmonary Disease (COPD)

Combination inhalant containing long-acting muscarinic antagonist (LAMA) plus a long-acting beta2-agonist (LABA) indicated for the long-term, maintenance treatment of airflow obstruction with COPD, including chronic bronchitis and/or emphysema

2 inhalations (ie, 18 mcg/9.6 mcg) PO BID (morning and evening)

Do not exceed 2 inhalations BID

Dosage Modifications

Renal impairment

  • Studies not conducted
  • Severe (CrCl ≤30 mL/min/1.73 m²) or end-stage renal disease requiring dialysis: Use only if expected benefit outweighs the potential risk

Hepatic impairment

  • Studies not conducted
  • Since formoterol fumarate is predominantly cleared by hepatic metabolism, impairment may lead to plasma formoterol accumulation; monitor closely

Dosing Considerations

Limitations of use: Not indicated for the relief of acute bronchospasm or for the treatment of asthma

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and glycopyrrolate inhaled/formoterol

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    Contraindicated

      Serious - Use Alternative

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            Contraindicated (1)

            • umeclidinium bromide/vilanterol inhaled

              glycopyrrolate inhaled, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Duplicate therapy.

            Serious - Use Alternative (66)

            • amisulpride

              amisulpride and formoterol both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

            • amitriptyline

              amitriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              amitriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amoxapine

              amoxapine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              amoxapine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • arformoterol

              arformoterol and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether/lumefantrine

              formoterol and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • chlorpromazine

              chlorpromazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              clarithromycin and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • clomipramine

              clomipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              clomipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • desipramine

              desipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              desipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • disopyramide

              disopyramide and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • dofetilide

              dofetilide and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • doxepin

              doxepin and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              doxepin, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dronedarone

              dronedarone and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • droperidol

              droperidol and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              formoterol and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • epinephrine

              epinephrine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • epinephrine racemic

              epinephrine racemic and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin base

              erythromycin base and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              erythromycin lactobionate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin stearate

              erythromycin stearate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

            • fluconazole

              fluconazole and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • fluphenazine

              fluphenazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • glasdegib

              formoterol and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • glucagon

              glucagon increases toxicity of glycopyrrolate inhaled by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

            • glucagon intranasal

              glucagon intranasal increases toxicity of glycopyrrolate inhaled by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

            • haloperidol

              formoterol and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • ibutilide

              formoterol and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • imipramine

              imipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              imipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • indapamide

              formoterol and indapamide both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              inotuzumab and formoterol both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

            • isocarboxazid

              isocarboxazid increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • ivosidenib

              ivosidenib and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

            • ketoconazole

              formoterol and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • levoketoconazole

              formoterol and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • linezolid

              linezolid increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • lofepramine

              lofepramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              lofepramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • lumefantrine

              formoterol and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              macimorelin and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • maprotiline

              maprotiline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              maprotiline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • mobocertinib

              mobocertinib and formoterol both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • moxifloxacin

              formoterol and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • nilotinib

              formoterol and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

            • nortriptyline

              nortriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              nortriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • octreotide

              formoterol and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

            • octreotide (Antidote)

              formoterol and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

            • ondansetron

              formoterol and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • panobinostat

              formoterol and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • pentamidine

              formoterol and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • perphenazine

              perphenazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • phenelzine

              phenelzine increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • pimozide

              formoterol and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

            • pitolisant

              formoterol and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • pramlintide

              pramlintide, glycopyrrolate inhaled. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • primaquine

              primaquine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • procainamide

              formoterol and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • prochlorperazine

              prochlorperazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • promazine

              promazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • promethazine

              promethazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • protriptyline

              protriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              protriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • quinidine

              quinidine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • revefenacin

              revefenacin and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.

            • sotalol

              formoterol and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Drugs known to prolong the QTc interval may potentiate the cardiovascular effects of formoterol.

              sotalol and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Drugs known to prolong the QTc interval may potentiate the cardiovascular effects of formoterol.

            Monitor Closely (348)

            • abobotulinumtoxinA

              abobotulinumtoxinA increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

            • acebutolol

              acebutolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              acebutolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • aceclofenac

              aceclofenac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • acemetacin

              acemetacin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aclidinium

              glycopyrrolate inhaled and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • albuterol

              albuterol and formoterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and formoterol both decrease sedation. Use Caution/Monitor.

              albuterol and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • alfentanil

              alfentanil increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfuzosin

              formoterol and alfuzosin both increase QTc interval. Use Caution/Monitor.

              alfuzosin and formoterol both increase QTc interval. Use Caution/Monitor.

            • alprazolam

              alprazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amantadine

              glycopyrrolate inhaled increases levels of amantadine by unknown mechanism. Use Caution/Monitor.

              glycopyrrolate inhaled, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.

            • amiloride

              amiloride increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • amiodarone

              amiodarone and formoterol both increase QTc interval. Use Caution/Monitor.

            • amitriptyline

              amitriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              glycopyrrolate inhaled and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.

              amitriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amobarbital

              amobarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amoxapine

              glycopyrrolate inhaled and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              amoxapine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

            • amoxapine

              amoxapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • anticholinergic/sedative combos

              anticholinergic/sedative combos and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • apomorphine

              apomorphine and formoterol both increase QTc interval. Use Caution/Monitor.

            • arformoterol

              arformoterol and formoterol both decrease serum potassium. Use Caution/Monitor.

              arformoterol and formoterol both decrease sedation. Use Caution/Monitor.

              arformoterol and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aripiprazole

              glycopyrrolate inhaled decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              aripiprazole and formoterol both increase QTc interval. Use Caution/Monitor.

              aripiprazole increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              aripiprazole increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • armodafinil

              formoterol and armodafinil both decrease sedation. Use Caution/Monitor.

            • atenolol

              glycopyrrolate inhaled increases levels of atenolol by unknown mechanism. Use Caution/Monitor.

            • arsenic trioxide

              arsenic trioxide and formoterol both increase QTc interval. Use Caution/Monitor.

            • artemether

              artemether and formoterol both increase QTc interval. Use Caution/Monitor.

            • aspirin

              aspirin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aspirin rectal

              aspirin rectal increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • atenolol

              atenolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              atenolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • atomoxetine

              formoterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

              atomoxetine and formoterol both increase QTc interval. Use Caution/Monitor.

            • atracurium

              atracurium and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine

              atropine and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine IV/IM

              atropine IV/IM and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • azelastine

              azelastine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • azithromycin

              azithromycin and formoterol both increase QTc interval. Use Caution/Monitor.

            • bedaquiline

              formoterol and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • belladonna alkaloids

              belladonna alkaloids and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • belladonna and opium

              glycopyrrolate inhaled and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bendroflumethiazide

              formoterol and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.

            • benperidol

              glycopyrrolate inhaled decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              benperidol increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • benperidol

              benperidol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benzphetamine

              formoterol and benzphetamine both decrease sedation. Use Caution/Monitor.

              formoterol and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • benztropine

              benztropine and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • betaxolol

              betaxolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              betaxolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • bethanechol

              bethanechol increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bisoprolol

              bisoprolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              bisoprolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • brompheniramine

              brompheniramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bumetanide

              formoterol and bumetanide both decrease serum potassium. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butabarbital

              butabarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butalbital

              butalbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butorphanol

              butorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • caffeine

              formoterol and caffeine both decrease sedation. Use Caution/Monitor.

            • carbachol

              carbachol increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbenoxolone

              formoterol and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carvedilol

              carvedilol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              carvedilol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • celecoxib

              celecoxib increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • celiprolol

              celiprolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              celiprolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • ceritinib

              ceritinib and formoterol both increase QTc interval. Use Caution/Monitor.

            • cevimeline

              cevimeline increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorothiazide

              formoterol and chlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorpromazine

              glycopyrrolate inhaled decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              chlorpromazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              chlorpromazine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              chlorpromazine increases toxicity of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

            • chlorthalidone

              formoterol and chlorthalidone both decrease serum potassium. Use Caution/Monitor.

            • cisatracurium

              cisatracurium and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • cinnarizine

              cinnarizine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clemastine

              clemastine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clomipramine

              clomipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              clomipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              glycopyrrolate inhaled and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • clonazepam

              clonazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              glycopyrrolate inhaled decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

              clozapine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • clorazepate

              clorazepate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              clozapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • codeine

              codeine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • cyclizine

              cyclizine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              cyclizine and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • cyclopenthiazide

              formoterol and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • darifenacin

              darifenacin and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • dasatinib

              dasatinib and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • deflazacort

              formoterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • degarelix

              degarelix and formoterol both increase QTc interval. Use Caution/Monitor.

            • desipramine

              desipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              desipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dicyclomine

              dicyclomine and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • dexfenfluramine

              formoterol and dexfenfluramine both decrease sedation. Use Caution/Monitor.

              formoterol and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmethylphenidate

              formoterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.

              formoterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextroamphetamine

              formoterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.

              formoterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextromoramide

              dextromoramide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diamorphine

              diamorphine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dichlorphenamide

              dichlorphenamide and formoterol both decrease serum potassium. Use Caution/Monitor.

              dichlorphenamide, formoterol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • diclofenac

              diclofenac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diethylpropion

              formoterol and diethylpropion both decrease sedation. Use Caution/Monitor.

              formoterol and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diflunisal

              diflunisal increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • digoxin

              glycopyrrolate inhaled increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

              digoxin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dipipanone

              dipipanone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dobutamine

              dobutamine and formoterol both decrease serum potassium. Use Caution/Monitor.

              dobutamine and formoterol both decrease sedation. Use Caution/Monitor.

              dobutamine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dolasetron

              dolasetron and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • donepezil

              donepezil increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              donepezil and formoterol both increase QTc interval. Use Caution/Monitor.

            • donepezil transdermal

              donepezil transdermal, glycopyrrolate inhaled. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

            • dopamine

              formoterol and dopamine both decrease sedation. Use Caution/Monitor.

              formoterol and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopexamine

              dopexamine and formoterol both decrease serum potassium. Use Caution/Monitor.

              dopexamine and formoterol both decrease sedation. Use Caution/Monitor.

              dopexamine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              dopexamine, formoterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • dosulepin

              glycopyrrolate inhaled and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • doxepin

              glycopyrrolate inhaled and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              doxepin increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              doxepin increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • droperidol

              droperidol increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              droperidol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • drospirenone

              drospirenone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • echothiophate iodide

              echothiophate iodide increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • efavirenz

              efavirenz and formoterol both increase QTc interval. Use Caution/Monitor.

            • encorafenib

              encorafenib and formoterol both increase QTc interval. Use Caution/Monitor.

            • ephedrine

              ephedrine and formoterol both decrease serum potassium. Use Caution/Monitor.

              ephedrine and formoterol both decrease sedation. Use Caution/Monitor.

              ephedrine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine

              epinephrine and formoterol both decrease serum potassium. Use Caution/Monitor.

              epinephrine and formoterol both decrease sedation. Use Caution/Monitor.

              epinephrine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

              formoterol and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.

              formoterol and epinephrine racemic both decrease sedation. Use Caution/Monitor.

              formoterol and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • eribulin

              eribulin and formoterol both increase QTc interval. Use Caution/Monitor.

            • escitalopram

              escitalopram increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

            • esmolol

              esmolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              esmolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • estazolam

              estazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ethacrynic acid

              formoterol and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.

            • ethanol

              ethanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • etodolac

              etodolac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fenfluramine

              formoterol and fenfluramine both decrease sedation. Use Caution/Monitor.

              formoterol and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • fenoprofen

              fenoprofen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fesoterodine

              fesoterodine and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • fingolimod

              fingolimod and formoterol both increase QTc interval. Use Caution/Monitor.

            • flavoxate

              flavoxate and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • flecainide

              flecainide and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluoxetine

              fluoxetine and formoterol both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system

            • fluphenazine

              fluphenazine increases toxicity of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              fluphenazine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              fluphenazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flurazepam

              flurazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • galantamine

              galantamine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flurbiprofen

              flurbiprofen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • foscarnet

              formoterol and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

            • fostemsavir

              formoterol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • furosemide

              formoterol and furosemide both decrease serum potassium. Use Caution/Monitor.

            • gemifloxacin

              gemifloxacin and formoterol both increase QTc interval. Use Caution/Monitor.

            • gentamicin

              formoterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

            • gilteritinib

              gilteritinib and formoterol both increase QTc interval. Use Caution/Monitor.

            • glycopyrronium tosylate topical

              glycopyrronium tosylate topical, glycopyrrolate inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

            • goserelin

              goserelin increases toxicity of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • haloperidol

              haloperidol increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              haloperidol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • henbane

              glycopyrrolate inhaled and henbane both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • histrelin

              histrelin increases toxicity of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • homatropine

              glycopyrrolate inhaled and homatropine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • huperzine A

              huperzine A increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydrochlorothiazide

              formoterol and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • hydromorphone

              hydromorphone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hyoscyamine

              glycopyrrolate inhaled and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • hyoscyamine spray

              glycopyrrolate inhaled and hyoscyamine spray both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • ibuprofen

              ibuprofen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen IV

              ibuprofen IV increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • iloperidone

              glycopyrrolate inhaled decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              iloperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              iloperidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              formoterol and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • imipramine

              glycopyrrolate inhaled and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              imipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              imipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • indapamide

              formoterol and indapamide both decrease serum potassium. Use Caution/Monitor.

            • ipratropium

              glycopyrrolate inhaled and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • indomethacin

              indomethacin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • isoproterenol

              formoterol and isoproterenol both decrease serum potassium. Use Caution/Monitor.

              formoterol and isoproterenol both decrease sedation. Use Caution/Monitor.

              formoterol and isoproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • itraconazole

              itraconazole and formoterol both increase QTc interval. Use Caution/Monitor.

            • ketoprofen

              ketoprofen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac

              ketorolac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac intranasal

              ketorolac intranasal increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • ketotifen, ophthalmic

              ketotifen, ophthalmic increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • labetalol

              labetalol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              labetalol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • lapatinib

              formoterol and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • lenvatinib

              formoterol and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • leuprolide

              leuprolide increases toxicity of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • levalbuterol

              formoterol and levalbuterol both decrease serum potassium. Use Caution/Monitor.

              formoterol and levalbuterol both decrease sedation. Use Caution/Monitor.

              formoterol and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • levodopa

              glycopyrrolate inhaled, levodopa. Other (see comment). Use Caution/Monitor. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .

            • levofloxacin

              formoterol and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • levorphanol

              levorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lisdexamfetamine

              formoterol and lisdexamfetamine both decrease sedation. Use Caution/Monitor.

              formoterol and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • lofepramine

              glycopyrrolate inhaled and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              lofepramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofexidine

              lofexidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine

              glycopyrrolate inhaled decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

              loxapine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • loprazolam

              loprazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lorazepam

              lorazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lormetazepam

              lormetazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lornoxicam

              lornoxicam increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine

              loxapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine inhaled

              glycopyrrolate inhaled decreases levels of loxapine inhaled by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

              loxapine inhaled increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              loxapine inhaled increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • maprotiline

              glycopyrrolate inhaled and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              maprotiline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              maprotiline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • marijuana

              marijuana increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meclizine

              glycopyrrolate inhaled and meclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • meclofenamate

              meclofenamate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mefenamic acid

              mefenamic acid increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • melatonin

              melatonin increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meloxicam

              meloxicam increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meperidine

              meperidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meprobamate

              meprobamate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaproterenol

              formoterol and metaproterenol both decrease serum potassium. Use Caution/Monitor.

              formoterol and metaproterenol both decrease sedation. Use Caution/Monitor.

              formoterol and metaproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methadone

              formoterol and methadone both increase QTc interval. Modify Therapy/Monitor Closely.

              methadone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methamphetamine

              formoterol and methamphetamine both decrease sedation. Use Caution/Monitor.

              formoterol and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methscopolamine

              glycopyrrolate inhaled and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • methyclothiazide

              formoterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              formoterol and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.

              formoterol and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methylphenidate

              formoterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • metolazone

              formoterol and metolazone both decrease serum potassium. Use Caution/Monitor.

            • metoprolol

              metoprolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              metoprolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • midazolam

              midazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midodrine

              formoterol and midodrine both decrease sedation. Use Caution/Monitor.

              formoterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • mifepristone

              mifepristone, formoterol. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • mirtazapine

              mirtazapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • modafinil

              formoterol and modafinil both decrease sedation. Use Caution/Monitor.

            • morphine

              morphine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • motherwort

              motherwort increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • moxonidine

              moxonidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabilone

              nabilone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabumetone

              nabumetone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nadolol

              nadolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nadolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • nalbuphine

              nalbuphine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • naproxen

              naproxen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nebivolol

              nebivolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nebivolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • neostigmine

              neostigmine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • norepinephrine

              formoterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.

              formoterol and norepinephrine both decrease sedation. Use Caution/Monitor.

              formoterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • nortriptyline

              glycopyrrolate inhaled and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              nortriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              nortriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ofloxacin

              formoterol and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • olanzapine

              glycopyrrolate inhaled decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

              olanzapine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • olanzapine

              olanzapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • olodaterol inhaled

              formoterol and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

            • onabotulinumtoxinA

              onabotulinumtoxinA and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • opium tincture

              opium tincture increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • orphenadrine

              glycopyrrolate inhaled and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • osilodrostat

              osilodrostat and formoterol both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and formoterol both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxaliplatin

              oxaliplatin will increase the level or effect of formoterol by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • oxaprozin

              oxaprozin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxazepam

              oxazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxybutynin

              glycopyrrolate inhaled and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin topical

              glycopyrrolate inhaled and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin transdermal

              glycopyrrolate inhaled and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxycodone

              oxycodone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxymorphone

              oxymorphone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ozanimod

              ozanimod and formoterol both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • paliperidone

              paliperidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              paliperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              formoterol and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • pancuronium

              glycopyrrolate inhaled and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • papaveretum

              papaveretum increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • parecoxib

              parecoxib increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • paroxetine

              formoterol and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

            • pasireotide

              formoterol and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • pazopanib

              formoterol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • penbutolol

              penbutolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              penbutolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • pentazocine

              pentazocine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pentobarbital

              pentobarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • perphenazine

              perphenazine increases toxicity of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              perphenazine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              perphenazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phendimetrazine

              formoterol and phendimetrazine both decrease sedation. Use Caution/Monitor.

              formoterol and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • physostigmine

              physostigmine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenoxybenzamine

              phenoxybenzamine, formoterol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

            • phentermine

              formoterol and phentermine both decrease sedation. Use Caution/Monitor.

              formoterol and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine

              formoterol and phenylephrine both decrease sedation. Use Caution/Monitor.

              formoterol and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine PO

              formoterol and phenylephrine PO both decrease sedation. Use Caution/Monitor.

              formoterol and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pholcodine

              pholcodine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine

              pilocarpine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimozide

              glycopyrrolate inhaled decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

              pimozide increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              pimozide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pindolol

              pindolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              pindolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • pralidoxime

              glycopyrrolate inhaled and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • pirbuterol

              formoterol and pirbuterol both decrease serum potassium. Use Caution/Monitor.

              formoterol and pirbuterol both decrease sedation. Use Caution/Monitor.

              formoterol and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • piroxicam

              piroxicam increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • posaconazole

              formoterol and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • potassium acid phosphate

              potassium acid phosphate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium chloride

              potassium chloride increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium citrate

              potassium citrate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • primidone

              primidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • procarbazine

              procarbazine increases effects of formoterol by pharmacodynamic synergism. Use Caution/Monitor.

            • prochlorperazine

              glycopyrrolate inhaled decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              prochlorperazine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              prochlorperazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • promethazine

              promethazine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

              promethazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • propantheline

              glycopyrrolate inhaled and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • propranolol

              propranolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              propranolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • propylhexedrine

              formoterol and propylhexedrine both decrease sedation. Use Caution/Monitor.

              formoterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • protriptyline

              protriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              glycopyrrolate inhaled and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              protriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

            • pseudoephedrine

              formoterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pyridostigmine

              pyridostigmine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quazepam

              quazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quetiapine

              glycopyrrolate inhaled decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              quetiapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

              quetiapine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • quinine

              formoterol and quinine both increase QTc interval. Use Caution/Monitor.

            • rapacuronium

              glycopyrrolate inhaled and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • ranolazine

              formoterol and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

            • ribociclib

              ribociclib increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

            • rimantadine

              glycopyrrolate inhaled, rimantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS side effects.

            • risperidone

              risperidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              formoterol and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              glycopyrrolate inhaled decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              risperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • rivastigmine

              rivastigmine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sacubitril/valsartan

              sacubitril/valsartan increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • rocuronium

              glycopyrrolate inhaled and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • salicylates (non-asa)

              salicylates (non-asa) increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salmeterol

              formoterol and salmeterol both decrease serum potassium. Use Caution/Monitor.

              formoterol and salmeterol both decrease sedation. Use Caution/Monitor.

              formoterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • salsalate

              salsalate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scopolamine

              glycopyrrolate inhaled and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • scullcap

              scullcap increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • secobarbital

              secobarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • selpercatinib

              selpercatinib increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

            • serdexmethylphenidate/dexmethylphenidate

              formoterol and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • shepherd's purse

              shepherd's purse increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              formoterol and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • solifenacin

              glycopyrrolate inhaled and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • solriamfetol

              formoterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • sorafenib

              sorafenib and formoterol both increase QTc interval. Use Caution/Monitor.

            • sotalol

              sotalol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • spironolactone

              spironolactone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • succinylcholine

              succinylcholine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              succinylcholine increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sufentanil

              sufentanil increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              glycopyrrolate inhaled decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

              thioridazine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • sulfamethoxazole

              sulfamethoxazole and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • sulfasalazine

              sulfasalazine increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sulindac

              sulindac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tapentadol

              tapentadol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • telavancin

              formoterol and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

            • temazepam

              temazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • terbutaline

              formoterol and terbutaline both decrease serum potassium. Use Caution/Monitor.

              formoterol and terbutaline both decrease sedation. Use Caution/Monitor.

              formoterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • thioridazine

              thioridazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thiothixene

              thiothixene increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              thiothixene increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • timolol

              timolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • tiotropium

              glycopyrrolate inhaled and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • tolfenamic acid

              tolfenamic acid increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolmetin

              tolmetin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolterodine

              glycopyrrolate inhaled and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • tolvaptan

              tolvaptan increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • topiramate

              topiramate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • torsemide

              formoterol and torsemide both decrease serum potassium. Use Caution/Monitor.

            • tramadol

              tramadol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trazodone

              trazodone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • triamterene

              triamterene increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • triazolam

              triazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • triclofos

              triclofos increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              trifluoperazine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • trihexyphenidyl

              glycopyrrolate inhaled and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

            • trimethoprim

              formoterol and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

            • trimipramine

              trimipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              glycopyrrolate inhaled and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              trimipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

            • triprolidine

              triprolidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trospium chloride

              glycopyrrolate inhaled and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • triptorelin

              triptorelin increases levels of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • tropisetron

              formoterol and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • umeclidinium bromide

              umeclidinium bromide and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents

            • vecuronium

              glycopyrrolate inhaled and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • venlafaxine

              formoterol and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

            • voriconazole

              formoterol and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • xylometazoline

              formoterol and xylometazoline both decrease sedation. Use Caution/Monitor.

              formoterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • yohimbine

              formoterol and yohimbine both decrease sedation. Use Caution/Monitor.

              formoterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ziconotide

              ziconotide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziprasidone

              glycopyrrolate inhaled decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

              ziprasidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              glycopyrrolate inhaled decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ziprasidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • zotepine

              glycopyrrolate inhaled decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

            Minor (28)

            • bendroflumethiazide

              formoterol, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • bumetanide

              formoterol, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chloroquine

              chloroquine increases toxicity of formoterol by QTc interval. Minor/Significance Unknown.

            • chlorothiazide

              formoterol, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorthalidone

              formoterol, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • cyclopenthiazide

              formoterol, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • desipramine

              glycopyrrolate inhaled and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

            • dimenhydrinate

              dimenhydrinate increases toxicity of glycopyrrolate inhaled by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • donepezil

              donepezil decreases effects of glycopyrrolate inhaled by pharmacodynamic antagonism. Minor/Significance Unknown.

            • ethacrynic acid

              formoterol, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • eucalyptus

              eucalyptus increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • furosemide

              formoterol, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • galantamine

              galantamine decreases effects of glycopyrrolate inhaled by pharmacodynamic antagonism. Minor/Significance Unknown.

            • green tea

              green tea increases effects of formoterol by pharmacodynamic synergism. Minor/Significance Unknown. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

            • hydrochlorothiazide

              formoterol, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • indapamide

              formoterol, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • lofepramine

              lofepramine increases levels of glycopyrrolate inhaled by unknown mechanism. Minor/Significance Unknown.

            • methyclothiazide

              formoterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • metolazone

              formoterol, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • noni juice

              noni juice increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • prochlorperazine

              prochlorperazine increases toxicity of glycopyrrolate inhaled by unknown mechanism. Minor/Significance Unknown.

            • promazine

              promazine increases toxicity of glycopyrrolate inhaled by unknown mechanism. Minor/Significance Unknown.

            • promethazine

              promethazine increases toxicity of glycopyrrolate inhaled by unknown mechanism. Minor/Significance Unknown.

            • rimantadine

              rimantadine increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Minor/Significance Unknown.

            • sage

              sage increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • thioridazine

              thioridazine increases toxicity of glycopyrrolate inhaled by unknown mechanism. Minor/Significance Unknown.

            • torsemide

              formoterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • trazodone

              glycopyrrolate inhaled and trazodone both decrease cholinergic effects/transmission. Minor/Significance Unknown.

              trazodone increases levels of glycopyrrolate inhaled by unknown mechanism. Minor/Significance Unknown.

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            Adverse Effects

            1-10%

            Cough (4%)

            Urinary tract infection (2.6%)

            Arthralgia (<2%)

            Chest pain (<2%)

            Tooth abscess (<2%)

            Muscle spasms (<2%)

            Headache (<2%)

            Oropharyngeal pain (<2%)

            Vomiting (<2%)

            Pain in extremity (<2%)

            Dizziness (<2%)

            Anxiety (<2%)

            Dry mouth (<2%)

            Fall (<2%)

            Influenza (<2%)

            Fatigue (<2%)

            Acute sinusitis (<2%)

            Contusion (<2%)

            Frequency Not Defined

            Formoterol

            • Hypersensitivity reactions
            • Hyperglycemia
            • Sleep disturbance
            • Agitation
            • Restlessness
            • Tremor
            • Nausea
            • Tachycardia
            • Palpitations
            • Cardiac arrhythmias
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            Warnings

            Contraindications

            Hypersensitivity

            All LABAs are contraindicated in patients with asthma without use of a long-term asthma control medication; not indicated for the treatment of asthma

            Cautions

            Do not use more often than recommended, at higher doses than recommended, or in combination with additional therapy containing a LABA because of risk of overdose; clinically significant cardiovascular effects and fatalities reported in association with excessive use of inhaled sympathomimetic medicines; patients using drug should not use another medicine containing a LABA for any reason

            Can produce paradoxical bronchospasm that may be life-threatening; treat immediately with an inhaled, short-acting bronchodilator, discontinue therapy, and institute alternative therapy

            Immediate hypersensitivity reactions have been reported after administration of formoterol or glycopyrrolate; if signs suggesting allergic reactions occur, in particular, angioedema (including difficulties in breathing or swallowing, swelling of tongue, lips, and face), urticaria, or skin rash, therapy should be stopped at once and alternative treatment considered

            Therapy should be used with caution in patients with narrow-angle glaucoma; prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (eg, eye pain or discomfort, blurred vision, visual halos, or colored images in association with red eyes from conjunctival congestion and corneal edema); instruct patients to consult a physician immediately should any of these signs or symptoms develop

            Therapy should be used with caution in patients with urinary retention; prescribers and patients should be alert for signs and symptoms of urinary retention (eg, difficulty passing urine, painful urination), especially in patients with prostatic hyperplasia or bladder neck obstruction; instruct patients to consult a physician immediately should any of these signs or symptoms develop

            Like all medications containing sympathomimetic amines, this medication should be used with caution in patients with convulsive disorders or thyrotoxicosis and in those who are unusually responsive to sympathomimetic amines

            Beta2-agonist medicines may produce transient hyperglycemia in some patients; clinical significance unknown

            LABAs can produce clinically significant cardiovascular effects, including increases in pulse rate or systolic or diastolic blood pressure; if such effects occur, therapy may need to be discontinued; beta-agonists have also been reported to produce electrocardiographic changes, such as flattening of the T wave, prolongation of the QTc interval, and ST-segment depression; clinical significance of these findings is unknown; the drug should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension

            Doses of the related beta2-agonist albuterol, when administered IV, have been reported to aggravate preexisting diabetes mellitus and ketoacidosis owing to transient hyperglycemia; use caution

            LABAs may produce significant hypokalemia, which has the potential to produce adverse cardiovascular effect; in patients with severe COPD, hypokalemia may be potentiated by hypoxia and concomitant treatment, which may increase the susceptibility for cardiac arrhythmias; the decrease in serum potassium is usually transient, not requiring supplementation

            Asthma-related events

            • The safety and efficacy in patients with asthma not established; not indicated for the treatment of asthma
            • Use of LABA as monotherapy, without inhaled corticosteroids (ICS), for asthma associated with increased risk of asthma-related death
            • Available data from controlled clinical trials also suggest that use of LABA as monotherapy increases risk of asthma-related hospitalization in pediatric and adolescent patients; these findings are considered a class effect of LABA monotherapy
            • When LABA are used in fixed-dose combination with ICS, data from large clinical trials do not show a significant increase in the risk of serious asthma-related events (hospitalizations, intubations, death) compared with ICS alone
            • No trial adequate to determine whether rate of asthma-related deaths is increased in patients treated with this drug combination has been conducted
            • Available data do not suggest an increased risk of death with use of LABA in patients with COPD

            Deterioration of disease and acute episodes

            • Therapy should not be initiated in patients with acutely deteriorating COPD, which may be a life-threatening condition; this drug has not been studied in patients with acutely deteriorating COPD; using the drug inthis setting is inappropriate
            • Therapy should not be used for relief of acute symptoms, eg, as rescue therapy for treatment of acute episodes of bronchospasm; the drug has not been studied in the relief of acute symptoms and extra doses should not be used for that purpose; acute symptoms should be treated with an inhaled short-acting beta2-agonist
            • When initiating therapy, patients who have been taking inhaled, short-acting beta2-agonists on a regular basis (eg, four times a day) should be instructed to discontinue the regular use of these medicines and use them only for symptomatic relief of acute respiratory symptoms
            • When prescribing the drug, the healthcare provider should also prescribe an inhaled, short-acting beta2-agonist and instruct the patient on how it should be used; increasing inhaled beta2-agonist use is a signal of deteriorating disease for which prompt medical attention is indicated
            • COPD may deteriorate acutely over a period of hours or chronically over several days or longer; if the drug no longer controls the symptoms of bronchoconstriction, or the patient’s inhaled, short-acting beta2-agonist becomes less effective, or the patient needs more inhalations of short-acting beta2-agonist than usual, these may be markers of deterioration of disease; in this setting, a re-evaluation of the patient and the COPD treatment regimen should be undertaken at once; increasing the daily dosage beyond the recommended dose is not appropriate in this situation
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            Pregnancy & Lactation

            Pregnancy

            There are no well-controlled human trials that have investigated the effects on preterm labor or labor at term; because beta 2 agonists may potentially interfere with uterine contractility, drug should be used during labor only if potential benefit justifies potential risk

            Single-dose studies in humans found that a very small amount of glycopyrrolate passed the placental barrier

            Animal studies

            • Glycopyrrolate
              • Administered by the subcutaneous route in rats and rabbits, there were no structural abnormalities or a decrease in fetal survival at exposures approximately 2700 and 5400 times from the maximum recommended human daily inhalation dose (MRHDID), respectively; it had no effects on physical, functional, and behavioral development of rat pups with exposures up to 2700 times the MRHDID
            • Formoterol fumarate
              • Formoterol fumarate alone, administered by the oral route in rats and rabbits, caused structural abnormalities at 1500 and 61,000 times the MRHDID, respectively
              • Formoterol fumarate was also embryocidal, increased pup loss at birth and during lactation, and decreased pup weight in rats at 110 times the MRHDID
              • The adverse effects generally occurred at large multiples of the MRHDID when formoterol fumarate was administered by oral route to achieve high systemic exposures
              • No structural abnormalities, embryocidal, or developmental effects were seen in rats that received inhalation doses up to 350 times the MRHDID

            Lactation

            There are no available data on effects of glycopyrrolate, or formoterol fumarate on breastfed child or milk production

            There are no available data on presence of glycopyrrolate or formoterol fumarate in human milk

            Formoterol fumarate and glycopyrrolate have been detected in plasma of undosed rat pups suckling from exposed dams; the developmental and health benefits of breastfeeding should be considered along with mother's clinical need for therapy and any potential adverse effects on breast-fed child from drug or from underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Glycopyrronium: Long-acting muscarinic antagonist (LAMA); often referred to as an anticholinergic; produces bronchodilation by inhibiting acetylcholine’s effect on muscarinic receptors in the airway smooth muscle

            Formoterol: Long-acting beta2-agonist (LABA) with a rapid onset of action; stimulates intracellular adenyl cyclase, causing conversion of ATP to cyclic AMP; increased cyclic AMP levels cause relaxation of bronchial smooth muscle

            Absorption

            Peak plasma concentration: 5 min (glycopyrrolate); 20-60 min (formoterol)

            Steady-state achieved: 2-3 days

            Extent of systemic exposure increases at steady state compared to first dose; 2.3 x higher (glycopyrrolate) and 1.5 x higher (formoterol)

            Distribution

            Protein bound: 46-58% (formoterol)

            Vd (central compartment): 951 L (glycopyrrolate); 948 L (formoterol)

            Vd (peripheral compartment): 2019 L (glycopyrrolate); 434 L (formoterol)

            Metabolism

            Glycopyrrolate: metabolism plays a minor role in the overall elimination of glycopyrrolate

            Formoterol

            • Primary metabolism of formoterol is by direct glucuronidation and by O-demethylation followed by conjugation to inactive metabolites
            • Secondary metabolic pathways include deformylation and sulfate conjugation
            • CYP2D6 and CYP2C have been identified as being primarily responsible for O-demethylation

            Elimination

            Half-life: 11.8 hr (glycopyrrolate); 11.8 hr (formoterol)

            Elimination

            • Glycopyrrolate: 85% urine; small amount in bile
            • Formoterol: 62% in urine; 24% in feces
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            Administration

            Orally Inhaled Administration

            Shake well before each use

            Do not exceed 2 inhalations twice daily

            Canister contains 120 inhalations and has an attached dose indicator, which indicates how many inhalations remain

            The dose indicator display will move after every tenth actuation

            When nearing the end of the usable inhalations, the color behind the number in the dose indicator display window changes to red

            Discarded when the dose indicator display window shows zero

            Prime device

            • Prime the inhaler to ensure appropriate drug content in each actuation
            • Prime before using for the first time
            • To prime, release 4 sprays into the air away from the face, shaking well before each spray
            • Must be reprimed when the inhaler has not been used for >7 days; to reprime, release 2 sprays into the air away from the face; shake canister well before each spray

            Storage

            Store at controlled room temperature 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F)

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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.