Dosing & Uses
Dosage Forms & Strengths
budesonide/formoterol/glycopyrrolate
inhalation aerosol
- 160mcg/9mcg/4.8mcg per inhalation
Chronic Obstructive Pulmonary Disease
Indicated for maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD)
2 oral inhalations BID
Dosage Modifications
Renal impairment
- Formal pharmacokinetic studies not conducted; however, glycopyrronium systemic exposure increased with moderate renal impairment (ie, eGFR 45 mL/min)
- Severe (CrCl ≤30 mL/min/1.73m2) or end-stage renal disease requiring dialysis: Use if expected benefit outweighs potential risk
Hepatic impairment
- Formal pharmacokinetic studies not conducted; however, budesonide and formoterol fumarate are predominantly cleared by hepatic metabolism
- Severe hepatic disease: Closely monitor
Dosing Considerations
Limitations of use: Not indicated for relief of acute bronchospasm or treatment of asthma
Safety and efficacy not established
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

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 (68)
- adagrasib
adagrasib, formoterol. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.
- 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. - lonafarnib
lonafarnib will increase the level or effect of budesonide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
- lumefantrine
formoterol and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
budesonide inhaled, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that directly affect the pituitary secretion of growth hormone (GH) may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH growth hormone release before administering prior to administration of macimorelin. Drugs that directly affect the pituitary secretion of growth hormone (GH) may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering 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 (323)
- 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.
- asenapine transdermal
asenapine transdermal 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.
- cobicistat
cobicistat increases levels of budesonide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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.
- quizartinib
quizartinib, formoterol. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.
- 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 chloride/magnesium sulfate/polyethylene glycol
formoterol and sodium sulfate/potassium chloride/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.
- stiripentol
stiripentol will increase the level or effect of budesonide inhaled by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.
- 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. - 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. - thiothixene
glycopyrrolate inhaled decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
glycopyrrolate inhaled decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.
thiothixene increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - tiotropium
glycopyrrolate inhaled and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- tolterodine
glycopyrrolate inhaled and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trifluoperazine
glycopyrrolate inhaled decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. 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. - trihexyphenidyl
glycopyrrolate inhaled and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.
- trimipramine
glycopyrrolate inhaled and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
trimipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor. - trospium chloride
glycopyrrolate inhaled and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.
- 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.
- ziprasidone
glycopyrrolate inhaled decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
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. - 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.
Adverse Effects
1-10%
Upper respiratory tract infection (5.7%)
Pneumonia (4.6%)
Dysphonia (3.3%)
Muscle spasms (2.8-3.3%)
Back pain (3.1%)
Oral candidiasis (3%)
Influenza (2.9%)
Urinary tract infection (2.7%)
Cough (2.7%)
Sinusitis (2.6%)
Diarrhea (2.1%)
<1%
Cataracts
Frequency Not Defined
Other adverse effects associated ≥1 of the individual components
- Hyperglycemia
- Anxiety
- Insomnia
- Headache
- Palpitations
- Nausea
- Hypersensitivity
- Depression
- Agitation
- Restlessness
- Nervousness
- Tremor
- Dizziness
- Angina pectoris
- Tachycardia
- Arrhythmias (eg, atrial fibrillation, supraventricular tachycardia, extrasystoles)
- Throat irritation
- Bronchospasm
- Dry mouth
- Bruising
- Urinary retention
- Chest pain
- Sign or symptoms of systemic glucocorticoid steroid effects (eg, hypofunctional adrenal gland)
- Abnormal behavior
Warnings
Contraindications
Hypersensitivity
Cautions
Safety and efficacy not established for asthma; use of long-acting beta2-adrenergic agonists (LABAs) as monotherapy (ie, without inhaled corticosteroids) for asthma is associated with increased risk asthma-related death; data do not suggest an increased risk of death with LABAs in patients with COPD
Do not initiate in patients with acutely deteriorating COPD, which may be a life-threatening condition; use only for maintenance and not as a rescue therapy
Patients who have been taking inhaled, short-acting beta2 agonists on a regular basis should discontinue these drugs when budesonide/formoterol/glycopyrrolate inhaled is initiated
Excess use or use with other long-acting beta2 agonists may result in overdose, clinically significant cardiovascular effects, and fatalities
Oropharyngeal candidiasis is associated with orally inhaled corticosteroids; advised patients to rinse mouth with water and without swallowing
Lower respiratory tract infections, including pneumonia, reported following inhaled corticosteroids
Immunosuppressive drugs (eg, corticosteroids) use increases susceptibility to infection; some infections may be more serious or fatal compared with others not taking corticosteroids
Caution if patients are being transferred from systemic corticosteroids; monitor for adrenal insufficiency, particularly for patients maintained on physiologic doses (eg, ≥20 mg/day of prednisone, or equivalent)
Hypercorticism and adrenal suppression may occur if dose is exceeded
Oral inhaled therapies can produce paradoxical bronchospasm, which may be life-threatening; if this occurs, permanently discontinue and treat immediately with inhaled, short-acting bronchodilator
Hypersensitivity, including anaphylaxis, reported; allergic reactions including angioedema, urticaria, or rash may occur; discontinue drug
Beta2 agonists can produce clinically significant cardiovascular effects (eg, increased heart rate and blood pressure, arrhythmias, ECG changes)
Decreased bone mineral density observed with long-term administration of corticosteroids
Use of long-term corticosteroids or inhaled anticholinergics associated with glaucoma, cataracts, or worsening of narrow-angle glaucoma
Caution in patients with urinary retention (eg, prostatic hyperplasia, bladder-neck obstruction)
Caution with sympathomimetic use in patients with convulsive disorders or thyrotoxicosis; beta2 agonists may aggravate preexisting diabetes mellitus and ketoacidosis
Beta agonists may produce significant hypokalemia and transient hyperglycemia
Drug interaction overview
-
Strong CYP3A4 inhibitors
- Exercise caution
- Coadministration with strong CYP3A4 inhibitors may increase budesonide systemic exposure
-
Adrenergic drugs
- Exercise caution
- Coadministration of formoterol with other adrenergic drugs may cause additive sympathetic effects
-
Xanthine derivatives, corticosteroids, or diuretics
- Monitor for hypokalemia
- Coadministration of beta2 agonists (eg, formoterol) with xanthine derivatives, corticosteroids, or diuretics may potentiate risk of hypokalemia
- The hypokalemia and/or ECG changes that may result from nonpotassium sparing diuretics may be worsened by beta2 agonists, especially if beta2 agonist dose exceeded
-
MAOIs, TCAs, or QTc prolonging drugs
- Use extreme caution with beta2 agonists in patients treated with MAOIs, TCAs, or other drugs known to prolong QTc interval owing to additive action of adrenergic agonists on the cardiovascular system
-
Beta blockers
- Beta blockers inhibit the therapeutic effect of beta2 agonists and may also produce severe bronchospasm
- Patients with COPD should normally not use beta blockers, excepts under certain circumstances (eg, prophylaxis after MI); consider cardioselective beta blockers when necessary
-
Anticholinergics
- Monitor
- Coadministration of glycopyrrolate with anticholinergic medications may cause additive effects
Pregnancy & Lactation
Pregnancy
Data are not available for glycopyrrolate or formoterol fumarate in pregnant women; however, studies are available for budesonide
Studies (Swedish registries) of pregnant women who received inhaled budesonide alone during pregnancy did not show increased risk of abnormalities
Clinical considerations
- Labor or delivery: No well-controlled human trials; because of potential for beta agonists interfering with uterine contractility, restrict use during labor to patients in whom benefits clearly outweigh risks
Animal studies
-
Budesonide
- SC administration caused structural abnormalities, was embryocidal, and reduced fetal weights in rats and rabbits at 0.3 and 0.75 times the maximum recommended human daily inhaled dose (MRHDID), but these effects were not seen in rats that received inhaled doses up to 4 times the MRHDID
- Experience with PO corticosteroids suggests that rodents are more prone to teratogenic effects from corticosteroid exposure than humans
-
Formoterol
- Oral administration in rats and rabbits caused structural abnormalities at 1,500 and 61,000 times the MRHDID
- It was also embryocidal, increased pup lost at birth and during lactation, and decreased pup weight in rats at 110 times the MRHDID
- No structural abnormalities, embryocidal, or developmental effects observed in rats that received inhalation doses up to 350 times the MRHDID
-
Glycopyrrolate
- SC administration in rats and rabbits did not cause structural abnormalities or affect fetal survival at 2,700-5,400 times MRHDID
- It also had no effects on physical, functional, and behavioral development of rat pups up to 2,700 times the MRHDID
Lactation
Data are not available for glycopyrrolate or formoterol fumarate in lactating women; however, studies are available for budesonide
Budesonide dry powder inhalation shows the total daily oral dose of budesonide available in breast milk to the infant is ~0.3-1% of the maternal inhaled dose
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.Pharmacology
Mechanism of Action
Budesonide: Anti-inflammatory corticosteroid; has potent glucocorticoid activity and weak mineralocorticoid activity
Formoterol: Long-acting selective beta-2 agonist with rapid onset of action; acts locally as bronchodilator; stimulates intracellular adenyl cyclase, which results in increased cyclic adenosine monophosphate levels, causing relaxation of bronchial smooth muscle and inhibition of release of mast cell mediators
Glycopyrrolate: Long-acting muscarinic antagonist; often referred to as an anticholinergic; produces bronchodilation by inhibiting acetylcholine’s effect on muscarinic receptors in the airway smooth muscle
Absorption
Peak plasma time
- Budesonide: 20-40 minutes
- Formoterol: 20-60 minutes
- Glycopyrrolate: 2-6 minutes
Steady-state
- Budesonide: 1 day
- Formoterol: 2 days
- Glycopyrrolate: 3 days
Distribution
Protein bound
- Budesonide: 86-87%
- Formoterol: 46-58%
- Glycopyrrolate: 43-54%
Vd
- Budesonide: 1,200 L
- Formoterol: 2,400 L
- Glycopyrrolate: 5,500 L
Metabolism
Budesonide: Extensively metabolized in liver by CYP3A4
Formoterol: Primarily metabolized by direct glucuronidation and by O-demethylation (by CYP2D6 and CYP2C) followed by conjugation to inactive metabolites; secondary metabolism by deformylation and sulfate
Glycopyrrolate: Metabolism plays a minor role in the overall elimination; CYP2D6 found to be the predominant enzyme involved
Elimination
Half-life
- Budesonide: ~5 hr
- Formoterol: ~10 hr
- Glycopyrrolate: ~15 hr
Excretion
- Budesonide: Excreted in urine and feces as metabolites; negligible unchanged drug detected in urine
- Formoterol: Urine 62%; feces 24%
- Glycopyrrolate: Urine 85%; also small amount in bile
Administration
Inhalation Preparation
Priming canister
- First use: Prime canister by releasing 4 sprays into the air when first administered
- Inhaler not used for >7 days or after cleaning: Prime canister by releasing 2 sprays into the air
Dose indicator
- Canister has dose indicator showing how many inhalations remain
- Display moves after every tenth actuation
- Color behind dose indicator changes to red when nearing end of usable inhalations
Inhalation Administration
Shake well before oral inhalation
Exhale fully through mouth, close lips around mouthpiece and tilt head back, keeping tongue below the mouthpiece, while breathing in deeply and slowly, release puff of medication by pressing on actuator; repeat for second inhalation
Rinse mouth with water and spit out water after each dose (2 inhalations) to reduce risk of thrush
Avoid spraying in eyes
Missed dose
- Take missed dose as soon as possible and the next dose at the usual time
- Do not take more than 1 dose to make up for a missed dose
Storage
Store at controlled room temperature of 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
Keep in dry place away from heat and sunlight
Contents under pressure; do not puncture or store near heat or open flame
Exposure to temperature >49ºC (>120ºF) may cause bursting
Never throw canister into fire or incinerator
Images
Formulary
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