formoterol/budesonide inhaled (Rx)

Brand and Other Names:Symbicort
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

budesonide/formoterol

aerosol

  • (80mcg/4.5mcg)/actuation
  • (160mcg/4.5mcg)/actuation

Asthma

Treatment in patients whose disease is not adequately controlled by long-term medication or whose disease severity warrants treatment with long-acting beta agonist (LABA) and inhaled corticosteroid

160 mcg/9 mcg (2 actuations of 80 mcg/4.5 mcg) q12hr; for more severe asthma, 320 mcg/9 mcg (2 actuations of 160 mcg/4.5 mcg) q12hr; not to exceed 320 mcg/9 mcg q12hr

Chronic Obstructive Pulmonary Disease

Treatment of airflow obstruction

160 mcg/9 mcg (2 actuations of 80 mcg/4.5 mcg) q12hr; not to exceed 320 mcg/9 mcg q12hr

Dosing Considerations

Asthma: If response is inadequate after 1-2 weeks of therapy with 80 mcg/4.5 mcg, switching to 160 mcg/4.5 mcg may provide additional control

Chronic obstructive pulmonary disease (COPD): 160 mcg/4.5 mcg is only approved treatment dose; if dyspnea occurs in period between doses, administer inhaled short-acting beta agonist (SABA) for immediate relief

Dosage Forms & Strengths

budesonide/formoterol

aerosol

  • (80mcg/4.5mcg)/actuation
  • (160mcg/4.5mcg)/actuation

Asthma

Indicated for the treatment of asthma in children aged ≥6 years

<6 years: Safety and efficacy not established

6-12 years: 160 mcg/9 mcg (2 actuations of 80 mcg/4.5 mcg) q12hr

>12 years

  • Starting dose is based on asthma severity
  • 160 mcg/9 mcg (2 actuations of 80 mcg/4.5 mcg) q12hr; for more severe asthma, 320 mcg/9 mcg (2 actuations of 160 mcg/4.5 mcg) q12hr; not to exceed 320 mcg/9 mcg q12hr
  • If response is inadequate after 1-2 weeks of therapy with 80 mcg/4.5 mcg, switching to 160 mcg/4.5 mcg may provide additional control
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Interactions

Interaction Checker

and formoterol/budesonide inhaled

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              Serious - Use Alternative (68)

              • 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.

              • 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.

              • 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.

              • 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.

              • 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.

              • thioridazine

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

              • tranylcypromine

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

              • trazodone

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

                trazodone, 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.

              • trifluoperazine

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

              • trimipramine

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

                trimipramine, 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.

              • umeclidinium bromide/vilanterol inhaled

                formoterol increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              • vilanterol/fluticasone furoate inhaled

                formoterol increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              • ziprasidone

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

              Monitor Closely (243)

              • 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.

              • 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.

              • 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 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

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

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

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

              • armodafinil

                formoterol and armodafinil both decrease sedation. 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.

              • 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 and opium

                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

                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.

              • 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.

              • 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.

              • 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.

              • 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

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

              • chlorthalidone

                formoterol and chlorthalidone both decrease serum potassium. 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.

              • clonazepam

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

              • 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.

              • 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.

              • 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 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.

              • 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

                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 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.

              • 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.

              • doxepin

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

              • droperidol

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

              • drospirenone

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

              • 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.

              • 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.

              • 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 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.

              • 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.

              • gentamicin

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

              • goserelin

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

              • haloperidol

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

              • histrelin

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

              • 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.

              • 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

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

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

              • imipramine

                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.

              • 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.

              • 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.

              • 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

                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.

              • 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

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

              • maprotiline

                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.

              • 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.

              • 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.

              • 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

                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

                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

              • opium tincture

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

              • 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

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

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

              • 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.

              • pimozide

                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.

              • 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

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

              • promethazine

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

              • pseudoephedrine

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

              • quazepam

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

              • quetiapine

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

              • quinine

                formoterol and quinine both increase QTc interval. 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.

              • risperidone

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

                risperidone increases and formoterol decreases sedation. 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.

              • 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.

              • 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.

              • 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.

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

              Minor (17)

              • 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.

              • 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.

              • 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.

              • 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.

              • sage

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

              • torsemide

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

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              Adverse Effects

              >10%

              Upper respiratory tract infection (URTI) (8-11%)

              Headache (7-11%)

              Nasopharyngitis (7-11%)

              1-10%

              Pharyngolaryngeal pain (6-9%)

              Stomach discomfort (1-7%)

              Sinusitis (5-6%)

              Oral candidiasis (1-6%)

              Bronchitis (5%)

              Viral URTI (4%)

              Backache (2-3%)

              Influenza (2-3%)

              Nasal congestion (2-3%)

              Vomiting (1- 3%)

              Postmarketing Reports

              Cardiovascular: Angina pectoris, tachycardia, atrial and ventricular tachyarrhythmias, atrial fibrillation, extrasystoles, palpitations, hypotension, hypertension

              Endocrine: Hypercorticism, growth velocity reduction (in children)

              Sensory: Cataract, glaucoma, increased intraocular pressure (IOP), skin bruising

              Gastrointestinal (GI): Oropharyngeal candidiasis, nausea

              Immunologic: Immediate and delayed hypersensitivity reactions, such as anaphylactic reaction, angioedema, bronchospasm, urticaria, exanthema, dermatitis, pruritus

              Metabolic: Hyperglycemia, hypokalemia

              Musculoskeletal: Muscle cramps

              Neurologic and psychiatric: Behavior disturbances, sleep disturbances, nervousness, agitation, depression, restlessness tremor, dizziness

              Respiratory: Dysphonia, cough, throat irritation

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              Warnings

              Contraindications

              Hypersensitivity

              Primary treatment of status asthmaticus or acute episodes of asthma or COPD requiring intensive measures

              Cautions

              Risk of LABAs used as monotherapy

              • Use of LABAs as monotherapy (without inhaled corticosteroids) for asthma is associated with an increased risk of asthma-related death
              • Data from controlled clinical trials also suggest that use of LABA as monotherapy increases the risk of asthma-related hospitalization in pediatric and adolescent patient
              • 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

              Do not initiate in patients experiencing rapidly deteriorating or potentially life-threatening asthma or COPD episodes; additionally, increased inhaled SABA use is marker of deteriorating asthma

              Do not use for relief of acute symptoms (rescue therapy)

              Maximum dosage must not be exceeded, because of increased risk of serious cardiovascular effects

              Localized infections with Candida albicans in mouth and pharynx occur in some patients; to reduce risk, mouth must be rinsed after inhalation

              Monitor COPD patients for signs and symptoms of pneumonia and lung infections

              Risk of more serious or fatal course of chickenpox or measles exists in susceptible patients (eg, unvaccinated or immunologically unexposed individuals); care must be taken to avoid exposure

              Excessive use may suppress hypothalamic-pituitary-adrenal function; monitor closely, especially postoperatively or during periods of stress

              During periods of stress, a severe asthma attack or a severe COPD exacerbation, patients who have been withdrawn from systemic corticosteroids should be instructed to resume oral corticosteroids (in large doses) immediately and to contact their physicians for further instruction

              Risk of paradoxical bronchospasm, which may be life-threatening; discontinue and treat immediately with inhaled SABA

              Risk of immediate hypersensitivity reactions (eg, urticaria, angioedema, rash, bronchospasm)

              Cardiovascular and central nervous system (CNS) effects due to excess beta-adrenergic stimulation; may result in asthma-related death; use with caution in patients with cardiovascular or convulsive disorders or thyrotoxicosis

              Particular care is needed to transfer patients from systemic to inhaled corticosteroids; potentially fatal adrenal insufficiency may occur before or afterward; taper withdrawal gradually

              Decrease in bone mineral density after long-term administration of corticosteroids; monitor patients at risk; assess bone mineral density initially and periodically thereafter

              May decrease growth velocity in children; monitor

              Risk of cataracts, glaucoma, and increased IOP; monitor

              Risk of systemic eosinophilic conditions, some consistent with Churg-Strauss syndrome

              Risk of transient hypokalemia; may not warrant supplementation

              Risk of overdose if used with additional long-acting beta2-agonist in other combination products

              Hypercorticism and adrenal suppression; may occur with very high dosages or at regular dosage in susceptible individuals; discontinue therapy if such changes occur

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              Pregnancy & Lactation

              Pregnancy

              In women with poorly or moderately controlled asthma, there is increased risk of several perinatal adverse outcomes such as preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in neonate; pregnant women with asthma should be closely monitored and medication adjusted as necessary to maintain optimal asthma control

              There are no well-controlled human studies that have investigated the effects of therapy during labor and delivery; because of potential for beta-agonist interference with uterine contractility, use of therapy during labor should be restricted to those patients in whom the benefits clearly outweigh risk

              Lactation

              There are no available data on the breastfed child or on milk production; budesonide, like other inhaled corticosteroids, is present in human milk; there are no available data on the presence of formoterol fumarate in human milk; formoterol fumarate is present in rat milk; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed infant from therapy 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

              Budesonide: Anti-inflammatory corticosteroid; has potent glucocorticoid activity and weak mineralocorticoid activity

              Formoterol: Long-acting selective beta2-adrenergic 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

              Absorption

              Peak plasma time: Budesonide, 20 min; formoterol, 5-10 min

              Peak plasma concentration: Budesonide, 0.6-1.6 nmol/L; formoterol, 136 pmol/L

              Distribution

              Protein bound: Budesonide, 85-90%; formoterol, 46-68%

              Vd: Budesonide, 3 L/kg

              Metabolism

              Metabolized in liver by CYP3A4 (budesonide) or CYP2D6/CYP2C (formoterol; O-demethylation)

              Elimination

              Excretion (budesonide): Urine (60%), feces

              Excretion (formoterol): Urine (62%), feces (24%)

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              Administration

              Oral Inhalation Administration

              Prime before first use by releasing 2 test sprays into air, shaking well for 5 seconds before each spray; repeat priming if inhaler is unused for >7 days or has been dropped

              After inhalation, rinse mouth with water without swallowing

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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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              • View the formulary and any restrictions for each plan.
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              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              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.