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RESPIRATORY SYSTEM › DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES › ADRENERGICS, INHALANTS › Adrenergics in combination with corticosteroids or other drugs, excl. anticholinergics
formoterol and fluticasone
R03AK11
Forms & Strengths
- Inhalation aerosol (press‑metered) 100 µg fluticasone propionate / 5 µg formoterol fumarate per actuation
- Dry powder inhaler 250 µg fluticasone / 10 µg formoterol per inhalation
- Available in 2‑dose inhaler devices (100/5 µg) and 4‑dose DPI (250/10 µg)
Adult Dosing
- Asthma: 1–2 inhalations twice daily (total 200–400 µg fluticasone / 10–20 µg formoterol).
- COPD: 2 inhalations twice daily (total 500 µg fluticasone / 20 µg formoterol) for patients requiring higher steroid dose.
- Maximum: 4 inhalations per day (800 µg fluticasone / 40 µg formoterol).
- Do not use for acute symptom relief; have rescue inhaler available.
Pediatric Dosing
- ≥12 yr: same as adult asthma dosing (1–2 inhalations BID).
- 4–11 yr: 1 inhalation BID (100 µg fluticasone / 5 µg formoterol).
- Children <4 yr: not recommended.
- Step‑down: reduce to lowest effective dose after control achieved.
Indications
- Maintenance therapy for persistent asthma in patients ≥4 yr.
- Long‑term maintenance treatment of COPD to reduce exacerbations.
Mechanism of Action
- Fluticasone: high‑affinity glucocorticoid receptor agonist → suppresses airway inflammation, cytokine production, eosinophil migration.
- Formoterol: selective β2‑adrenergic receptor agonist with rapid onset and 12‑hour duration → smooth‑muscle relaxation and bronchodilation.
Contraindications
- Known hypersensitivity to fluticasone, formoterol, or any inhaler excipients.
- Primary treatment of status asthmaticus or acute bronchospasm.
- Patients with a history of severe hypersensitivity to LABA (e.g., paradoxical bronchospasm).
- Severe lactose intolerance when using lactose‑based DPI.
Adverse Reactions
- Oral candidiasis, dysphonia, hoarseness.
- Tremor, palpitations, tachycardia, headache.
- Hypokalemia, especially with high‑dose β2‑agonist use.
- Potential systemic steroid effects: adrenal suppression, bone mineral density loss.
- Paradoxical bronchospasm, cough, throat irritation.
Drug Interactions
- β‑blockers (e.g., propranolol) may antagonize bronchodilator effect of formoterol.
- Strong CYP3A4 inhibitors (ketoconazole, itraconazole) can increase systemic fluticasone exposure.
- Other sympathomimetics (e.g., epinephrine) may enhance cardiovascular effects.
- Diuretics and glucocorticoids may exacerbate hypokalemia when combined with formoterol.
- Concurrent use of other inhaled or systemic corticosteroids increases risk of systemic steroid side‑effects.
Curated Content: Needs Vetting Before Put to Clinical Use