than or equal to 50 mL/minute—plasma-tiotropium
concentration raised.
lPATIENT AND CARER ADVICEPatients or carers should be
given advice on appropriate inhaler technique.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Pressurised inhalation
▶Spiriva Respimat(Boehringer Ingelheim Ltd)
Tiotropium (as Tiotropium bromide) 2.5 microgram per
1 doseSpiriva Respimat 2. 5 micrograms/dose solution for inhalation
cartridge with device| 60 doseP£ 23. 00 DT = £ 23. 00BETA 2 -ADRENOCEPTOR AGONISTS, SELECTIVE
Beta 2 -adrenoceptor agonists, f
selective 12-Feb-2016
lCONTRA-INDICATIONSSevere pre-eclampsia
lCAUTIONSArrhythmias.cardiovascular disease.diabetes
(risk of hyperglycaemia and ketoacidosis, especially with
intravenous use).hypertension.hyperthyroidism.
hypokalaemia.susceptibility to QT-interval prolongation
CAUTIONS, FURTHER INFORMATION
▶HypokalaemiaPotentially serious hypokalaemia may result
from beta 2 agonist therapy. Particular caution is required
in severe asthma, because this effect may be potentiated
by concomitant treatment with theophylline and its
derivatives, corticosteroids, diuretics, and by hypoxia.
lSIDE-EFFECTS
▶Common or very commonArrhythmias.dizziness.
headache.hypokalaemia (with high doses).nausea.
palpitations.tremor
▶UncommonHyperglycaemia.myocardial ischaemia
▶Rare or very rareBronchospasm paradoxical (sometimes
severe)
lPREGNANCYWomen planning to become pregnant should
be counselled about the importance of taking their asthma
medication regularly to maintain good control.
lMONITORING REQUIREMENTS
▶In severe asthma, plasma-potassium concentration should
be monitored (risk of hypokalaemia).
▶In patients with diabetes, monitor blood glucose (risk of
hyperglycaemia and ketoacidosis, especially when beta 2
agonist given intravenously).
lPATIENT AND CARER ADVICEThedose, the frequency, and
the maximum number of inhalations in 24 hours of the
beta 2 agonist should bestated explicitlyto the patient or
their carer. The patient or their carer should be advised to
seek medical advice when the prescribed dose of beta 2
agonist fails to provide the usual degree of symptomatic
relief because this usually indicates a worsening of the
asthma and the patient may require a prophylactic drug.
Patients or their carers should be advised to follow
manufacturers’instructions on the care and cleansing of
inhaler devices.BETA 2 -ADRENOCEPTOR AGONISTS,
SELECTIVE›LONG-ACTING
eiiiiFaboveFormoterol fumarate
(Eformoterol fumarate)
lINDICATIONS AND DOSE
Reversible airways obstruction in patients requiring long-
term regular bronchodilator therapy|Nocturnal asthma
in patients requiring long-term regular bronchodilator
therapy|Prophylaxis of exercise-induced bronchospasm
in patients requiring long-term regular bronchodilator
therapy|Chronic asthma in patients who regularly use
an inhaled corticosteroid
▶BY INHALATION OF POWDER
▶Child 6–11 years: 12 micrograms twice daily, a daily dose
of 24 micrograms of formoterol should be sufficient for
the majority of children, particularly for younger age-
groups; higher doses should be used rarely, and only
when control is not maintained on the lower dose
▶Child 12–17 years: 12 micrograms twice daily, dose may
be increased in more severe airway obstruction;
increased to 24 micrograms twice daily, a daily dose of
24 micrograms of formoterol should be sufficient for
the majority of children, particularly for younger age-
groups; higher doses should be used rarely, and only
when control is not maintained on the lower dose
▶BY INHALATION OF AEROSOL
▶Child 12–17 years: 12 micrograms twice daily, dose may
be increased in more severe airway obstruction;
increased to 24 micrograms twice daily, a daily dose of
24 micrograms of formoterol should be sufficient for
the majority of children, particularly for younger age-
groups; higher doses should be used rarely, and only
when control is not maintained on the lower dose
OXIS®
Chronic asthma
▶BY INHALATION OF POWDER
▶Child 6–17 years: 6 – 12 micrograms 1 – 2 times a day
(max. per dose 12 micrograms), occasionally doses up
to the maximum daily may be needed, reassess
treatment if additional doses required on more than
2 days a week; maximum 48 micrograms per day
Relief of bronchospasm
▶BY INHALATION OF POWDER
▶Child 6–17 years: 6 – 12 micrograms
Prophylaxis of exercise-induced bronchospasm
▶BY INHALATION OF POWDER
▶Child 6–17 years: 6 – 12 micrograms, dose to be taken
before exercise
PHARMACOKINETICS
▶At recommended inhaled doses, the duration of action
of formoterol is about 12 hours.IMPORTANT SAFETY INFORMATION
CHM ADVICE
To ensure safe use, the CHM has advised that for the
management of chronic asthma, long-acting beta 2
agonist (formoterol) should:
.be added only if regular use of standard-dose inhaled
corticosteroids has failed to control asthma
adequately;
.not be initiated in patients with rapidly deteriorating
asthma;
.be introduced at a low dose and the effect properly
monitored before considering dose increase;
.be discontinued in the absence of benefit;154 Airways disease, obstructive BNFC 2018 – 2019
Respiratory system3