Home Drug Guide Formoterol Fumarate and Mometasone Furoate

Drug Guide

Generic Name

Formoterol Fumarate and Mometasone Furoate

Brand Names Dulera

Classification

Therapeutic: Asthma and COPD maintenance therapy

Pharmacological: Beta2-adrenergic agonist and inhaled corticosteroid combination

FDA Approved Indications

  • Management of asthma in patients aged 12 years and older
  • Management of airflow obstruction in COPD (less common for this specific combination)

Mechanism of Action

Formoterol is a long-acting beta2-adrenergic receptor agonist that relaxes airway smooth muscle, resulting in bronchodilation. Mometasone is an inhaled corticosteroid that reduces inflammation by inhibiting multiple types of inflammatory cells and decreasing cytokine production.

Dosage and Administration

Adult: Two inhalations (each containing 4.5 mcg formoterol and 200 mcg mometasone) twice daily

Pediatric: Not approved for children under 12 years.

Geriatric: No specific dosage adjustment; monitor for cardiovascular effects.

Renal Impairment: No specific dosage adjustment recommended.

Hepatic Impairment: No specific dosage adjustment recommended.

Pharmacokinetics

Absorption: Rapid absorption for both components when inhaled.

Distribution: Systemic distribution mostly in plasma and tissues.

Metabolism: Formoterol is metabolized via CYP2D6 and CYP2C19 pathways; Mometasone undergoes extensive first-pass metabolism via hepatic enzymes.

Excretion: Renal and fecal excretion of metabolites.

Half Life: Formoterol approximately 12 hours; Mometasone approximately 12 hours (systemic half-life).

Contraindications

  • Hypersensitivity to mometasone or formoterol or other beta2-agonists or corticosteroids
  • Status asthmaticus or other acute episodes of asthma

Precautions

  • Use with caution in patients with cardiovascular disorders, hypertension, hyperthyroidism, diabetes, or seizures
  • Monitor for paradoxical bronchospasm

Adverse Reactions - Common

  • Throat irritation (Common)
  • Headache (Common)
  • Pharyngitis (Common)
  • Oral candidiasis (Less common)

Adverse Reactions - Serious

  • Paradoxical bronchospasm (Uncommon)
  • Cardiovascular effects (tachycardia, palpitations) (Uncommon)
  • Hypersensitivity reactions including angioedema (Rare)

Drug-Drug Interactions

  • Other beta-agonists, monoamine oxidase inhibitors, tricyclic antidepressants (may increase cardiovascular effects)
  • CYP2D6 or CYP2C19 inhibitors (may affect formoterol metabolism)

Drug-Food Interactions

  • Avoid potent CYP2D6 inhibitors like fluoxetine, paroxetine

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess respiratory status, lung sounds, and pulse before and periodically during therapy.

Diagnoses:

  • Ineffective Airway Clearance related to bronchospasm or inflammation
  • Risk for Infection related to inhaled corticosteroid use

Implementation: Educate patient on proper inhaler technique, adherence, and symptom monitoring.

Evaluation: Monitor for symptom control, adverse effects, and adherence.

Patient/Family Teaching

  • Instruct on correct inhaler technique.
  • Rinse mouth after inhalation to prevent oropharyngeal candidiasis.
  • Do not use for acute bronchospasm; carry a rescue inhaler.
  • Report any signs of adverse reactions to healthcare provider.

Special Considerations

Black Box Warnings:

  • Potential risk of severe asthma episodes or death with LABA monotherapy, always combine with ICS as prescribed.

Genetic Factors: Genetic polymorphisms in CYP2D6 may affect metabolism of formoterol.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe tachycardia, hypokalemia, hyperglycemia, tremors, seizures.

Treatment: Provide supportive care, monitor cardiac and respiratory status, administer beta-blockers cautiously if needed, and correct electrolyte disturbances.

Storage and Handling

Storage: Store at room temperature, away from moisture and direct heat.

Stability: Stable for prescribed shelf life, check packaging for expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.