Foradil (Formoterol Fumarate)
Also sold as: Foradil, Formatris, Foracort (with budesonide), Symbicort (with budesonide)
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
DPI capsule 12 mcg (Aerolizer) +2
Indications
- COPD — maintenance bronchodilation (combined with LAMA or ICS)
- Asthma — maintenance (ALWAYS combined with ICS, NEVER as monotherapy)
- Exercise-induced bronchospasm prevention
Adult Dosing
COPD / Asthma (maintenance)
12 mcg inhaled BD (Aerolizer DPI)
Ongoing
Combination (Foracort 200/6)
1-2 puffs BD (ICS/LABA fixed combination)
Preferred over monotherapy for asthma
Pediatric Dosing
LABA monotherapy in asthma is CONTRAINDICATED in children — must always combine with ICS
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any | No adjustment; inhaled route minimal systemic absorption |
Hepatic Adjustment
No significant adjustment required
Pregnancy & Lactation
Pregnancy: Category C
Inhaled LABAs generally considered safe; prefer salbutamol for acute relief. Formoterol may be continued in well-controlled asthma — uncontrolled asthma is greater risk.
Lactation: Caution
Unknown in breast milk; inhaled route systemic exposure minimal — likely safe.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| MAO inhibitors / Tricyclic antidepressants | Increased cardiovascular effects — avoid combination | Major |
| Non-selective beta-blockers (propranolol) | Antagonism of bronchodilator effect; potential severe bronchospasm | Major |
| QT-prolonging drugs | Additive QT prolongation | Moderate |
| Loop diuretics / Thiazides | Hypokalaemia — monitor K+ especially in severe asthma | Moderate |
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Side Effects
Common
- Tremor (hands)
- Palpitations
- Headache
- Muscle cramps
- Hypokalaemia (high doses)
- Throat irritation
Serious / Discontinue If
- LABA monotherapy in asthma — increased risk of asthma death (FDA Black Box Warning — use only with ICS)
- Severe hypokalaemia
- QT prolongation
- Paradoxical bronchospasm
Contraindications
- Asthma monotherapy (without ICS) — CONTRAINDICATED
- Hypersensitivity to formoterol or lactose (DPI)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Foradil 12 mcg Aerolizer | Novartis | 30 cap ₹485 |
| Foracort 200/6 Inhaler | Cipla | 120 puffs ₹395 |
| Formatris 12 mcg | Cipla | 30 cap ₹325 |
Monitoring Required
- Serum potassium (especially in severe asthma + high doses)
- ECG (QT) if cardiac risk factors
- Spirometry (FEV1, PEF) — response to therapy
- Symptom control scores
Patient Counseling Points
- ASTHMA: NEVER use formoterol alone — must always be with an ICS inhaler
- This is NOT a rescue inhaler — use salbutamol for sudden breathlessness
- Aerolizer: pierce capsule then inhale rapidly and deeply
- Report palpitations, hand tremor, or worsening breathing
- Do not use more than prescribed — overuse is dangerous
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Clinically reviewed by: Dr. Kavitha Rao, MD (Pulmonology), Consultant
Last reviewed: 2026-04-01
References
- BNF — Formoterol
- GINA Asthma Guidelines 2024
- GOLD COPD Guidelines 2025
- FDA LABA Black Box Warning