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Perforomist 20mcg/2mL Nebulizer Solution
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Indications & Clinical Uses
- Perforomist 20 mcg/2 mL (formoterol fumarate) is a long-acting beta2-adrenergic agonist (LABA) bronchodilator supplied as a single-dose nebulizer solution.
- It is approved for the long-term, twice-daily maintenance treatment of bronchoconstriction in adults with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.
- Perforomist is not approved for asthma and must never be used as a rescue medicine for a sudden attack of breathlessness — a separate short-acting bronchodilator is needed for that.
- It is given only by nebulizer with a standard jet nebulizer connected to an air compressor, never by mouth.
- Formoterol is also marketed for asthma maintenance in other inhaler devices and combination products; Perforomist itself is licensed specifically for COPD maintenance, and dosing must not be increased beyond the prescribed twice-daily schedule even if symptoms persist.
Side Effects
- The most common side effects reported with Perforomist (formoterol fumarate) include diarrhoea, nausea, a blocked or runny nose (nasopharyngitis), dry mouth, vomiting, dizziness and insomnia.
- Perforomist can also cause a fast or irregular heartbeat, palpitations, tremor, nervousness and, rarely, allergic reactions including rash, swelling of the face or throat, or difficulty breathing, which need urgent medical attention.
- Like other long-acting beta-agonists, formoterol used without an inhaled corticosteroid is associated with a higher risk of serious, sometimes fatal, asthma-related events; this is why Perforomist is licensed for COPD only, never as monotherapy for asthma.
- A rare but serious risk is paradoxical bronchospasm — sudden worsening of wheeze or breathlessness right after a dose — which means treatment should be stopped and the healthcare provider contacted straight away.
- Seek urgent help for chest pain, fainting, or a racing heartbeat that does not settle.
Precautions & Warnings
- Perforomist must not be used as a rescue inhaler for sudden breathing difficulty; keep a separate fast-acting bronchodilator on hand for emergencies.
- It is contraindicated as monotherapy in asthma without a background inhaled corticosteroid, and should be used cautiously in people with heart disease, high blood pressure, seizure disorders, thyroid overactivity, or diabetes, since formoterol can affect heart rhythm, blood pressure, blood sugar and potassium levels.
- Only one 20 mcg/2 mL vial should be used per dose, twice daily 12 hours apart, and the total daily dose should never exceed 40 mcg.
- Perforomist is for inhalation by nebulizer only and must not be swallowed or injected.
- There are no specific pregnancy or breastfeeding restrictions beyond general caution; discuss use during pregnancy or while breastfeeding with a healthcare provider.
- Store vials refrigerated in the protective foil pouch, protected from light, and use as directed once removed from the pouch.
Avoid Interactions
- Tell your healthcare provider about all medicines you take before starting Perforomist (formoterol fumarate).
- Other beta-adrenergic bronchodilators should generally be avoided in combination, as effects may add up and increase side effects.
- Beta-blockers, even eye-drop forms used for glaucoma, can block formoterol's effect and worsen bronchospasm, so they should be avoided or used only with caution.
- Diuretics such as loop and thiazide diuretics can worsen ECG changes and lower potassium when combined with formoterol, so potassium levels may need monitoring.
- Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants can increase the cardiovascular effects of formoterol and should be used with extreme caution, ideally with at least two weeks between stopping an MAOI and starting Perforomist.
- Drugs that prolong the QT interval may raise the risk of heart rhythm problems in combination with formoterol.
- Always mention any heart medicines, diabetes treatment, or supplements to your prescriber.
References
Frequently Asked Questions
Perforomist (formoterol fumarate) is a long-acting bronchodilator used twice daily, morning and evening, for long-term maintenance treatment of bronchoconstriction in adults with chronic obstructive pulmonary disease (COPD). It is not approved for asthma and cannot relieve a sudden attack of breathlessness.
Perforomist comes as a 20 mcg/2 mL solution used only with a standard jet nebulizer and air compressor, never taken by mouth. One vial is inhaled twice daily, 12 hours apart, and the total dose should not exceed 40 mcg a day.
Common side effects include diarrhoea, nausea, a blocked or runny nose, dry mouth, dizziness and insomnia. Get urgent help for chest pain, a fast or irregular heartbeat, or sudden worsening of wheeze or breathlessness right after a dose (paradoxical bronchospasm), which needs immediate treatment.
Avoid using Perforomist as monotherapy for asthma without an inhaled corticosteroid, since this raises the risk of serious, sometimes fatal, asthma events. Avoid other beta-agonist bronchodilators and beta-blockers (including eye drops), and use caution with MAOIs, tricyclic antidepressants and diuretics.
Keep Perforomist vials refrigerated at 2°C to 8°C inside the protective foil pouch until ready to use. Do not use a vial if the solution is discoloured or contains particles. Ask your pharmacist how long an opened pouch can be kept at room temperature.
No. A boxed warning about LABA-related asthma deaths was formally removed from Perforomist label in May 2019. A warning about the asthma-monotherapy risk still remains in the regular warnings section, which is why Perforomist is approved only for COPD maintenance, never for asthma.
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