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The following safety information highlights crucial risks and precautions associated with the use of formoterol (Perforomist). Please read these carefully and discuss with your healthcare provider if you have any questions or concerns.

• Risk of Asthma-related Death: Formoterol (Perforomist) should not be used by individuals with asthma. There is a heightened risk of asthma-related hospitalizations and fatalities among these patients. It is not suitable for asthma treatment or as a rescue inhaler. Those with a history of asthma should avoid its use.

• COPD Symptom Worsening: Do not use formoterol (Perforomist) for sudden exacerbations of COPD symptoms. In the event that a fast-acting inhaler like albuterol does not alleviate breathing difficulties, seek emergency medical assistance immediately by contacting 911 or your healthcare provider. If symptoms persist or worsen over time despite using formoterol (Perforomist), consult your healthcare provider to explore alternative treatment options.

• Acute Breathing Difficulties: On rare occasions, users may experience breathing problems immediately after using formoterol (Perforomist). If this occurs, discontinue use and employ a fast-acting rescue inhaler. Consult your healthcare provider promptly to consider switching to an alternative medication.

• Cardiac Concerns: Formoterol (Perforomist) can potentially increase blood pressure and heart rate. If you experience these symptoms, stop using the medication immediately. Individuals with a history of heart disease, abnormal heart rhythm, or high blood pressure, or those using more than the prescribed dose, should exercise caution.

Please note that there are no specific contraindications provided for formoterol (Perforomist). Always use this medication as directed by your healthcare provider, and report any adverse effects or concerns promptly for further guidance.

Common side effects:

• Diarrhea
• Nausea
• Symptoms similar to the common cold
• Dry mouth
• Vomiting
• Dizziness
• Difficulty sleeping

Less common but important to monitor:

• Allergic reactions
• Worsening of copd symptoms
• Paradoxical bronchospasm

When using formoterol, it's important to be aware of potential interactions with other medications, as these can affect its effectiveness or increase the risk of side effects. Here are some key considerations:

Other Adrenergic Drugs: Combining formoterol with other adrenergic medications, such as certain decongestants found in cold remedies (e.g., phenylephrine, pseudoephedrine), can amplify sympathetic effects, potentially leading to increased heart rate and blood pressure. Use caution and consult your healthcare provider before using these medications together.

Beta-Blockers: Beta-blockers, commonly prescribed for heart conditions and high blood pressure, can counteract the effects of formoterol. In some cases, they may even cause severe bronchospasm, especially in individuals with asthma or COPD. If you require both medications, your doctor may consider using a cardioselective beta-blocker and will monitor you closely.

Diuretics: Non-potassium-sparing diuretics (like loop or thiazide diuretics) can lower potassium levels in the blood. When used with formoterol, this effect may be intensified, leading to significant hypokalemia (low potassium levels), which can cause muscle weakness, cramps, and irregular heart rhythms. It's important to monitor potassium levels if you're taking these medications together.

Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants (TCAs): These types of antidepressants can enhance the cardiovascular effects of formoterol, increasing the risk of heart-related side effects. If you're on MAOIs or TCAs, inform your doctor, as they may need to adjust your treatment plan.

Medications That Prolong the QTc Interval: Certain drugs can prolong the QTc interval on an electrocardiogram, which may lead to serious heart rhythm abnormalities. Using formoterol with these medications can further increase this risk. Examples include specific antibiotics, antifungals, and some antipsychotic medications. Always inform your healthcare provider about all the medications you're taking to assess potential risks.

Xanthine Derivatives and Corticosteroids: Medications like Theophylline (a xanthine derivative) and systemic corticosteroids can enhance the hypokalemic effect of formoterol. This means they can further lower potassium levels in your blood, increasing the risk of side effects. Close monitoring is advised when these are used together.

Alcohol and Tobacco: While there are no well-documented interactions between formoterol and alcohol or tobacco, it's generally advisable to discuss your use of these substances with your healthcare provider, as they can influence overall health and medication effectiveness.

Always inform your doctor and pharmacist about all the medications, supplements, and over-the-counter products you're using. This will help them identify potential interactions and adjust your treatment plan accordingly to ensure your safety and the effectiveness of your therapy.