page197
ograms twice daily in more severe airways obstruction (see also
CHM advice above)
Chronic obstructive pulmonary disease,
12 micrograms twice
daily
Atimos Modulite
c
(Chiesi) T A
Aerosol inhalation
,
formoterol fumarate 12 micr-
ograms/metered inhalation, net price 100-dose unit =
£30.06.
Counselling,
administration
Dose
by aerosol inhalation,
asthma,
ADULT and CHILD over 12
years,
12 micrograms twice daily,
increased to max.
24 micr-
ograms twice daily in more severe airways obstruction
Chronic obstructive pulmonary disease,
ADULT over 18 years,
12 micrograms twice daily;
for symptom relief additional doses
may be taken to total max. 48 micrograms daily (max. single dose
24 micrograms)
Foradil
c
(Novartis) A
Dry powder for inhalation
,
formoterol fumarate
12 micrograms/capsule,
net price 60-cap pack (with
inhaler device) = £23.38.
Counselling,
administration
Dose
by inhalation of powder, asthma, ADULT and CHILD over 12
years,
12 micrograms twice daily,
increased to max.
24 micr-
ograms twice daily in more severe airways obstruction;
CHILD 5–
12 years 12 micrograms twice daily
Chronic obstructive pulmonary disease,
12 micrograms twice
daily
Oxis
c
(AstraZeneca) A
Turbohaler
c
(= dry powder inhaler),
formoterol
fumarate 6 micrograms/metered inhalation, net price
60-dose unit = £24.80; 12 micrograms/metered inha-
lation,
60-dose unit = £24.80.
Counselling,
adminis-
tration
Dose
by inhalation of powder, chronic asthma, 6–12 micrograms
1–2 times daily,
increased up to 24 micrograms twice daily if
necessary; occasionally up to 72 micrograms daily may be needed
(max. single dose 36 micrograms); reassess treatment if additional
doses required on more than 2 days a week;
CHILD 6–18 years, 6–
12 micrograms 1–2 times daily; occasionally up to 48 micrograms
daily may be needed (max.
single dose 12 micrograms) (see also
CHM advice above)
Relief of bronchospasm,
ADULT and CHILD over 6 years,
6–
12 micrograms
Prophylaxis of exercise-induced bronchospasm,
12 micrograms
before exercise;
CHILD 6–18 years,
6–12 micrograms before
exercise
Chronic obstructive pulmonary disease, 12 micrograms 1–2 times
daily;
for symptom relief additional doses can be taken to total
max.
48 micrograms daily (max.
single dose 24 micrograms)
Compound preparations
For compound preparations containing formoterol,
see section 3.2
INDACATEROL
Indications
maintenance treatment of chronic
obstructive pulmonary disease
Cautions
see notes above; convulsive disorders
Hepatic impairment
use with caution in severe
impairment—no information available
Pregnancy
manufacturer advises use only if potential
benefit outweighs risk
Breast-feeding
manufacturer advises use only if
potential benefit outweighs risk—present in milk in
animal
studies
Side-effects
see notes above; also peripheral oedema,
cough, pharyngolaryngeal pain, nasopharyngitis,
sinusitis, rhinorrhoea;
less commonly
atrial fibrillation,
non-cardiac chest pain,
paraesthesia
Dose
. By inhalation of powder,
ADULT
over 18 years,
150 micrograms once daily,
increased to max.
300 micrograms once daily
Onbrez Breezhaler
c
(Novartis) T A
Inhalation powder, hard capsule
(for use with
Onbrez Breezhaler
c
device), indacaterol (as maleate)
150 micrograms,
net price 30-cap pack with
Onbrez
Breezhaler
c
device = £29.26;
300 micrograms,
net
price 30-cap pack with
Onbrez Breezhaler
c
device =
£29.26.
Counselling,
administration
SALBUTAMOL
(Albuterol)
Indications
asthma and other conditions associated
with reversible airways obstruction; premature labour
(section 7.1.3)
Cautions
see notes above
Pregnancy
see p.
170
Breast-feeding
see p.
170
Side-effects
see notes above; also lactic acidosis with
high doses
Dose
. By mouth (but use by inhalation preferred),
4 mg
(elderly and sensitive patients initially 2 mg) 3–4 times
daily; max.
single dose 8 mg (but unlikely to provide
much extra benefit or to be tolerated);
CHILD
under 2
years see
BNF for Children
;
2–6 years 1–2 mg 3–4
times daily,
6–12 years 2 mg 3–4 times daily
. By subcutaneous
or
intramuscular injection,
500 micrograms,
repeated every 4 hours if necessary
. By slow intravenous injection (but see also Manage-
ment of Acute Asthma table,
p.
173),
(dilute to a
concentration of 50 micrograms/mL), 250 micr-
ograms,
repeated if necessary;
CHILD
under 18 years
see
BNF for Children
. By intravenous infusion (but see also Management of
Acute Asthma table,
p.
173),
initially 5 micrograms/
minute, adjusted according to response and heart-rate
usually in range 3–20 micrograms/minute, or more if
necessary;
CHILD
under 18 years see
BNF for Children
. By aerosol inhalation (but see also Management of
Acute Asthma table,
p.
173,
or
Management of
Chronic Asthma table,
p.
172),
100–200 micrograms
(1–2 puffs);
for persistent symptoms up to 4 times
daily;
CHILD
100 micrograms (1 puff),
increased to
200 micrograms (2 puffs) if necessary;
for persistent
symptoms up to 4 times daily
Prophylaxis of allergen- or exercise-induced bron-
chospasm,
200 micrograms (2 puffs);
CHILD
100 micr-
ograms (1 puff), increased to 200 micrograms (2 puffs)
if necessary
. By inhalation of powder (but see also Management of
Chronic Asthma table,
p.
172),
200–400 micrograms;
for persistent symptoms up to 4 times daily;
CHILD
over 5 years 200 micrograms;
for persistent symp-
toms up to 4 times daily (for
Asmasal Clickhaler
c
,
Salbulin Novolizer
c
, and
Ventolin Accuhaler
c
doses,
see under preparations)
Prophylaxis of allergen- or exercise-induced bron-
chospasm,
400 micrograms;
CHILD
200 micrograms
. By inhalation of nebulised solution,
ADULT
and
CHILD
over 5 years 2.5–5 mg, repeated up to 4 times daily or
more frequently in severe cases;
CHILD
under 5 years
2.5 mg,
repeated up to 4 times daily or more fre-
quently in severe cases;
see also Management of
Acute Asthma table,
p.
173 and Management of
Chronic Asthma table,
p.
172
BNF 61
3.1.1 Adrenoceptor agonists
177
3
Respiratory system