Perforomist (formoterol fumarate)

Perforomist is a brand-name prescription drug that’s used to treat chronic obstructive pulmonary disease (COPD) in adults. COPD is a condition that includes several lung diseases that get worse over time, such as emphysema and chronic bronchitis. With COPD, you may have shortness of breath, coughing, or wheezing.

Perforomist contains the drug formoterol fumarate, which is a long-acting beta2-agonist (LABA). It works over time to open up your airways and make it easier for you to breathe. Perforomist is not meant to be used as a rescue medication to treat sudden breathing problems.

Perforomist comes as a liquid solution inside single-dose vials. It’s available in one strength: 20 mcg/2 mL. You’ll take Perforomist by inhaling it through a nebulizer (a machine that turns the liquid solution into a mist). This medication should be taken twice daily.

Effectiveness

In clinical studies, Perforomist has been found effective to treat COPD.

In a 12-week clinical study, people with COPD took either Perforomist or a placebo (treatment with no active drug). To evaluate how well each treatment improved people’s breathing, a measurement called forced expiratory volume in 1 second (FEV1) was recorded.

FEV1 is the maximum amount of air you can forcefully blow out of your lungs in 1 second’s time. Higher FEV1s indicate better lung function, while lower FEV1s indicate poorer lung function.

Of those who took Perforomist, 78% of people had a 15% increase in their FEV1 after their first dose of the drug.

Perforomist contains the active drug formoterol fumarate. It’s available only as a brand-name medication. It’s not currently available in generic form.

Perforomist can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Perforomist. These lists do not include all possible side effects.

For more information on the possible side effects of Perforomist, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

More common side effects

The more common side effects of Perforomist can include:

• diarrhea
• nausea
• vomiting
• dizziness
• trouble sleeping
• common cold
• high blood sugar level
• headache
• nervousness
• shakiness
• dry mouth

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Perforomist aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Problems with your heart or blood pressure. Symptoms can include:
  • chest pain
  • changes in blood pressure (either increased or decreased)
  • fast heart rate
  • palpitations (feeling your heart flutter or skip a beat)
• Paradoxical bronchospasm (tightening of your airway that’s unexpected because the drug is meant to open up your airway). Symptoms can include:
  • being unable to breathe
  • pain or tightness in your chest or back
  • coughing
  • wheezing
• Hypokalemia (low blood potassium level). Symptoms can include:
  • feeling weak or tired
  • palpitations (feeling your heart flutter or skip a beat)
  • tingling or numbness, which is usually in your hands, arms, legs, or feet
  • loss of appetite
• Severe allergic reaction. See “Side effect details” below for more information.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on some of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Perforomist. However, it’s not known for sure how many people using Perforomist have had an allergic reaction to the drug.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have a severe allergic reaction to Perforomist. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Diarrhea

You may have diarrhea when you’re taking Perforomist. In clinical studies, 4.9% of people who took the drug had diarrhea. In comparison, 3.5% of people who took a placebo (treatment with no active drug) had diarrhea.

Having occasional, mild diarrhea is common and usually not anything to worry about. But if you have severe diarrhea or diarrhea that doesn’t go away after a few days, talk with your doctor. They can recommend ways to reduce this side effect.

Nausea

Nausea is a common side effect of Perforomist. In clinical studies, 4.9% of people who took the drug had nausea. Of those taking a placebo (treatment with no active drug), 2.6% had nausea.

If you’re bothered by nausea while you’re using Perforomist, talk with your doctor. They can recommend ways to improve your nausea.

Your doctor will recommend the usual Perforomist dosage for you. They may adjust your dosage over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Perforomist comes as a liquid solution inside single-dose vials. It’s taken by using a nebulizer (a machine that turns the liquid solution into a mist that can be inhaled).

Each single-dose vial contains 20 mcg of formoterol fumarate in 2 mL of solution.

Dosage for COPD

The typical dosage of Perforomist is one single-dose vial, nebulized and inhaled through your mouth twice each day. Each dose should be taken about 12 hours apart. It’s not recommended that you take more than two doses of Perforomist each day.

Keep in mind that Perforomist isn’t meant to be used as a rescue medication for sudden breathing problems. Instead, it should be taken consistently, twice each day, whether or not you’re having trouble breathing.

What if I miss a dose?

If you miss a dose of Perforomist, just skip the missed dose and take your next dose at the usual time. Don’t take more than one dose of Perforomist at a time to make up for a missed dose.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Perforomist is meant to be used as a long-term treatment for COPD. This is because COPD is a life-long disease that typically gets worse over time. If you and your doctor determine that Perforomist is safe and effective for you, you’ll likely take it long term.

Other drugs are available that can treat chronic obstructive pulmonary disease (COPD). Some may be a better fit for you than others. If you’re interested in finding an alternative to Perforomist, talk with your doctor. They can tell you about other medications that may work well for you.

Examples of other drugs that may be used to treat COPD include:

• tiotropium (Spiriva)
• umeclidinium (Incruse Ellipta)
• aclidinium (Tudorza)
• aformoterol (Brovana)
• glycopyrrolate (Seebri Neohaler)
• indacaterol (Arcapta)
• olodaterol (Striverdi Respimat)
• budesonide/formoterol (Symbicort)
• fluticasone/salmeterol (Advair Diskus)
• fluticasone/vilanterol (Breo Ellipta)
• glycopyrrolate/formoterol (Bevespi Aerosphere)
• tiotropium/olodaterol (Stiolto Respimat)
• umeclidinium/vilanterol (Anoro Ellipta)
• fluticasone/umeclidinium/vilanterol (Trelegy)

You may wonder how Perforomist compares to other medications that are prescribed for similar uses. Here we look at how Perforomist and Brovana are alike and different.

Ingredients

Perforomist contains the drug formoterol fumarate, while Brovana contains the drug aformoterol. Both of these medications belong to a class of drugs called long-acting beta2-agonists (LABAs).

Uses

Perforomist and Brovana are both approved by the Food and Drug Administration (FDA) to treat chronic obstructive pulmonary disease (COPD) in adults.

These drugs shouldn’t be used as rescue medications, which are used to treat sudden breathing problems. Instead, Perforomist and Brovana are meant to be used as maintenance (long-term) treatments to help control COPD symptoms over time.

Drug forms and administration

Perforomist and Brovana each come as a liquid solution inside single-dose vials. They’re taken by using a nebulizer. With a nebulizer, the liquid solution is turned into a mist that can be inhaled. These drugs are each taken twice daily, about 12 hours apart. It’s not recommended that you take more than two doses each day of either drug.

Side effects and risks

Perforomist and Brovana both contain similar drugs. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Perforomist, with Brovana, or with both drugs (when taken individually).

• Can occur with Perforomist:
  • nausea
  • vomiting
  • dizziness
  • trouble sleeping
• Can occur with Brovana:
  • general body pain, or pain in your chest or back
  • leg cramps
  • rash
  • flu-like symptoms such as fever, cough, sore throat, or runny nose
  • swelling in your arms or legs
  • chest congestion
  • shortness of breath
• Can occur with both Perforomist and Brovana:
  • diarrhea
  • nervousness
  • high blood sugar level
  • feeling shaky
  • headache
  • dry mouth
  • common cold

Serious side effects

This list contain examples of serious side effects that can occur with both Perforomist and Brovana (when they’re taken individually).

• chest pain
• changes in your blood pressure (may be increased or decreased)
• fast heart rate
• palpitations (feeling your heart flutter or skip a beat)
• low blood potassium level
• paradoxical bronchospasm (tightening of your airway that’s unexpected because these drugs are meant to treat bronchospasm)
• severe allergic reaction

Effectiveness

Perforomist and Brovana are both FDA-approved to treat chronic obstructive pulmonary disease (COPD) in adults.

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Perforomist and Brovana to be effective for treating COPD.

Costs

Perforomist and Brovana are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

You may wonder how Perforomist compares to other medications that are prescribed for similar uses. Here we look at how Perforomist and Symbicort are alike and different.

Ingredients

Perforomist contains the drug formoterol fumarate, which is a long-acting beta2-agonist (LABA). Symbicort contains two drugs: formoterol fumarate and a corticosteroid called budesonide.

Uses

Perforomist and Symbicort are both approved by the Food and Drug Administration (FDA) to treat chronic obstructive pulmonary disease (COPD) in adults.

In addition to treating COPD, Symbicort is also approved to treat asthma in people ages 6 years and older.

These drugs shouldn’t be used as rescue medications, which are used to treat sudden breathing problems. Instead, Perforomist and Symbicort are meant to be used as maintenance (long-term) treatments to help control COPD symptoms over time.

Drug forms and administration

Perforomist comes as a liquid solution inside single-dose vials. It’s taken by using a nebulizer machine. With a nebulizer, the liquid solution is turned into a mist that can be inhaled. Perforomist should be taken twice daily, about 12 hours apart. It’s not recommended that you take more than two doses of Perforomist each day.

Symbicort comes as an aerosol spray that’s taken using a metered dose inhaler (MDI). With an MDI, the medication is released in puffs that can be inhaled. Symbicort should be inhaled through your mouth twice daily, taking two inhalations (puffs) each time. After taking each dose of Symbicort, you should rinse your mouth with water.

Note: Symbicort is available in two strengths. However, only one of those strengths should be used by people with COPD.

Side effects and risks

Perforomist and Symbicort both contain a long-acting beta2-agonist (LABA). Symbicort also contains a corticosteroid in addition to the LABA. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Perforomist, with Symbicort (when used to treat COPD), or with both drugs (when taken individually).

• Can occur with Perforomist:
  • diarrhea
  • nausea
  • vomiting
  • dizziness
  • trouble sleeping
  • headache
  • nervousness
  • feeling shaky
  • dry mouth
• Can occur with Symbicort:
  • upper respiratory tract infection, such as influenza (also called the flu)
  • sinus infection
  • fungal infection in your mouth (called oral thrush or candidiasis)
• Can occur with both Perforomist and Symbicort:
  • common cold
  • high blood sugar level

Serious side effects

These lists contain examples of serious side effects that can occur with Perforomist, with Symbicort, or with both drugs (when taken individually).

• Can occur with Perforomist:
  • no unique serious side effects
• Can occur with Symbicort:
  • lowered ability of your immune system to fight off infections
  • reduced ability of your adrenal glands to produce the hormone cortisol
  • weakened bones, caused by decreased bone mineral density
  • problems with your eyes, such as glaucoma (increased pressure in your eye) or cataracts (cloudiness in the lens of your eye)
  • pneumonia or other lung infections, such as bronchitis
• Can occur with both Perforomist and Symbicort:
  • chest pain
  • changes in your blood pressure (may be increased or decreased)
  • fast heart rate
  • palpitations (feeling your heart flutter or skip a beat)
  • low blood potassium level
  • paradoxical bronchospasm (tightening of your airway that’s unexpected because this drug is meant to treat bronchospasm)

Effectiveness

Perforomist and Symbicort are both FDA-approved to treat COPD in adults. Symbicort is also approved to treat asthma in people ages 6 years and older.

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Perforomist and Symbicort to be effective for treating COPD.

Costs

Perforomist and Symbicort are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

The Food and Drug Administration (FDA) approves prescription drugs such as Perforomist to treat certain conditions. Perforomist may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Perforomist for COPD

Perforomist is FDA-approved to treat chronic obstructive pulmonary disease (COPD) in adults.

COPD is a condition that includes several lung diseases that get worse over time, such as emphysema and chronic bronchitis. With COPD you may have shortness of breath, coughing, or wheezing. These symptoms, which are caused by narrowing of your airways, may get worse over time.

Perforomist contains the drug formoterol fumarate, which is a long-acting beta2-agonist (LABA). It works over time to open up your airways and make it easier for you to breathe.

You’ll use Perforomist twice each day as a maintenance (long-term) treatment for your COPD. Perforomist should not be used as a rescue medication, which is taken to treat sudden breathing problems.

Effectiveness for COPD

In clinical studies, Perforomist has been found effective to treat COPD.

In a clinical study, people with COPD took either Perforomist or a placebo (treatment with no active drug). To evaluate how well each treatment improved people’s breathing, a measurement called forced expiratory volume in 1 second (FEV1) was recorded.

FEV1 is the maximum amount of air you can forcefully blow out of your lungs in 1 second’s time. Higher FEV1s indicate better lung function, while lower FEV1s indicate poorer lung function. A typical FEV1 for someone with COPD is about 1.8 L.

Over 12 weeks of treatment, FEV1 in people who took Perforomist was increased by about 0.2 L more than FEV1 in people in using the placebo. Also in the study, over a 4-week period, people who took Perforomist needed to use about 1.5 puffs from their rescue inhaler each day. In comparison, people who took the placebo used about 2.7 puffs from their rescue inhaler each day.

Perforomist for other conditions

In addition to the use listed above, you may wonder if Perforomist is used for certain other conditions. Here we describe a condition that Perforomist shouldn’t be used to treat.

Perforomist for asthma (not an appropriate use)

Perforomist should not be used in people who have asthma. This drug hasn’t been studied in people with asthma, and it may worsen their asthma instead of making the condition better.

Medications that are similar to Perforomist have been studied in people with asthma. These drugs were seen to increase the risk of asthma-related death when used alone to treat the condition.

If you’d like to know about treatment options for asthma, talk with your doctor.

Perforomist is meant to be used as a maintenance (long-term) treatment for chronic obstructive pulmonary disease (COPD). It’s not meant to be used as a rescue medication, which is taken to treat sudden breathing problems.

You’ll likely use other medications or therapies in combination with Perforomist to control your COPD symptoms. The number of treatments you’ll use depends on the severity of your COPD symptoms and how often you have symptoms.

Below, we describe some treatments that may be used with Perforomist to treat COPD.

Note: Some of the drugs listed below are used off-label to treat COPD. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Rescue medications

Rescue medications are inhaled drugs that work quickly to relax the muscles around your airways, which allows you to breathe easier. These drugs are typically used if you’re having sudden breathing problems, such as cough or shortness of breath. Sometimes these drugs are used before exercise to prevent breathing problems.

Examples of rescue medications include:

• albuterol (ProAir HFA, Ventolin HFA)
• levalbuterol (Xopenex)
• ipratropium (Atrovent)

Inhaled corticosteroids

Inhaled corticosteroids can be used over time to reduce swelling in your airways, as well as reduce symptoms of coughing and wheezing. These drugs are usually prescribed in addition to drugs similar to Perforomist.

Examples of inhaled corticosteroids include:

• fluticasone (Flovent HFA)
• budesonide (Pulmicort, Uceris)

Oral corticosteroids

If you have moderate or severe COPD symptoms, your doctor may also prescribe oral corticosteroids for you. These steroids come as pills that are taken by mouth. They’re typically given for just a few days at a time to help reduce swelling in your airways and improve COPD symptoms. The most commonly prescribed oral steroid is prednisone (Rayos).

Methylxanthines

Methylxanthines can be used consistently over time to help reduce inflammation in your lungs and improve COPD symptoms. These medications come as either liquid or pills that are each taken by mouth. The most commonly used methylxanthine is theophylline (Theo-24, Theocron, Elixophylline).

Oxygen therapy

Because COPD affects proper airflow through your lungs, some people with COPD may have a low oxygen level in their blood. If you have a low oxygen level caused by severe COPD symptoms, your doctor may prescribe oxygen therapy for you. Depending on your needs, oxygen therapy can be used either just during activities or all day long.

With oxygen therapy, you’ll use a portable oxygen tank that’s connected to a mask or nasal cannula (tube that sends oxygen into your nose). This way, you can take your oxygen treatment with you as you move around.

Here are answers to some frequently asked questions about Perforomist and about how it’s used to treat chronic obstructive pulmonary disease (COPD).

Can Perforomist be mixed with budesonide?

No, you shouldn’t mix Perforomist solution with any other drugs that you’re taking, including budesonide. While both of these drugs are used to treat COPD, the formulations and doses of each drug were specifically designed to be taken separately.

A combination of budesonide and formoterol fumarate (the active drug in Perforomist) is available as the medication Symbicort 160/4.5. However, this medication contains a much lower dose of formoterol than Perforomist contains.

If you’d like to use a combination drug in order to reduce the number of inhaled medications you need to take, talk with your doctor. They can discuss all of your treatment options with you.

Can I use Perforomist for sudden breathing problems?

No, you shouldn’t use Perforomist for sudden breathing problems. Perforomist is meant to be used consistently for maintenance (long-term) treatment of COPD. Unlike rescue medications, which work quickly to improve breathing problems, Perforomist works over time to treat breathing symptoms.

However, you should always have a rescue medication available to use for sudden breathing problems. Examples of rescue medications include:

• albuterol (ProAir HFA, Ventolin HFA)
• levalbuterol (Xopenex)
• ipratropium (Atrovent)

If you have questions about rescue medications, talk with your doctor.

Will I be able to taste Perforomist when I take it?

It’s possible that you may notice a taste when you inhale Perforomist. However, the makers of this drug haven’t stated for sure what the medication tastes like.

If you’re concerned about the taste of Perforomist, talk with your doctor or pharmacist.

There aren’t any known interactions between Perforomist and alcohol. Talk with your doctor about whether it’s safe for you to consume alcohol while you’re using Perforomist.

Perforomist can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Perforomist and other medications

Below are lists of medications that can interact with Perforomist. These lists do not contain all the drugs that may interact with Perforomist.

Before taking Perforomist, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Perforomist and other long-acting beta2-agonists (LABAs)

Perforomist contains the drug formoterol fumarate, which belongs to a class of drugs called long-acting beta2-agonists (LABAs). If you use Perforomist with other LABAs, you have an increased risk of serious heart-related side effects. These side effects can include heart palpitations, blood pressure problems, and in rare cases death.

Examples of other LABA drugs include:

• salmeterol (Serevent Diskus)
• arformoterol (Brovana)
• olodaterol (Striverdi Respimat)
• indacaterol (Arcapta)

Some medications contain a combination of a LABA and another drug, such as a corticosteroid. Examples of these combination medications, which should not be used with Perforomist, include:

• fluticasone salmeterol (Advair Diskus/Advair HFA)
• budesonide/formoterol (Symbicort)
• mometasone/formoterol (Dulera)
• fluticasone/vilanterol (Breo Ellipta)

If you’re taking any of the medications listed above, talk with your doctor about the safety of using Perforomist.

Perforomist and diuretics

Certain diuretics (also called water pills) may interact with Perforomist and lower your blood potassium level. This can result in serious side effects including heart palpitations, weakness, and muscle cramps.

Examples of diuretics that can interact with Perforomist include:

• hydrochlorothiazide (Microzide)
• chlorothiazide (Diuril)
• furosemide (Lasix)
• bumetanide (Bumex)

If you’re taking any of the diuretics listed above, talk with your doctor about whether it’s safe for you to use Perforomist.

Perforomist and certain antidepressants

Certain antidepressants can interfere with heart conduction (the electrical signaling in your heart). This condition can be worsened if you take a long-acting beta2-agonist (LABA), such as Perforomist, with those antidepressants.

Examples of antidepressants that may affect conduction in your heart include:

• certain monoamine oxidase inhibitors (MAOIs), such as:
  • selegiline (Emsam, Zelapar)
  • phenelzine (Nardil)
  • tranylcypromine (Parnate)
• certain tricyclic antidepressants (TCAs), such as:
  • nortriptyline (Pamelor)
  • amitriptyline
  • imipramine (Tofranil)
  • trimipramine

If you’re taking any of the antidepressants listed above, talk with your doctor about the safety of using Perforomist.

Perforomist and beta-blockers

Certain blood pressure and heart conduction medications called beta-blockers may interfere with long-acting beta2-agonists (LABAs), such as Perforomist. Beta-blockers can affect how well Perforomist works or even completely stop it from working.

It’s best to avoid taking beta-blockers while you’re using a LABA, such as Perforomist.

Examples of beta-blockers include:

• atenolol (Tenormin)
• bisoprolol
• metoprolol (Lopressor, Toprol XL)
• propranolol (Inderal, InnoPran XL)

If you’re taking any of the beta-blockers listed above, talk with your doctor about whether it’s safe for you to use Perforomist.

Perforomist and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Perforomist. However, you should still check with your doctor or pharmacist before using any of these products while taking Perforomist.

As with all medications, the cost of Perforomist can vary.

The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Your insurance plan may require you to get prior authorization before they approve coverage for Perforomist. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug.

If you’re not sure if you’ll need to get prior authorization for Perforomist, contact your insurance plan.

Financial and insurance assistance

If you need financial support to pay for Perforomist, help is available. Mylan Inc., the manufacturer of Perforomist, offers a savings card, which may help lower the cost of your prescription. For more information and to find out if you’re eligible for support, call 800-657-7613 or visit the program website.

You should take Perforomist according to your doctor’s or healthcare provider’s instructions. Perforomist should be taken by using a standard jet nebulizer machine that’s connected to an air compressor. With a nebulizer, the Perforomist liquid solution will be turned into a mist that you can inhale.

When inhaling Perforomist, you should breathe in through your mouth as calmly and deeply as possible. You should continue doing this until there’s no more mist coming out through the nebulizer. The entire treatment usually takes about 9 minutes.

You’ll take Perforomist twice each day, about 12 hours apart. Don’t use Perforomist more than two times each day.

When to take

You should take Perforomist once every 12 hours. For some people, this may mean taking the drug once in the morning and once in the evening.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Perforomist is used to treat chronic obstructive pulmonary disease (COPD). This condition includes several lung diseases that get worse over time, such as emphysema and chronic bronchitis.

With COPD, your airways become tight and narrow. This makes it harder for air to flow through them as you breathe. You may have symptoms such as shortness of breath, cough, or wheezing. These symptoms usually get worse over a long period of time.

Perforomist contains the drug formoterol fumarate, which is a long-acting beta2-agonist (LABA). It works over time to relax the muscles around your airways. This opens up your airways, allowing air to flow in and out better, which makes it easier for you to breathe.

How long does it take to work?

Perforomist starts working in as little as 5 minutes after it’s taken. But on average, it takes about 9 minutes to nebulize your full dose of Perforomist. This means that the drug may start working while you’re still nebulizing your dose.

In clinical studies, some people using Perforomist had a 15% improvement in their breathing about 12 minutes following their dose. Perforomist will continue to work in your body for about 12 hours after you’ve taken your dose.

Not much is known about the safety of using Perforomist during pregnancy. Some studies suggest that drugs similar to Perforomist (other long-acting beta2-agonists) might prevent the uterus from contracting properly during childbirth. For this reason, these types of drugs should be avoided during labor and delivery, if possible.

In animal studies, pregnant females were given formoterol fumarate (the active drug in Perforomist) at a higher dose than the dose contained in Perforomist. Some animals were given the drug in a pill form, while others were given the drug in an inhaled form.

The offspring of females taking the pill form had low birth weights and other birth defects. There weren’t any problems seen in the offspring of females using the inhaled form of formoterol. However, keep in mind that animal studies don’t always predict what will happen in humans.

If you’re pregnant or planning to become pregnant, talk with your doctor about the safety of using Perforomist. Your doctor may recommend that instead of using Perforomist, you use a medication that has been studied in pregnant women.

It’s not known if Perforomist is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Perforomist.

It’s not known if Perforomist passes into the milk of breastfeeding women. And it’s not known if Perforomist could cause harm to a child who is breastfed. Because of this, it’s not known if it’s safe to breastfeed while using Perforomist.

In some animal studies, formoterol fumarate (the active drug in Perforomist) did pass into the breast milk of lactating females. But keep in mind that animal studies don’t always predict what will happen in humans.

If you’re taking Perforomist and planning to breastfeed, talk with your doctor. They can recommend healthy and safe ways to feed your child.

Before taking Perforomist, talk with your doctor about your health history. Perforomist may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Asthma. Perforomist, which is a long-acting beta2-agonist (LABA), should not be used alone in people with asthma. If you have asthma, you should also be using an inhaled corticosteroid (such as fluticasone or budesonide) with Perforomist. People with asthma who are using LABAs alone have an increased risk of asthma-related hospitalizations and even deaths.
• Diabetes. Perforomist may raise blood sugar levels in some people. If you have diabetes, it’s important to monitor your blood sugar levels more often than usual if you’re taking Perforomist.
• Thyrotoxicosis (elevated thyroid hormone level). If you have a severe form of hyperthyroidism called thyrotoxicosis, you may be more sensitive to Perforomist and drugs that are similar to it than other people are. This may increase your risk of certain side effects such as fast heartbeat and excessive sweating.
• Seizure disorders. If you have a seizure disorder, Perforomist can increase the risk of your seizures worsening. Talk with your doctor to find out if Perforomist is safe for you.
• Heart problems or high blood pressure. If you have heart problems, such as abnormal heart rate, abnormal heart rhythm, or high blood pressure, Perforomist can make the condition worse. Talk with your doctor to find out if Perforomist is safe for you.
• Pregnancy. There are limited studies in pregnant women using Perforomist. Some studies suggest that long-acting beta2-agonist drugs (such as Perforomist) may impair the ability of your uterus to contract properly during childbirth. For more information, please see the “Perforomist and pregnancy” section above.
• Breastfeeding. It’s not known if breastfeeding is safe while you’re using Perforomist. For more information, please see the “Perforomist and breastfeeding” section above.

Note: For more information about the potential negative effects of Perforomist, see the “Perforomist side effects” section above.

Using more than the recommended dosage of Perforomist can lead to serious side effects, including cardiac arrest, and in rare cases even death.

Overdose symptoms

Symptoms of an overdose can include:

• chest pain
• changes in your blood pressure (may be increased or decreased)
• fast heart rate (up to 200 beats each minute)
• palpitations (feeling your heart flutter or skip a beat)
• feeling unusually tired
• nervousness
• headache
• tremor (shakiness)
• muscle cramps
• dry mouth
• nausea
• dizziness
• high blood sugar level
• cardiac arrest (when your heart stops beating)

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

When you get Perforomist from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Perforomist vials should be stored in the refrigerator, at a temperature between 36°F and 46°F (2°C to 8°C). The vials can be stored in the refrigerator until the expiration date printed on their label.

If the vials are stored at room temperature (between 68°F and 77°F/20°C to 25° C), they should be thrown away after 3 months.

Disposal

If you no longer need to take Perforomist and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.