Arformoterol Tartrate, Inhalation ar-foh-MOH-ter-ol TAR-trayt

What are other names for this medicine?

Type of medicine: long-acting beta-agonist; bronchodilator

Generic and brand names: arformoterol tartrate inhalation; Brovana

What is this medicine used for?

This long-acting medicine is inhaled to treat chronic obstructive pulmonary (lung) disease such as chronic bronchitis or emphysema.

This medicine is not usually used alone. It is usually used with steroids or other medicines to improve breathing.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a thyroid disorder
• diabetes
• heart disease
• high blood pressure
• liver problems
• long QT syndrome (problems with electrical activity in the heart muscle)
• problems with low levels of potassium in your blood
• seizures

Tell your healthcare provider about all other medicines you are taking or using for your breathing problem.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without discussing with your healthcare provider.

How do I use it?

Check the label on the medicine for directions about your specific dose. Read the information sheet that comes in the medicine package. Ask your healthcare provider or pharmacist about anything you do not understand.

Use this medicine exactly as your healthcare provider prescribes. Do not use more or less or use it longer than prescribed. Do not stop using this medicine or any other medicine without your healthcare provider's approval.

Be sure you know how to use the nebulizer and how much medicine to use. This medicine is inhaled by nebulizer only. Do not swallow this medicine. Follow these steps when you use the nebulizer:

1. Pour the medicine into the nebulizer, following the directions for that type of system. Do not use the medicine if it is not clear. Do NOT mix this medicine with another medicine in the nebulizer.
2. If you are using a mouthpiece, put the mouthpiece in your mouth between your teeth and close your lips around it. If you are using a mask, place the mask over your nose and mouth, making it sure it fits snugly.
3. Hold the nebulizer in an upright position. This prevents spilling and promotes nebulization.
4. Gently breathe out.
5. If you are using equipment with a finger valve, start the mist by covering the hole in the finger valve with a finger.
   • As the mist starts, breathe in slowly and deeply over 3 to 5 seconds. Keep your finger over the valve hole.
   • At the end of a deep breath, uncover the finger valve hole to stop the mist.
   • Hold your breath for 5 to 10 seconds, or as long as is comfortable. This allows the medicine time to build up in the airway.
   • Start breathing normally.
6. If you are not using a finger valve, the nebulizer will mist constantly. Breathe in slowly and deeply through the mouthpiece or mask. Exhale normally through your nose.
7. Tap the side of the nebulizer occasionally to help the solution drop to where it can be misted.
8. Continue these steps until the nebulizer starts sputtering or the medicine is gone.

What if I miss a dose?

If you miss a dose, skip the missed dose and use the next one as directed. Do not use double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: chest pain, fast irregular heartbeat, seizures, tremors, muscle cramps, lightheadedness, fainting.

What should I watch out for?

This medicine must not be the only medicine you use to treat asthma. You must also use another asthma control medicine.

In people with asthma, long-acting beta2-adrenergic agonists increase the risk of asthma-related death. Talk with your healthcare provider about this. If you have any of these signs of worsening asthma, call your healthcare provider right away:

• You need to use more puffs than usual of your short-acting inhaler or use it more often.
• You have severe breathing trouble that does not improve, such as persistent wheezing, coughing, or shortness of breath.
• You have a bluish color in your lips or fingernails or cannot speak.
• You have any asthma symptoms that are getting worse.

Do not use this medicine for sudden breathing problems. Your healthcare provider may also prescribe a short-acting inhaled medicine to use when you have a sudden breathing problem. Use all medicines as directed by your healthcare provider.

This medicine may increase your heart rate or blood pressure. Talk with your healthcare provider about this.

This medicine may make you dizzy. Do not drive or operate machinery unless you are fully alert.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are using this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives, itching, rash, swelling of your tongue or throat, tightness in your chest, increased trouble breathing).

Serious (report these to your healthcare provider right away): Chest pain, fast or irregular heartbeat, tremor, nervousness, fever, cough, sore throat, trouble breathing, fainting, lightheadedness.

Other: Nausea, vomiting, dizziness, trouble sleeping, headache, muscle cramps, hoarseness, back pain, diarrhea, dry mouth, runny nose, tiredness.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• antiarrhythmics such as procainamide (Procan SR), quinidine, disopyramide (Norpace), sotalol (Betapace), amiodarone (Cordarone, Pacerone), and dofetilide (Tikosyn)
• antibiotics such as erythromycin (Erythrocin, E.E.S., EryPed), clarithromycin (Biaxin), azithromycin (Zithromax), gatifloxacin, and moxifloxacin (Avelox)
• antipsychotic medicines such as chlorpromazine, fluphenazine, perphenazine, prochlorperazine, trifluoperazine, thioridazine, pimozide (Orap), haloperidol (Haldol), clozapine (Clozaril), ziprasidone (Geodon), and olanzapine (Zyprexa)
• beta blockers such as acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), esmolol (Brevibloc), carteolol, bisoprolol (Zebeta), pindolol, metoprolol (Lopressor, Toprol XL), timolol, sotalol (Betapace), nadolol (Corgard), and propranolol (Inderal)
• corticosteroids such as prednisone, dexamethasone, and methylprednisolone (Medrol)
• diuretics such as bumetanide, ethacrynic acid (Edecrin), furosemide (Lasix), torsemide (Demadex), chlorothiazide (Diuril), hydrochlorothiazide (Microzide), chlorthalidone (Thalitone), and methyclothiazide
• MAO inhibitor antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• medicines to treat breathing or lung problems such as oxtriphylline (Choledyl), formoterol (Foradil), salmeterol (Serevent, Advair), aminophylline, and theophylline (Theolair, Theo-24, Uniphyl)
• stimulants such as dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), amphetamine sulfate, caffeine, and pseudoephedrine (Sudafed)
• tricyclic antidepressants such as amitriptyline, doxepin, imipramine (Tofranil), and nortriptyline (Pamelor)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

It is best to store the medicine in the refrigerator. If kept at room temperature, discard the medicine after 6 weeks. Protect the medicine from heat, high humidity, and bright light. Do not open the foil pouch until just before use. Once the foil pouch is opened, use the medicine right away.

This advisory includes selected information only and may not include all side effects of this medicine or drug interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.