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Formoterol is a long-acting beta-2 sympathomimetic (LABA) that widens the airways within a few minutes and keeps them open for around twelve hours. In asthma it may only be used together with inhaled cortisone, because it does not treat the inflammation and, on its own, can increase the risk of severe attacks. In COPD the situation is different: there, formoterol is also an established option as the sole maintenance medicine.
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The most important interactions of formoterol concern the heart, the potassium balance and drugs with the opposite mode of action.¹
| Combination | Consequence | What to do |
|---|---|---|
| Beta blockers, including as eye drops — especially non-selective ones such as propranolol | The effect of formoterol is weakened or cancelled out; in asthma, risk of the airways narrowing | Avoid according to the SmPC unless there are compelling reasons; heart-selective drugs such as bisoprolol are often tolerated — the practice decides |
| Water tablets such as furosemide, cortisone tablets such as prednisolone, theophylline | Increased potassium loss | Check potassium, especially during exacerbations and in heart disease |
| Digitalis preparations | A low potassium level increases the risk of rhythm disorders | Keep an eye on potassium |
| QT-prolonging drugs, e.g. tricyclic antidepressants such as amitriptyline, some antipsychotics, erythromycin | Increased risk of heart rhythm disorders | Inform the prescribing practice, ECG if needed |
| MAO inhibitors, tricyclic antidepressants | Stronger effect on the heart and circulation | Combine only with caution |
| Other beta-2 agonists and sympathomimetics (e.g. ephedrine in cold remedies) | Side effects add up | Never two long-acting beta-2 agonists at the same time; use the reliever according to plan |
| Anticholinergics such as tiotropium | Airway widening is increased | An intended combination in COPD |
| Anaesthetic gases (halogenated anaesthetics) | Increased risk of rhythm disorders | Mention before surgery; see medications before surgery |
Beta blockers are the trickiest combination, because they often come from the cardiology or ophthalmology side: even eye drops for glaucoma can narrow the airways in asthma. Alcohol has no specific interaction with formoterol; larger amounts of caffeine can increase palpitations and tremor. Whether anything on your list clashes is shown by the brite interaction check; the basics are in the guide drug interactions.
If you have several inhalers, it is easy to lose track of which device is for what. This overview shows where formoterol fits in:
| Drug | Group | Onset / duration | Role |
|---|---|---|---|
| Salbutamol | Short-acting beta-2 agonist | Minutes / a few hours | The classic reliever inhaler |
| Formoterol | Long-acting beta-2 agonist | 1–3 minutes / around 12 hours | Maintenance treatment; combined with cortisone also as a reliever |
| Salmeterol | Long-acting beta-2 agonist | Slower / around 12 hours | Maintenance treatment only, not as a reliever |
| Tiotropium | Long-acting anticholinergic | Slower / around 24 hours | Maintenance treatment, mainly in COPD |
| Budesonide | Inhaled cortisone | Days to weeks | Controls inflammation; the foundation in asthma |
Which checks make sense: at every appointment, your inhaler technique, symptom control — such as waking at night, a dry cough at night or limitations in everyday life — and how much reliever you use. Lung function regularly. With high doses, water tablets or heart disease, your potassium level; with diabetes, blood sugar at the start; with heart disease and QT-prolonging concomitant medicines, an ECG.¹,²
Well-controlled asthma is the most important goal in pregnancy — for mother and child. On the basis of very extensive experience, Embryotox classifies formoterol as a drug of choice and considers its use in line with the asthma guidelines to be justifiable throughout pregnancy and during breastfeeding.⁶ So if you become pregnant, do not stop your inhalers, but talk to your practice; more in the guide medications during pregnancy.
According to the SmPC, particular caution is needed with an overactive thyroid, severe high blood pressure, coronary heart disease, heart rhythm disorders, severe heart failure, certain heart muscle diseases, aneurysms and an already prolonged QT interval.¹ This does not mean that formoterol is ruled out — many people with COPD in particular also have heart disease — but dose limits are strictly observed and new symptoms such as skipped heartbeats are taken seriously. In diabetes, blood sugar is checked more often at the start.
According to the SmPC, formoterol can lead to positive results in doping tests. Under the Prohibited List of the World Anti-Doping Agency (WADA), inhaled formoterol is permitted up to a set maximum daily amount — if you take part in competitions, check the current list with NADA (Germany's National Anti Doping Agency). According to the SmPC, exercise-induced asthma that regularly requires extra puffs despite treatment is a sign of inadequate asthma control. More in the guide medications and exercise.
There is no physical withdrawal syndrome. The risk lies elsewhere: in asthma, according to the guideline, treatment is only reduced after a period of stable control, and then step by step.² Which component is reduced first is decided by the practice — leaving out the cortisone and keeping only the beta-2 agonist is not an option. In COPD, leaving it out usually simply means more breathlessness and less stamina. What a planned attempt at reduction looks like is explained in the guide stopping medications.
That depends on the product and on your plan. If you have been explicitly prescribed a combination inhaler of cortisone and formoterol for as-needed use as well, yes — up to the set maximum number of puffs. A formoterol-only product, on the other hand, is not a reliever inhaler in asthma: every extra puff would widen the airways without tackling the inflammation. In COPD, according to the SmPC, extra puffs are possible up to a daily limit. Ask for your plan in writing — including which device is the right one in an emergency.
Usually not. Tremor is the most typical side effect of beta-2 agonists and often eases after a few days to weeks. Watch whether it is linked to the number of puffs — if you are also taking a lot of salbutamol, the effects add up. If a racing heart, restlessness or muscle cramps come on top, have your pulse and potassium level checked.
Feeling fine is often precisely thanks to the cortisone — the inflammation is under control, not gone. If you have asthma and leave out the cortisone while keeping only the beta-2 agonist, you will often go on feeling fine for weeks while the inflammation returns. A reduction is quite possible once control is stable, but as a planned step with your practice, not by quietly leaving it out.
Not necessarily. In COPD, according to the guideline, a long-acting beta-2 agonist on its own is a standard treatment if the symptoms are mild to moderate and exacerbations are not frequent. In COPD, cortisone is only added in specific cases. But do ask whether you have been checked for asthmatic features — if so, the asthma rule applies.
The interaction check reviews all your medicines — including those from other practices.
