Brovana (Arformoterol) - Inhalation

Warning:

Brovana (arformoterol) carries a boxed warning for an increased risk of asthma-related death. A large study compared salmeterol, which is in the same family of medications as arformoterol, with a placebo in addition to standard asthma therapy. The results showed increased asthma-related deaths in people receiving salmeterol.

Because arformoterol is similar to salmeterol, a similar risk may exist with Brovana. However, these studies were in people with asthma; it’s unknown whether the same risk exists in people with chronic obstructive pulmonary disorder (COPD).

What Is Brovana?

Brovana (arformoterol) is a long-acting beta-2-adrenergic receptor agonist (LABA) used as a long-term maintenance treatment for bronchoconstriction in chronic obstructive pulmonary disease (COPD). Bronchoconstriction is the tightening of the smooth muscle of the bronchi and bronchioles (airways), causing breathing-related complications.

LABAs work by binding to beta-2 receptors in the bronchial smooth muscle causing relaxation of these muscles, resulting in bronchodilation.

This medication is available as a solution for inhalation via a nebulizer.

Drug Facts

Generic Name: Arformoterol

Brand Name(s): Brovana

Drug Availability: Prescription

Administration Route: Inhalation

Therapeutic Classification: Bronchodilator

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Arformoterol titrate

Dosage Form(s): Solution for inhalation via a nebulizer

What Is Brovana Used For?

The Food and Drug Administration (FDA) approved Brovana for long-term use to treat bronchoconstriction in COPD, including chronic bronchitis and emphysema. Bronchoconstriction can cause wheezing, shortness of breath, coughing, and chest tightness. Daily use of Brovana helps keeps these symptoms under control, but it does not cure COPD.

However, Brovana is not indicated for asthma or acute deterioration of COPD and it is not approved for use in children. Always make sure you have a rescue inhaler medication to treat sudden symptoms.

How to Take Brovana

Take Brovana twice a day (morning and evening) via a standard jet nebulizer. The medication comes in ready-to-use vials for each dose. Your healthcare provider will instruct you on how to use your nebulizer to take the medication, but you can also refer to the medication label that comes with it.

While you are using Brovana, do not:

  • Take other LABAs
  • Take short-acting beta-2-agonist medications regularly
  • Take more or more often than prescribed

Storage

Store Brovana vials in the protective foil pouch in the refrigerator. Once the foil pouch is opened, use the vial's contents immediately. Sealed foil pouches of Brovana can be stored at room temperature (68 F to 77 F) for up to six weeks but should be discarded if not used after six weeks at room temperature.

How Long Does Brovana Take to Work?

The onset of action for Brovana is around seven minutes after dosing. However, the peak effects can be felt within one to three hours after taking a dose, and it maintains activity for 12 hours or more.

What Are the Side Effects of Brovana?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Common side effects of Brovana can include:

Severe Side Effects

Call your healthcare provider immediately 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 can include:

  • Cardiovascular (heart-related) events, such as heart block (an issue with the heart's electrical signals) and myocardial infarction (heart attack)
  • Hypersensitivity (allergic) reaction
  • Paradoxical bronchospasm (airway constriction after treatment with a bronchodilator)

Report Side Effects

Brovana may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Brovana Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral inhalation dosage form (solution):
    • For maintenance treatment of COPD:
      • Adults—15 micrograms (mcg) 2 times a day (morning and evening) by nebulization. The total dose should not be more than 30 mcg per day.
      • Children—Use and dose must be determined by your doctor.

Modifications

Safe use of Brovana in pregnancy has not been established; therefore, deciding to use it during pregnancy must be based on weighing the benefits and potential risks to the pregnant person and fetus.

It is not known if Brovana is present in human breast milk. However, most experts agree that inhaled bronchodilators are safe to use while breastfeeding due to low bioavailability and maternal serum levels.

Clinical trials of Brovana included a substantial number of adults 65 and older. No safety or effectiveness differences were observed between older and younger adults.

Missed Dose

If you miss a dose of Brovana, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and take the next dose at the regularly scheduled time. Do not take an extra dose to make up for the missed dose.

Overdose: What Happens If I Take Too Much Brovana?

Overdoses of arformoterol can cause signs and symptoms of excessive beta-adrenergic stimulation. Symptoms of overdose may include:

  • Heart dysrhythmias
  • Severely high or low blood pressure
  • Rapid heartbeat
  • Nervousness
  • Headache
  • Tremor
  • Dry mouth
  • Palpitations
  • Nausea
  • Dizziness
  • Fatigue

Treatment of overdose should be symptomatic and supportive. Cardiac monitoring is recommended.

What Happens If I Overdose on Brovana?

If you think you or someone else may have overdosed on Brovana, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Brovana, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits to make sure the medicine is working properly and to decide if you should continue to take it. Blood tests may also be needed to check for unwanted effects.

Tell your doctor if you are also using any other medicine for your COPD. Your doctor may want you to use it only during a severe COPD attack. Follow your doctor's instructions on how you should take your medicine.

This medicine should not be used if you are having a severe COPD attack, or if symptoms of a COPD attack has already started. Your doctor may prescribe another medicine for you to use in case of an acute COPD attack. If the other medicine does not work as well, tell your doctor right away.

Talk to your doctor or get medical care right away if:

  • Your symptoms do not improve after using this medicine within a few days or if they become worse.
  • Your short-acting inhaler does not seem to be working as well as usual and you need to use it more often.

This medicine should not be used together with similar inhaled medicines such as budesonide/formoterol (Symbicort®), formoterol (Foradil®, Perforomist™), indacaterol (Arcapta® Neohaler®), salmeterol (Serevent®), or salmeterol/fluticasone (Advair®).

This medicine may increase the risk of worsening asthma, which may lead to hospitalization, intubation, and death in patients with asthma who take this medicine without an inhaled steroid medicine. Talk to your doctor about any questions or concerns you may have.

This medicine may cause paradoxical bronchospasm, which means your breathing or wheezing will get worse. Paradoxical bronchospasm may be life-threatening. Check with your doctor right away if you have coughing, difficulty breathing, shortness of breath, or wheezing after using this medicine.

Arformoterol may cause heart or blood vessel problems, including heart rhythm problems. Check with your doctor right away if you have chest pain or tightness, decreased urine output, dilated neck veins, extreme fatigue, irregular heartbeat, swelling of the face, fingers, feet, or lower legs, troubled breathing, or weight gain.

Hypokalemia (low potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you have more than one of the following symptoms: decreased urine, dry mouth, increased thirst, loss of appetite, mood changes, muscle pain or cramps, nausea or vomiting, numbness or tingling in the hands, feet, or lips, seizures, uneven heartbeat, or unusual tiredness or weakness.

This medicine may affect blood sugar levels. If you are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.

This medicine may cause serious allergic reactions, including anaphylaxis and angioedema, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, or swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Brovana?

Do not take Brovana if you have a known hypersensitivity (allergy) to arformoterol or formoterol (e.g., Foradil, Perforomist, also contained in Symbicort) or any of its inactive ingredients.

What Other Medications Interact With Brovana?

Drug interactions can occur with Brovana. Therefore, sharing all your medications, including prescription and over-the-counter (OTC) products and vitamins or herbal supplements, with your healthcare provider is important.

The following drug interactions are possible with Brovana:

  • Drugs that prolong the QTc interval: Using Brovana with drugs that prolong the QTc interval, including monoamine oxidase inhibitors and tricyclic antidepressants, increase the risk of heart arrhythmias.
  • Beta-blockers: The effects of beta-agonists like Brovana and beta-blockers can interfere with each other when used simultaneously. Beta-blockers block the therapeutic effects of beta-agonists and may cause bronchospasms. Consider the use of cardioselective beta-blockers if indicated.
  • Drugs that can cause low potassium levels: Medications like potassium-wasting diuretics, aminophylline, theophylline, and steroids can worsen low potassium levels caused by beta-agonists. This may result in electrocardiogram (EKG) changes. Therefore, your healthcare provider may monitor your potassium levels if you take any of these medications.

What Medications Are Similar?

Alformoterol belongs to a family of drugs known as long-acting beta-agonists (LABAs), commonly used to treat asthma and COPD.

Other medications in this family include:

  • Performist (formoterol)
  • Arcapta Neohaler (indacaterol)
  • Striverdi Respimat (olodaterol)
  • Salmeterol

LABAs differ in their duration of action and available formulation. Formoterol is the only other LABA available as a nebulizer solution. The others come in inhalers (e.g., dry powder, metered dose, and soft mist inhalers). You should only use one LABA at a time.

Frequently Asked Questions

  • What side effects can I expect while taking Brovana?

    The most common side effects of Brovana include chest, back, and body pain, diarrhea, leg cramps, sinusitis, swelling in the extremities, flu-like illness, rash, and lung disorders.

  • How is Brovana (arformoterol) related to Foradil or Perforomist (formoterol)?

    Arformoterol is the (R-R)-enantiomer of formoterol, whereas formoterol consists of a mix of R- and S-enantiomers. Arformoterol is two times more potent than formoterol. Because arformoterol is chemically identical to a component of formoterol, it should not be used in people allergic to formoterol.

  • What is the difference between maintenance inhaled medications like Brovana and rescue inhalers?

    Inhaled maintenance medications for COPD should be taken regularly (usually once or twice a day), regardless of your symptoms. These medications work to maintain control over COPD symptoms and have a longer duration of action.

    Rescue inhalers are used only when needed to relieve acute (sudden) symptoms. They start working faster than maintenance medications but usually have a shorter duration of action. You can monitor the status of your COPD by tracking your rescue medication use. An increase in rescue meds means a decrease in overall COPD control. This should be a signal to contact your healthcare provider.

How Can I Stay Healthy While Taking Brovana?

Brovana is indicated for the maintenance treatment of COPD symptoms; it should not be used to relieve sudden respiratory symptoms. Be sure to have a rescue inhaler on hand for acute use.

Do not exceed the recommended dose of Brovana. Excessive use of Brovana will not increase its therapeutic effect and can result in serious side effects, including cardiac emergencies and even death. 

Seek medical attention if your COPD symptoms worsen, if treatment becomes less effective, or if you require more short-acting bronchodilators. These could indicate that you need a change in COPD medications. Mixing Brovana with other nebulized drugs has not been studied, so finish nebulizing your Brovana dose before nebulizing another medication.

Living with COPD can be overwhelming, but taking your prescribed medications can help control the symptoms. Talk to your healthcare team about other lifestyle changes to reduce the risk of exacerbations.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. MedlinePlus. Arformoterol oral inhalation.

  3. Miles MC, Donohue JF, Ohar JA. Nebulized arformoterol: what is its place in the management of COPD? Ther Adv Respir Dis. 2013;7(2):81-86. doi:10.1177/1753465812465784

  4. Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Arformoterol.

  5. Ferguson GT. Stable COPD: initial pharmacologic management. UpToDate.

  6. King P. Role of arformoterol in the management of COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):385-391. doi:10.2147/copd.s753

By Carrie Yuan, PharmD
Carrie Yuan PharmD is a clinical pharmacist with expertise in chronic disease medication management for conditions encountered in primary care.