Perforomist (Formoterol) – Inhalation

What Is Perforomist?

Perforomist is a medication prescribed to control the symptoms of chronic obstructive pulmonary disease (COPD).

With COPD, it becomes difficult to breathe due to blockages in your airways. Perforomist contains the active ingredient formoterol, also known as formoterol fumarate. It belongs to a class of drugs called long-acting beta-agonists (LABAs). LABAs are bronchodilators. They work by relaxing the smooth muscles that line the airways in your lungs, which opens up the airways. The drug keeps airways relaxed for up to 12 hours, making breathing easier.

Perforomist comes as a liquid solution that you inhale using a nebulizer, a machine that turns the liquid into a mist. The typical dosage is one inhalation every 12 hours. 

Drug Facts

Generic Name: Formoterol

Brand Name(s): Perforomist

Drug Availability: Prescription

Administration Route: Inhalation via nebulizer

Therapeutic Classification: Long-acting beta-agonist (LABA)

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Formoterol fumarate

Dosage Form(s): Inhalation solution

What Is Perforomist Used For?

The Food and Drug Administration (FDA) approved Perforomist to control the symptoms of COPD, including chronic bronchitis and emphysema, in adults. Common symptoms of COPD include:

  • Shortness of breath, especially after walking or climbing stairs
  • Persistent cough, with or without mucus
  • Chest tightness
  • Recurrent colds or other upper respiratory infections
  • Wheezing (a high-pitched whistling or rattling sound when you breathe)
  • Fatigue

Perforomist has limitations on its use. It should not be used to treat sudden episodes of severe COPD symptoms. Also, Perforomist is not approved to treat asthma or relieve asthma attacks.

How to Take Perforomist

Take Perforomist according to your healthcare provider’s instructions. 

You will need a nebulizer to use this medication. A nebulizer is a machine that turns a liquid into a mist that you inhale. Before using Perforomist, learn how your nebulizer works. Familiarize yourself with its parts and make sure you have a mouthpiece or mask.

Perforomist comes as a clear liquid solution in single-dose plastic vials. To use the medication, follow these steps:

  • You will pour the contents of one vial into the medicine cup of the nebulizer.
  • Next, connect the air compressor and mouthpiece or mask.
  • Then, sit upright in a comfortable position. After putting the mouthpiece or mask in place, turn on the air compressor. The nebulizer will start turning the liquid medication into a mist.
  • Now, you will breathe in and out, calmly and deeply, through the mouthpiece or mask until you do not see any more mist. 

Be sure to clean the nebulizer according to the instructions in its user manual.

The usual dosing schedule for Perforomist is once every 12 hours. Each Perforomist nebulizer treatment takes around nine minutes to complete.

Storage

Store Perforomist in the refrigerator between 36 and 46 degrees F, away from light. You can also store it at room temperature (between 68 and 77 degrees F) for up to three months (90 days).

Keep Perforomist sealed in its original foil pouch until just before you are ready to use it.

How Long Does Perforomist Take to Work?

Perforomist starts working to open up your airways within five to 12 minutes. On average, it takes around nine minutes to complete a Perforomist nebulizer treatment. You may notice an improvement in your COPD symptoms by the time you finish your first dose. The medication keeps working to relax your airways for up to 12 hours.

What Are the Side Effects of Perforomist?

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 side effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of formoterol inhalation include:

  • Diarrhea
  • Nausea
  • Nose and throat irritation
  • Dry mouth
  • Vomiting
  • Dizziness
  • Insomnia (trouble sleeping)
  • Shakiness
  • Muscle cramps

Severe Side Effects

Less common but serious side effects can occur in people taking formoterol. Call your healthcare provider immediately if you notice any of the symptoms described below. Dial 911 if your symptoms feel severe or life-threatening. Serious side effects and their symptoms can include the following:

  • Heart problems: Chest pain, fast heart rate, high or low blood pressure
  • Low blood potassium: Muscle weakness, muscle spasms, or heart palpitations
  • Sudden shortness of breath (rare): Struggling to breathe, chest tightness, wheezing, coughing.
  • Serious allergic reaction: Hives, swelling of your face or throat, rash, or trouble breathing

Report Side Effects

Perforomist 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 Perforomist 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 inhalation dosage form (powder):
    • For preventing an asthma attack:
      • Adults and children 5 years of age and older—12 micrograms (mcg) (1 capsule) by oral inhalation every 12 hours.
      • Children younger than 5 years of age—Use and dose must be determined by your doctor.
    • For preventing exercise-induced bronchospasm (EIB):
      • Adults and children 5 years of age and older—12 micrograms (mcg) (1 capsule) by oral inhalation at least 15 minutes before exercise, as needed.
      • Children younger than 5 years of age—Use and dose must be determined by your doctor.
    • For maintenance treatment of COPD:
      • Adults and children 5 years of age and older—12 micrograms (mcg) (1 capsule) by oral inhalation every 12 hours.
      • Children younger than 5 years of age—Use and dose must be determined by your doctor.
  • For inhalation dosage form (solution):
    • For maintenance treatment of COPD:
      • Adults—20 micrograms (mcg) (1 vial) in the nebulizer 2 times a day (morning and evening). Do not use more than 2 vials (40 mcg) per day.
      • Children—Use is not recommended.

Missed Dose

If you miss a Perforomist inhalation solution dose, skip the missed dose and take your next dose at its usual time. Do not take two doses simultaneously to make up for a missed dose.

Missing doses of this medication may worsen COPD symptoms, including shortness of breath. Therefore, it is best to take Perforomist on a consistent schedule. Plan to take a dose of Perforomist around the same hour in the morning and evening, every 12 hours.

Overdose: What Happens If I Take Too Much Perforomist?

An overdose of formoterol may cause:

  • Chest pain
  • Fast or irregular heartbeat
  • Headache
  • High blood pressure
  • Nervousness or anxiety
  • Tremor

What Happens If I Overdose on Perforomist?

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

If someone collapses or isn't breathing after taking Perforomist, 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. Blood tests may be needed to check for any unwanted effects.

If your symptoms do not improve within a few days or if they become worse, check with your doctor.

Tell your doctor if you are also using other medicines for your COPD. Your doctor may want you to stop using the medicine and 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.

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

This medicine should only be used as an additional treatment for patients who cannot be treated with other asthma medicines (such as inhaled corticosteroids) or for asthma patients that require two medicines, including formoterol. Ask your doctor if you have any questions.

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

  • Your or your child's symptoms do not improve after using this medicine for 1 week 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 (eg, you use 1 whole canister of your short-acting inhaler in 8 weeks time, or you need to use 4 or more inhalations of your short-acting inhaler for 2 or more days in a row).
  • You have a significant decrease in your peak flow when measured as directed by your doctor.

You or your child may also be using an anti-inflammatory medicine, such as a steroid, together with this medicine. Do not stop using the anti-inflammatory medicine even if your asthma seems better, unless you are told to do so by your doctor.

Although this medicine decreases the number of asthma episodes, this medicine may also increase the chances of a severe asthma episode when they do occur. Be sure to read about these risks in the Medication Guide and talk to your doctor or pharmacist about any questions or concerns that you have.

Perforomist® 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 if you have concerns about this.

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.

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 or your child has a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Perforomist® 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: convulsions (seizures), decreased urine, dry mouth, increased thirst, irregular heartbeat, loss of appetite, mood changes, muscle pain or cramps, nausea or vomiting, numbness or tingling in the hands, feet, or lips, shortness of breath, 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.

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 Perforomist?

Perforomist is not used to treat asthma.

This medication belongs to a class of drugs called LABAs. If someone with asthma uses LABAs, they must also use an inhaled corticosteroid under the direction of their healthcare provider. Using LABAs as the only treatment for asthma (without a concurrent inhaled corticosteroid) may significantly increase the risk of serious asthma-related side effects.

What Other Medications Interact With Perforomist?

Drug interactions occur when one medication affects how another works. Before using Perforomist, talk to your healthcare provider about your current medications, including prescription drugs, over-the-counter (OTC) medicines, vitamins, herbs, and dietary supplements.

The following medications may interact with Perforomist and increase the risk of adverse effects:

Keep in mind that other interactions are possible. Also, it is important not to mix formoterol with other nebulizer solutions. Nebulize other prescribed inhalation solutions separately.

Consult your pharmacist or healthcare provider before taking other medications while using formoterol.

What Medications Are Similar?

Other medications are available to control the symptoms of COPD. The following medications are also LABAs, which are in the same drug class as Perforomist:

Some COPD medications contain a combination of LABA and a corticosteroid. Examples include: 

The above-listed medications should not be used together with Perforomist. If you have more than one of these medications at home and are unsure which one to take, check with your healthcare provider.

This is a list of drugs also prescribed for COPD. It is not a list of drugs recommended to take with Perforomist. In fact, you should not take these drugs together. Talk to your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • Can I mix other nebulizer solutions with formoterol?

    No, you should not mix formoterol, the main ingredient in Perforomist, with other nebulizer solutions. Formoterol should be nebulized by itself.

  • Can I take both albuterol and Perforomist?

    Yes, but regular doses of a short-acting beta-agonist, such as albuterol nebulizer solution, are not typically necessary while using formoterol inhalation solution. This is because formoterol inhalation solution is a long-acting drug and should keep working to control your COPD symptoms for 12 hours.
    If your COPD symptoms suddenly worsen, your healthcare provider may advise taking a short-acting inhaled drug like albuterol. Albuterol is meant to open up the airways quickly. But if you notice that you are using albuterol more than usual, or if it is not helping, seek prompt medical care.

  • How often can I take a dose of Perforomist?

    Perforomist inhalation solution is taken every 12 hours: once in the morning and once in the evening. Even if your COPD symptoms feel worse than usual, do not take this medication more often than every 12 hours. Call your healthcare provider for advice.

  • I forgot to put Perforomist back in the refrigerator. Is it still OK to use?

    Yes. There are two options for storing Perforomist inhalation solution. You may either store it in the refrigerator until the expiration date printed on the package or keep it at room temperature for up to three months (90 days).

How Can I Stay Healthy While Taking Perforomist?

Living with COPD can be challenging, as it can drastically affect your day-to-day life. However, taking your medication as prescribed can help to better control your symptoms.

Make it a priority to take Perforomist nebulizer solution every morning and every evening. Perforomist works to control COPD symptoms for 12 hours. You can read or watch television while taking Perforomist to make your nebulizer treatment times more enjoyable.

Smoking cigarettes with COPD can lead to additional lung damage and exacerbate your condition. If you are a smoker, try smoking cessation methods to further protect your health. Even if you don't smoke, you can avoid certain triggers or airborne irritants, like secondhand smoke, that can worsen symptoms.

A dry mouth can be a bothersome side effect of Perforomist, but adding lemon to your water or using a mouthwash like Biotene may help to boost moisture in your mouth.

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.

4 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.
  1. Food and Drug Administration. Perforomist (formoterol fumarate) inhalation solution label.

  2. American Lung Association. COPD symptoms and diagnosis.

  3. Rodrigo GJ, Castro-Rodríguez JA. Safety of long-acting β agonists for the treatment of asthma: clearing the air. Thorax. 2012;67(4):342-349. doi:10.1136/thx.2010.155648

  4. MedlinePlus. Albuterol oral inhalation.

By Patricia Weiser, PharmD
Patricia Weiser, PharmD, is a licensed pharmacist and freelance medical writer. She has more than 14 years of professional experience.