Eformoterol fumarate dihydrate

Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.

Foradile (Novartis Pharmaceuticals)
capsules containing 12 micrograms for inhalation

Indication: asthma
Patients with frequent nocturnal asthma who are already taking corticosteroids may benefit from taking a long-acting beta2 adrenoceptor agonist. Eformoterol will be competing with salmeterol which has been available for this indication since 1993.

After inhalation of eformoterol powder, bronchodilatation begins within 3 minutes. This effect lasts for 12 hours with a peak effect within two hours of inhalation. These properties make eformoterol suitable for twice daily inhalation in patients who require regular, long-term treatment of reversible airways obstruction. It is not recommended for use in acute asthma. Patients should have a short-acting agonist, such as salbutamol, available to help deal with acute attacks.

Inhaled eformoterol is absorbed through the lungs into the circulation. Most of the dose is metabolised with less than 10% being excreted unchanged in the urine.

Common adverse effects include tremor, palpitations, headache, dizziness and pharyngitis. There is a potential for eformoterol to cause paradoxicalbronchospasm. The beta2 agonists can also alter concentrations of glucose and potassium. Extra caution is needed when prescribing eformoterol for patients with diabetes, heart disease or thyrotoxicosis. The cardiac effects may be potentiated by other drugs such as antidepressants, antihistamines and phenothiazines. Concomitant treatment with diuretics, steroids or theophylline can increase the risk of hypokalaemia. This may increase the risk of arrhythmia in patients taking digoxin.

Eformoterol is effective, but more information will be needed to confirm its safety in long-term use. Salmeterol costs approximately $45 for a month's supply, so the uptake of eformoterol may be determined by its relative cost.