rate. Use Caution/Monitor.shepherd's purseMonitor Closely (1)shepherd's purse increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)formoterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.solriamfetolMonitor Closely (1)formoterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sorafenibMonitor Closely (1)sorafenib and formoterol both increase QTc interval. Use Caution/Monitor.sotalolMonitor Closely (2)sotalol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor. sotalol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)formoterol and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Drugs known to prolong the QTc interval may potentiate the cardiovascular effects of formoterol. sotalol and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Drugs known to prolong the QTc interval may potentiate the cardiovascular effects of formoterol.spironolactoneMonitor Closely (1)spironolactone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.succinylcholineMonitor Closely (1)succinylcholine increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sufentanilMonitor Closely (1)sufentanil increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.sulfamethoxazoleMonitor Closely (1)sulfamethoxazole and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.sulfasalazineMonitor Closely (1)sulfasalazine increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sulindacMonitor Closely (1)sulindac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tapentadolMonitor Closely (1)tapentadol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.telavancinMonitor Closely (1)formoterol and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.temazepamMonitor Closely (1)temazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.terbutalineMonitor Closely (3)formoterol and terbutaline both decrease serum potassium. Use Caution/Monitor. formoterol and terbutaline both decrease sedation. Use Caution/Monitor. formoterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.thioridazineMonitor Closely (1)thioridazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.thiothixeneMonitor Closely (1)thiothixene increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.timololMonitor Closely (2)timolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor. timolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolfenamic acidMonitor Closely (1)tolfenamic acid increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolmetinMonitor Closely (1)tolmetin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolvaptanMonitor Closely (1)tolvaptan increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.topiramateMonitor Closely (1)topiramate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.torsemideMonitor Closely (2)formoterol and torsemide both decrease serum potassium. Use Caution/Monitor. mometasone inhaled increases toxicity of torsemide by Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase hypokalemic effect of loop diuretics.Minor (1)formoterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.tramadolMonitor Closely (1)tramadol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tranylcypromineSerious - Use Alternative (1)tranylcypromine increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.trazodoneMonitor Closely (1)trazodone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)trazodone and formoterol both increase QTc interval. Avoid or Use Alternate Drug. trazodone, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triamtereneMonitor Closely (1)triamterene increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.triazolamMonitor Closely (1)triazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.trifluoperazineMonitor Closely (1)trifluoperazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.trimethoprimMonitor Closely (1)formoterol and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.trimipramineMonitor Closely (1)trimipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)trimipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug. trimipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triprolidineMonitor Closely (1)triprolidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.triptorelinMonitor Closely (1)triptorelin increases levels of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.tropisetronMonitor Closely (1)formoterol and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)formoterol increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.venlafaxineMonitor Closely (1)formoterol and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)formoterol increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.voriconazoleMonitor Closely (1)formoterol and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.xylometazolineMonitor Closely (2)formoterol and xylometazoline both decrease sedation. Use Caution/Monitor. formoterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.yohimbineMonitor Closely (2)formoterol and yohimbine both decrease sedation. Use Caution/Monitor. formoterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.ziconotideMonitor Closely (1)ziconotide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)formoterol and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. 1-10% Nasopharyngitis (4.7%) Headache (2-4.5%) Sinusitis (2-3.3%) <1% Oral candidiasis Postmarketing Reports Cardiac: Angina pectoris, cardiac arrhythmias (eg, atrial fibrillation, ventricular extrasystoles, tachyarrhythmia), QT prolongation, elevated blood pressure (including hypertension) Metabolic, nutritional: Hypokalemia, hyperglycemia Respiratory, thoracic, mediastinal: Asthma aggravation (potentially including cough, dyspnea, wheezing, bronchospasm) Vision blurred Contraindications Hypersensitivity Primary treatment for acute bronchospasm, status asthmaticus, or exercise-induced bronchospasm Cautions Risk of LABAs used as monotherapy Use of LABAs as monotherapy (without inhaled corticosteroids) for asthma is associated with an increased risk of asthma-related death Data from controlled clinical trials also suggest that use of LABA as monotherapy increases the risk of asthma-related hospitalization in pediatric and adolescent patient These findings are considered a class effect of LABA monotherapy When LABA are used in fixed-dose combination with ICS, data from large clinical trials do not show a significant increase in the risk of serious asthma-related events (hospitalizations, intubations, death) compared with ICS alone Fungal infections Localized infections of the mouth and pharynx with Candida albicans reported; if oropharyngeal candidiasis develops, treat with appropriate local or systemic (i.e., oral) antifungal therapy while remaining on treatment; at times therapy may need to be interrupted To reduce risk of oropharyngeal candidiasis, after dosing, advise patients to rinse their mouth with water and spit out the contents without swallowing Do not use to treat acutely deteriorating asthma or acute symptoms; additionally, increased inhaled short-acting beta agonist (SABA) use is marker of deteriorating asthma Do not use in combination with additional LABA, because of risk of overdose Localized Candida albicans infections develop in mouth and pharynx in some patients; to reduce risk, mouth must be rinsed after inhalation Persons who are using drugs that suppress the immune system are more susceptible to infections than healthy individuals; risk of more serious or fatal course of chickenpox or measles exists in susceptible patients (eg, unvaccinated or immunologically unexposed individuals); care must be taken to avoid exposure Because of possibility of systemic absorption of inhaled corticosteroids, patients should be observed carefully for any evidence of systemic corticosteroid effects; particular care should be taken in observing patients postoperatively or during periods of stress for evidence of inadequate adrenal response Particular care is needed in switching patients from systemic to inhaled corticosteroids; potentially fatal adrenal insufficiency may occur before or afterward; taper withdrawal gradually During stress or severe asthma attack, patients who have been withdrawn from systemic corticosteroids should resume PO corticosteroids immediately Excessive use may suppress hypothalamic-pituitary-adrenal function; monitor closely, especially postoperatively or during periods of stress Risk of paradoxical bronchospasm, which may be life-threatening; discontinue, and treat immediately with inhaled SABA Cardiovascular and central nervous system (CNS) effects may occur as consequences of excess beta-adrenergic stimulation; may result in asthma-related death; caution must be exercised in patients with cardiovascular (eg, aneurysm, pheochromocytoma) or convulsive disorders or thyrotoxicosis Long-term administration of corticosteroids may decrease in bone mineral density; monitor patients at risk May decrease growth velocity in children Risk of cataracts, glaucoma, and increased intraocular pressure; consider referral to an ophthalmologist in patients who develop ocular symptoms or use therapy long term Risk of systemic eosinophilic conditions, some consistent with Churg-Strauss syndrome Risk of transient hypokalemia; supplementation may not be necessary Exercise caution when considering coadministration with long-term ketoconazole and other known strong CYP3A4 inhibitors (e.g., ritonavir, cobicistat-containing products, atazanavir, telithromycin); consider benefit of coadministration versus potential risk of systemic corticosteroid effects, in which case patients should be monitored for systemic corticosteroid side effects Prolonged treatment with corticosteroids associated with development of Kaposi sarcoma; consider discontinuing therapy if it occurs Psychiatric disturbances reported with corticoid use; therapy may exacerbate preexisting psychiatric conditions Potential worsening of existing tuberculosis, fungal, bacterial, viral, or parasitic infection; or ocular herpes simplex infections may occur; more serious or even fatal course of chickenpox or measles can occur in susceptible patients; use with caution in patients with these infections because of potential for worsening of these infections Risk of impaired adrenal function when transferring from oral steroids; taper patients slowly from systemic corticosteroids if transferring to inhaler Hypercorticism and adrenal suppression; may occur with very high dosages or at regular dosage in susceptible individuals Decreases in bone mineral density; monitor patients with major risk factors for decreased bone mineral content Pregnancy: There are no randomized clinical studies in pregnant women; there are clinical considerations with use in pregnant women In women with poorly or moderately controlled asthma, there is increased risk of several perinatal adverse outcomes such as preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate; pregnant women with asthma should be closely monitored and medication adjusted as necessary to maintain optimal asthma control Lactation: There are no available data on the presence of mometasone furoate, or formoterol fumarate in human milk; the effects on the breastfed child, or the effects on milk production; The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal conditionPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Mometasone: Glucocorticoid; elicits local anti-inflammatory effects on respiratory tract with minimal systemic absorption Formoterol: Long-acting selective beta2-adrenergic agonist with rapid onset of action; acts locally as bronchodilator; stimulates intracellular adenyl cyclase, which results in increased cyclic adenosine monophosphate levels, causing relaxation of bronchial smooth muscle and inhibition of release of mast cell mediators Absorption Peak plasma time: Mometasone, 1-2 hr; formoterol, 0.5-2