BETA AGONISTS

SABA - short-acting beta agonist | LABA - long-acting beta agonist | SAMA - short-acting muscarinic antagonists | LAMA - long-acting muscarinic antagonists | ICS - inhaled corticosteroids
PRICING INFO


References:

ASTHMA STUDIES


COPD STUDIES


Drug Dosage form Dosage Generic/Price Other Mechanism /
FDA-approved indications
Side effects Drug Interactions Precautions / Contraindications
Albuterol

(Proventil HFA®)
(Ventolin HFA®)
(ProAir HFA®)
(ProAir RespiClick®)(Accuneb®)
Inhalers - HFA
  • Proventil HFA®
  • Ventolin HFA®
  • ProAir HFA®
  • Each inhaler delivers 90 mcg of albuterol base per actuation
  • All 3 brands contain 200 actuations per inhaler. Ventolin also comes in a 60 actuation inhaler (8g size).
  • HFA stands for Hydrofluoroalkane which is the propellant used in the inhalers

ProAir® RespiClick
  • Delivers 90 mcg of albuterol in a dry powder
  • Inhaler is breath-actuated
  • Each inhaler contains 200 inhalations

Nebulizer solution (Accuneb®)
  • Albuterol 0.50% (2.5 mg/0.5 ml)
  • Albuterol 0.083% (2.5 mg/3 ml)
  • Albuterol 0.042% (1.25 mg/3 ml)
  • Albuterol 0.021% (0.63 mg/3 ml)
  • Comes in box of 25 nebs

Nebulizer solution concentrate
  • Albuterol 0.50% (5 mg/1 ml of concentrate)
  • Comes in 20 ml bottle
Acute bronchospasm
    Inhalers (≥ 4 years old)
    • 2 puffs every 4 - 6 hours as needed
    Nebulizer
    • Age ≤ 12 years:
      • 0.1 - 0.15 mg/kg/dose every 6 - 8 hours as needed
      • Weight 10 - 15kg: 1.25 mg
      • Weight > 15kg: 2.5 mg
    • Age 13 years and older:
      • 2.5 mg every 6 - 8 hours as needed

Acute asthma exacerbations

See NHLBI asthma exacerbation recommendations


Prevention of exercise-induced asthma
    Inhalers (≥ 4 years)
    • 2 puffs 15 - 30 minutes before exercise
ProAir/Proventil/Ventolin
(200 actuations)

NO/$$

Ventolin
(60 actuations)

NO/$

Nebulizer solution
YES/$

Nebulizer concentrate
YES/$

Combivent Respimat®
NO/$$$$

Duoneb®
YES/$
  • Shake inhaler well before use

  • Most inhalers need to be primed before the first use and if they have not been used for > 2 weeks

  • To prime inhalers, release 3-4 sprays into the air (see inhaler instructions for specific directions)

  • Clean inhalers and nebulizers periodically according to instructions

Mechanism
  • Stimulates Beta-2 adrenergic receptors which causes bronchial smooth muscle dilation

FDA-approved indications
  • Asthma
  • Prevention of exercise-induced asthma
  • Relief of bronchospasm
NOTE: P = % of patients on placebo who reported side effect. Data from Proventil® PI.

  • Upper respiratory tract infections - 21%, P - 18%
  • Rhinitis - 16%, P - 14%
  • Nausea- 10%, P - 5%
  • Rapid heart rate - 7%, P - < 1%
  • Nervousness- 7%, P - 3%
  • Tremor- 7%, P - 2%
  • Inhalation site sensation - 6%, P - 2%
  • Allergic reactions - 6%, P - < 1%
  • Beta blockers - Beta blockers may block the action of albuterol. Nonselective beta blockers may carry a greater risk. Recent studies have found that beta blockers may actually be beneficial in patients with COPD/asthma. See beta blockers in RAD.
  • Thiazide diuretics - albuterol may worsen hypokalemia (low potassium) caused by these drugs
  • Loop diuretics - albuterol may worsen hypokalemia (low potassium) caused by these drugs
  • Digoxin - oral and IV albuterol may decrease digoxin levels. It's unclear if inhaled albuterol has the same effect.
  • MAO inhibitors - MAO inhibitors may potentiate the cardiovascular effects of albuterol
  • Tricyclic antidepressants - Tricyclic antidepressants may potentiate the cardiovascular effects of albuterol
  • Severe allergy to milk proteins (ProAir RespiClick only ) - DO NOT USE, contains lactose
  • Hypokalemia (low potassium) - albuterol may cause potassium levels to decrease
  • Paradoxical bronchospasm - cases of paradoxical bronchospasm have been reported
  • Hyperglycemia (elevated blood sugar) - albuterol may cause an increase in blood sugars. This effect is typically insignificant.
  • Cardiovascular effects - increases in pulse and blood pressure can occur in some patients. These reactions are rare.
  • EKG changes - flattening of the T-wave, QT-interval prolongation, and ST-segment depression have been reported
  • Cardiovascular disease - use with caution in patients with cardiovascular disease
  • Heart arrhythmias - use with caution in patients with heart arrhythmias
  • Liver disease - has not been studied extensively
  • Kidney disease - may decrease albuterol clearance
Drug Dosage form Dosage Generic/Price Other Mechanism /
FDA-approved indications
Side effects Drug Interactions Precautions / Contraindications
Levalbuterol

(Xopenex®)
Inhalers - Xopenex-HFA®
  • Each inhaler delivers 45 mcg of levalbuterol base per actuation
  • 200 actuations per inhaler
  • HFA stands for Hydrofluoroalkane which is the propellant used in the inhalers

Nebulizer solution
  • Levalbuterol 0.25% (1.25 mg/0.5 ml)
  • Levalbuterol 0.042% (1.25 mg/3 ml)
  • Levalbuterol 0.021% (0.63 mg/3 ml)
  • Levalbuterol 0.0103% (0.31 mg/3 ml)
  • Comes in box of 24 nebs
Acute bronchospasm
    Inhalers (≥ 4 years)
    • 1 - 2 puffs every 4-6 hours as needed

    Nebulizer
    • Age < 6 years
      • 0.075 mg/kg/dose
    • Age 6 - 11 years
      • 0.31 mg three times a day
    • Age ≥ 12 years
      • 0.63 mg - 1.25 mg every 6-8 hrs

Acute Asthma Exacerbations

See NHLBI asthma exacerbation recommendations

Inhalers
YES/$-$$

Nebulizer solution
YES/$-$$
  • Shake inhaler well before use

  • Prime inhaler before initial use and if inhaler has not been used for more than 3 days

  • To prime inhaler, release 4 sprays into the air (see inhaler instructions for specific directions)

  • Clean inhalers and nebulizers periodically according to instructions

Mechanism
  • Stimulates Beta-2 adrenergic receptors which causes bronchial smooth muscle dilation
  • Albuterol contains equal parts of a racemic mixture of R-enantiomers and S-enantiomers. The R-enantiomer is the active form of albuterol where the S-enantiomer is inactive. Levalbuterol contains only the R-enantiomer of albuterol.

FDA-approved indications
  • Asthma
  • Relief of bronchospasm
NOTE: Alb = % of patients on albuterol who experienced side effect. P = % of patients on placebo who reported side effect

  • Viral respiratory infection - 12.3%, Alb - 12.2%, P - 9.3%
  • Muscle spasticity - 9.6%, Alb - 8.1%, P - 0%
  • Nervousness - 6.8%, Alb - 2.7%, P - 0%
  • Increased cough - 4.1%, Alb - 2.7%, P - 2.7%
  • Rapid heart rate - 2.7%, Alb - 2.7%, P - 0%
  • Tremor- 2.7%, Alb - 0%, P - 0%
  • Upset stomach - 2.7%, Alb - 1.4%, P - 1.3%
  • Beta blockers - Beta blockers may block the action of levalbuterol. Nonselective beta blockers may carry a greater risk. Recent studies have found that beta blockers may actually be beneficial in patients with COPD/asthma. See beta blockers in RAD.
  • Thiazide diuretics - levalbuterol may worsen hypokalemia (low potassium) caused by these drugs
  • Loop diuretics - levalbuterol may worsen hypokalemia (low potassium) caused by these drugs
  • Digoxin - oral and IV albuterol may decrease digoxin levels. It's unclear if inhaled levalbuterol has the same effect.
  • MAO inhibitors - MAO inhibitors may potentiate the cardiovascular effects of levalbuterol
  • Tricyclic antidepressants - Tricyclic antidepressants may potentiate the cardiovascular effects of levalbuterol
  • Hypokalemia (low potassium) - levalbuterol may cause potassium levels to decrease
  • Paradoxical bronchospasm - cases of paradoxical bronchospasm have been reported
  • Hyperglycemia (elevated blood sugar) - levalbuterol may cause an increase in blood sugars. This effect is typically insignificant.
  • Cardiovascular effects - increases in pulse and blood pressure can occur in some patients. These reactions are rare.
  • EKG changes - flattening of the T-wave, QT-interval prolongation, and ST-segment depression have been reported
  • Cardiovascular disease - use with caution in patients with cardiovascular disease
  • Heart arrhythmias - use with caution in patients with heart arrhythmias
  • Liver disease - has not been studied extensively
  • Kidney disease - may decrease levalbuterol clearance
Drug Dosage form Dosage Generic/Price Other Mechanism /
FDA-approved indications
Side effects Drug Interactions Precautions / Contraindications
Formoterol
and arformoterol

(Foradil®)
(Brovana®)
(Perforomist®)
Foradil® - inhaler
  • Foradil® comes in a capsule that has 12 mcg of formoterol powder in the center
  • Powder is inhaled through a device called an aerolizer
  • Comes in package of 60 capsules

Brovana® (arformoterol)
nebulizer solution

  • 15 mcg/2 ml
  • Comes in package of 60 nebs

Perforomist® (formoterol)
nebulizer solution

  • 20 mcg/2 ml
  • Comes in package of 60 nebs
Asthma
  • Foradil inhaler
    • Age ≥ 5 years and adults
      • One capsule every 12 hours

COPD
  • Foradil inhaler
    • One capsule every 12 hours
  • Nebulizers (Brovana and Perforomist)
    • One treatment twice a day

Prevention of exercise-induced asthma

    Inhaler (≥ 5 years and adults)
    • One capsule at least 15 minutes before exercise
    • Protection may last up to 12 hours
    • Effect will diminish if used frequently
Inhaler
NO/$$$$

Nebulizer
NO/$$$$
  • Foradil® - store in refrigerator before dispensing. May store at room temperature. Follow patient instructions for using inhaler.
  • Brovana® - store in refrigerator. May store at room temperature for up to 6 weeks. Protect from light.
  • Perforomist® - store in refrigerator before dispensing. May store at room temperature for up to 3 months. Protect from light.

Mechanism
  • Stimulates Beta-2 adrenergic receptors which causes bronchial smooth muscle dilation

FDA-approved indications
    Foradil® inhaler
    • Asthma (≥ 5 years). Should only be used as concomitant therapy with a long-term asthma control medication like an inhaled corticosteroid
    • Prevention of exercise-induced asthma (≥ 5 years)
    • COPD
    • NOT indicated for relief of acute bronchospasm
    Brovana® and Perforomist
    • COPD
  • Side effects of formoterol are similar to those seen with albuterol. In trials, formoterol was often added to albuterol, so it is difficult to discern which effects may be attributable to formoterol only.
  • Side effects that demonstrated a dose-response to formoterol included:
    • Tremor
    • Dizziness
    • Voice impairment
    • Data from Foradil® PI
  • Beta blockers - Beta blockers may block the action of formoterol. Nonselective beta blockers may carry a greater risk. Recent studies have found that beta blockers may actually be beneficial in patients with COPD/asthma. See beta blockers in RAD.
  • Thiazide diuretics - formoterol may worsen hypokalemia (low potassium) caused by these drugs
  • Drugs that prolong the QT interval - formoterol may potentiate QT prolongation
  • Loop diuretics - formoterol may worsen hypokalemia (low potassium) caused by these drugs
  • Theophylline - may potentiate hypokalemia (low potassium)
  • Corticosteroids - may potentiate hypokalemia (low potassium)
  • MAO inhibitors - MAO inhibitors may potentiate the cardiovascular effects of formoterol
  • Tricyclic antidepressants - Tricyclic antidepressants may potentiate the cardiovascular effects of formoterol
  • Halogenated hydrocarbons - may increase risk of arrhythmia
  • Severe allergy to milk proteins (Foradil® only) - DO NOT USE, contains lactose
  • - LABAs have been associated with an increased risk of asthma-related deaths
  • Increased risk of serious asthma exacerbations - in several formoterol trials, children aged 5 - 11 years had an increased risk of severe asthma exacerbation when compared to placebo
  • Hypokalemia (low potassium) - formoterol may cause potassium levels to decrease. The effect is usually transient and insignificant.
  • Hyperglycemia (elevated blood sugar) - formoterol may cause an increase in blood sugars. This effect is typically insignificant.
  • Paradoxical bronchospasm - cases of paradoxical bronchospasm have been reported
  • Cardiovascular effects - increases in pulse and blood pressure can occur in some patients. These reactions are rare.
  • EKG changes - flattening of the T-wave, QT-interval prolongation, and ST-segment depression have been reported
  • Cardiovascular disease - use with caution in patients with cardiovascular disease
  • Heart arrhythmias - use with caution in patients with heart arrhythmias
  • Liver disease - has not been studied extensively. Use caution.
  • Kidney disease - has not been studied extensively

Drug Dosage form Dosage Generic/Price Other Mechanism /
FDA-approved indications
Side effects Drug Interactions Precautions / Contraindications
Indacaterol

(Arcapta®)
Arcapta NeoHaler®
  • Arcapta® comes in a capsule that has 75 mcg of indacaterol powder in the center
  • Powder is inhaled through a device called a Neohaler
  • Comes in package of 30 capsules
COPD
  • One capsule via Neohaler once daily
NO/$$$$
  • Protect from light and moisture

  • Remove from blister pack immediately before use

Mechanism
  • Stimulates Beta-2 adrenergic receptors which causes bronchial smooth muscle dilation

FDA-approved indication
  • Chronic Obstructive Pulmonary Disease (COPD)
  • NOT indicated for relief of acute bronchospasm
NOTE: P = % of patients on placebo who reported side effect

  • Cough- 6.5%, P - 4.5%
  • Nasopharyngitis- 5.3%, P - 2.7%
  • Headache- 5.1%, P - 2.5%
  • Nausea- 2.4%, P - 0.9%
  • Mouth pain - 2.2%, P - 0.7%
  • Beta blockers - Beta blockers may block the action of indacaterol. Nonselective beta blockers may carry a greater risk. Recent studies have found that beta blockers may actually be beneficial in patients with COPD/asthma. See beta blockers in RAD.
  • Thiazide diuretics - indacaterol may worsen hypokalemia (low potassium) caused by these drugs
  • Drugs that prolong the QT interval - indacaterol may potentiate QT prolongation
  • Loop diuretics - indacaterol may worsen hypokalemia (low potassium) caused by these drugs
  • Theophylline - may potentiate hypokalemia (low potassium)
  • Corticosteroids - may potentiate hypokalemia (low potassium)
  • MAO inhibitors - MAO inhibitors may potentiate the cardiovascular effects of indacaterol
  • Tricyclic antidepressants - Tricyclic antidepressants may potentiate the cardiovascular effects of indacaterol
  • Indacaterol is a CYP3A4 substrate and a minor P-gp substrate. In studies, combined inhibition of CYP3A4 and P-gp did not have a significant effect on indacaterol.
  • Severe allergy to milk proteins - DO NOT USE. Contains lactose
  • Prolonged QT interval - DO NOT USE. May worsen QT prolongation.
  • - LABAs have been associated with an increased risk of asthma-related deaths
  • Hypokalemia (low potassium) - indacaterol may cause potassium levels to decrease. The effect is usually transient and insignificant.
  • Hyperglycemia (elevated blood sugar) - indacaterol may cause an increase in blood sugars. This effect is typically insignificant.
  • Paradoxical bronchospasm - cases of paradoxical bronchospasm have been reported
  • Cardiovascular effects - increases in pulse and blood pressure can occur in some patients. These reactions are rare.
  • EKG changes - flattening of the T-wave, QT-interval prolongation, and ST-segment depression have been reported
  • Cardiovascular disease - use with caution in patients with cardiovascular disease
  • Heart arrhythmias - use with caution in patients with heart arrhythmias
  • Liver disease - mild-moderate - no dose adjustment necessary; severe - has not been studied
  • Kidney disease - has not been studied; indacaterol undergoes minimal kidney elimination
Drug Dosage form Dosage Generic/Price Other Mechanism /
FDA-approved indications
Side effects Drug Interactions Precautions / Contraindications
Olodaterol

(Striverdi Respimat®)
Striverdi Respimat® inhaler
  • Each actuation delivers 2.7 mcg olodaterol hydrochloride, equivalent to 2.5 mcg olodaterol
  • Inhaler comes with cartridge that contains 60 sprays (inhalations)
COPD
  • Two inhalations once daily at the same time of the day
NO/$$$$
  • After assembly, inhaler should be discarded at the latest 3 months after first use

Mechanism
  • Stimulates Beta-2 adrenergic receptors which causes bronchial smooth muscle dilation

FDA-approved indication
  • Chronic Obstructive Pulmonary Disease (COPD)
  • NOT indicated for relief of acute bronchospasm
NOTE: P = % of patients on placebo who reported side effect

  • Nasopharyngitis- 11.3%, P - 7.7%
  • Upper respiratory infection - 8.2%, P - 7.5%
  • Bronchitis- 4.7%, P - 3.6%
  • Cough - 4.2%, P - 4.0%
  • Beta blockers - Beta blockers may block the action of olodaterol. Nonselective beta blockers may carry a greater risk. Recent studies have found that beta blockers may actually be beneficial in patients with COPD/asthma. See beta blockers in RAD.
  • Thiazide diuretics - olodaterol may worsen hypokalemia (low potassium) caused by these drugs
  • Drugs that prolong the QT interval - olodaterol may potentiate QT prolongation
  • Loop diuretics - olodaterol may worsen hypokalemia (low potassium) caused by these drugs
  • Theophylline - may potentiate hypokalemia (low potassium)
  • Corticosteroids - may potentiate hypokalemia (low potassium)
  • MAO inhibitors - MAO inhibitors may potentiate the cardiovascular effects of olodaterol
  • Tricyclic antidepressants - tricyclic antidepressants may potentiate the cardiovascular effects of olodaterol
  • Olodaterol is a CYP2C9 and CYP2C8 substrate. No dose adjustment is recommended when used with inhibitors of these enzymes.
  • - LABAs have been associated with an increased risk of asthma-related deaths
  • Congenital long QT syndrome - DO NOT USE. May cause QT prolongation
  • Hypokalemia (low potassium) - olodaterol may cause potassium levels to decrease. The effect is usually transient and insignificant.
  • Hyperglycemia (elevated blood sugar) - olodaterol may cause an increase in blood sugars. This effect is typically insignificant.
  • Paradoxical bronchospasm - cases of paradoxical bronchospasm have been reported
  • Cardiovascular effects - increases in pulse and blood pressure can occur in some patients. These reactions are rare.
  • EKG changes - flattening of the T-wave, QT-interval prolongation, and ST-segment depression have been reported
  • Cardiovascular disease - use with caution in patients with cardiovascular disease
  • Heart arrhythmias - use with caution in patients with heart arrhythmias
  • Liver disease - mild-moderate - no dose adjustment necessary; severe - has not been studied
  • Kidney disease - no dose adjustment necessary
Drug Dosage form Dosage Generic/Price Other Mechanism /
FDA-approved indications
Side effects Drug Interactions Precautions / Contraindications
Salmeterol

(Serevent®)
Inhaler - Serevent®
  • Comes as a powder that is packaged in a diskus device
  • Each dose delivers 50 mcg of salmeterol
  • Each diskus contains 60 doses
Asthma
    Age ≥ 4 years and adults
    • One inhalation twice a day

COPD
  • One inhalation twice a day

Prevention of exercise-induced asthma
    Age ≥ 4 years and adult
    • One inhalation at least 30 minutes before exercise
    • Protection may last up to 9 hours in adolescents and adults and up to 12 hours in patients aged 4 to 11 years
    • Effect will diminish if used frequently
NO/$$$$
  • Diskus is good for 6 weeks after removing from foil pouch

  • Store at room temperature

  • Protect from sunlight
Mechanism
  • Stimulates Beta-2 adrenergic receptors which causes bronchial smooth muscle dilation

FDA-approved indications
  • Asthma (≥ 4 years and adults). Should only be used as concomitant therapy with a long-term asthma control medication like an inhaled corticosteroid.
  • Prevention of exercise-induced asthma in patients ≥ 4 years and adults
  • COPD
  • NOT indicated for relief of acute bronchospasm
NOTE: P = % of patients on placebo who reported side effect. Alb = % of patients on albuterol 4 times a day that experienced side effect

  • Headache- 13%, Alb - 12%, P - 9%
  • Sinus congestion - 9%, Alb - 8%, P - 6%
  • Tracheitis/Bronchitis - 7%, Alb - 3%, P - 4%
  • Runny nose - 5%, Alb - 4%, P - 4%
  • Influenza- 5%, Alb - 5%, P - 2%
  • CYP3A4 strong inhibitors - DO NOT COMBINE. Salmeterol is a CYP3A4 substrate. Strong inhibitors of CYP3A4 may increase salmeterol levels and may cause EKG changes.
  • Beta blockers - Beta blockers may block the action of salmeterol. Nonselective beta blockers may carry a greater risk. Recent studies have found that beta blockers may actually be beneficial in patients with COPD/asthma. See beta blockers in RAD.
  • Thiazide diuretics - salmeterol may worsen hypokalemia (low potassium) caused by these drugs
  • Drugs that prolong the QT interval - salmeterol may potentiate QT prolongation
  • Loop diuretics - salmeterol may worsen hypokalemia (low potassium) caused by these drugs
  • Theophylline - may potentiate hypokalemia (low potassium)
  • Corticosteroids - may potentiate hypokalemia (low potassium)
  • MAO inhibitors - MAO inhibitors may potentiate the cardiovascular effects of salmeterol
  • Tricyclic antidepressants - Tricyclic antidepressants may potentiate the cardiovascular effects of salmeterol
  • Severe allergy to milk proteins - DO NOT USE, contains lactose
  • - LABAs have been associated with an increased risk of asthma-related deaths
  • Increased risk of serious asthma exacerbations - In trials involving pediatric and adolescent patients, LABAs have been associated with an increased risk of severe asthma exacerbations
  • Hypokalemia (low potassium) - salmeterol may cause potassium levels to decrease. The effect is usually transient and insignificant.
  • Hyperglycemia (elevated blood sugar) - salmeterol may cause an increase in blood sugars. This effect is typically insignificant.
  • Paradoxical bronchospasm - cases of paradoxical bronchospasm have been reported
  • Cardiovascular effects - increases in pulse and blood pressure can occur in some patients. These reactions are rare.
  • EKG changes - flattening of the T-wave, QT-interval prolongation, and ST-segment depression have been reported
  • Cardiovascular disease - use with caution in patients with cardiovascular disease
  • Heart arrhythmias - use with caution in patients with heart arrhythmias
  • Liver disease - has not been studied extensively. Use caution.
  • Kidney disease - has not been studied extensively
Drug Dosage form Dosage Generic/Price Other FDA-approved indications
Symbicort®

formoterol + budesonide
Symbicort® Inhaler (budesonide/formoterol)
  • Symbicort® 80/4.5 - 80 mcg/4.5 mcg per actuation
  • Symbicort® 160/4.5 - 160 mcg/4.5 mcg per actuation
  • Comes in inhaler with 120 actuations
Asthma
  • 6 to 11 years old
    • Dose: Symbicort 80/4.5 two inhalations twice daily

  • 12 years of age and older
    • Dose: two inhalations twice daily
    • Starting - may start with 80/4.5 or 160/4.5, depending on severity
    • Max: Symbicort 160/4.5 two inhalations twice daily
    • Maximum benefit seen after 2 weeks

COPD
  • For patients with COPD, the recommended dose is Symbicort 160/4.5 two inhalations twice daily
NO/$$$$
  • Shake well for 5 seconds before use

  • Inhaler is good for 3 months after removal from foil pouch

  • If you do not use your inhaler for more than 7 days or if you drop it, you will need to prime again

  • See patient instructions for details
  • Maintenance treatment of Asthma
  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • NOT for relief of acute bronchospasm

  • Budesonide is an inhaled corticosteroid
  • Formoterol is a long-acting beta agonist
Drug Dosage form Dosage Generic/Price Other FDA-approved indications
Dulera®

formoterol + mometasone
Dulera® Inhaler (mometasone/formoterol)
  • Dulera® 100/5 - 100 mcg/5 mcg per actuation
  • Dulera® 200/5 - 200 mcg/5 mcg per actuation
  • Comes in inhaler with 120 actuations
Asthma (≥ 12 years old)
  • Dose: 2 inhalations twice daily
  • Medium dose corticosteroids: Dulera® 100 mcg/5 mcg, two inhalations twice daily
  • High dose corticosteroids: Dulera® 200 mcg/5 mcg, two inhalations twice daily
  • Maximum benefit seen after 2 weeks
NO/$$$$
  • Shake well before use

  • Prime inhaler by releasing 4 test sprays

  • Re-prime if not used for ≥ 5 days
  • Maintenance treatment of Asthma
  • NOT for relief of acute bronchospasm

  • Mometasone is a inhaled corticosteroid
  • Formoterol is a long-acting beta agonist
Drug Dosage form Dosage Generic/Price Other FDA-approved indications
Advair®

Salmeterol + fluticasone
Advair® Diskus (fluticasone/salmeterol)
  • Advair® 100/50 - 100/50 mcg per inhalation
  • Advair® 250/50 - 250/50 mcg per inhalation
  • Advair® 500/50 - 500/50 mcg per inhalation
  • Inhalation powder packaged in diskus with 60 doses

Advair® HFA (fluticasone/salmeterol)
  • Advair HFA® 45/21 - 45/21 mcg per actuation
  • Advair HFA® 115/21 - 115/21 mcg per actuation
  • Advair HFA® 230/21 - 230/21 mcg per actuation
  • Inhaler with 120 actuations per inhaler
Advair® Diskus
  • Asthma
    • 4 - 11 years old
      • One inhalation of 100/50 twice daily
    • 12 years of age and older
      • Dose: one inhalation twice daily
      • Starting: strength will depend on asthma severity
      • Max dose: 500/50, one inhalation twice daily
      • Maximum benefit seen after 2 weeks
  • COPD
    • 1 inhalation of 250/50 twice daily

Advair® HFA
  • Asthma in children ≥ 12 years and adults
    • Dose: two inhalations twice daily
    • Starting: strength will depend on asthma severity
    • Max dose: 230/21, two inhalations twice daily
    • Maximum benefit seen after 2 weeks

HFA and diskus
NO/$$$$
Advair® HFA
  • Shake well for 5 seconds before use
  • Prime before using for the first time by releasing 4 test sprays
  • In cases where the inhaler has not been used for more than 4 weeks or when it has been dropped, prime the inhaler again by releasing 2 test sprays
  • Rinse mouth after use

Advair® Diskus
  • The device should be discarded 1 month after removal from the moisture-protective foil overwrap pouch
  • Rinse mouth after use
Advair® Diskus
  • Asthma in children ≥ 4 years and adults
  • Chronic Obstructive Pulmonary Disease (COPD)
  • NOT for relief of acute bronchospasm

Advair® HFA
  • Asthma in children ≥ 12 years and adults
  • NOTfor relief of acute bronchospasm

  • Salmeterol is a long-acting beta agonist
  • Fluticasone is an inhaled corticosteroid
Drug Dosage form Dosage Generic/Price Other FDA-approved indications
AirDuo RespiClick®

salmeterol + fluticasone
AirDuo RespiClick® powder inhaler (fluticasone/salmeterol)
  • AirDuo RespiClick® 55/14 - 55/14 mcg per inhalation
  • AirDuo RespiClick® 113/14 - 113/14 mcg per inhalation
  • AirDuo RespiClick® 232/14 - 232/14 mcg per inhalation
  • Each inhaler contains 60 actuations
Asthma (≥ 12 years old)
  • Starting: 55/14 mcg twice daily
  • Maintenance: 55/14 - 232/14 mcg twice daily
  • Max dose: 232/14 mcg twice daily
  • Increase dose at intervals of 2 weeks
  • Inhale at the same time each day
  • Patients switching from other inhaled corticosteroids may require higher starting doses
YES/$$
  • Inhaler does not require priming
  • Never wash or put any part of the inhaler in water
  • Do not use with a spacer or volume holding chamber
  • Asthma in children ≥ 12 years and adults
  • NOT for relief of acute bronchospasm
Drug Dosage form Dosage Generic/Price Other FDA-approved indications
Breo Ellipta®

vilanterol + fluticasone
Breo Ellipta® inhaler
  • Inhaler delivers 100 mcg of fluticasone powder and 25 mcg of vilanterol powder per inhalation
  • Inhaler comes with 30 inhalations
COPD
  • One inhalation once daily

Asthma (≥ 18 years old)
  • One inhalation once daily
NO/$$$$
  • See Breo Ellipta® PI for complete prescribing information

  • Discard inhaler 6 weeks after opening the foil tray

  • DO NOT USE in patients with severe milk allergy

  • Vilanterol is a CYP3A4 substrate. Use caution with strong CYP3A4 inhibitors.
  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • Asthma in patients ≥ 18 years old that is not well-controlled with other medications
  • NOT for relief of acute bronchospasm

  • Vilanterol is a long-acting beta agonist
  • Fluticasone is an inhaled corticosteroid
Drug Dosage form Dosage Generic/Price Other FDA-approved indications
Combivent Respimat®
Duoneb®

albuterol + ipratropium
Inhaler - Combivent Respimat®
  • Inhaler delivers 100 mcg of albuterol and 20 mcg of ipratropium per actuation
  • Each inhaler contains 120 actuations

Nebulizer solution - Duoneb®
  • Ipratropium 0.5 mg/Albuterol 3 mg per 3 ml neb
  • Comes in box of 30 or 60 nebs
Acute bronchospasm in COPD
    Combivent Respimat®
    • Dosing: One inhalation four times a day with up to two additional inhalations if required
    • Max: Six inhalations in 24 hours

    Duoneb®
    • Dosing: One neb four times a day with up to two additional nebs if required
    • Max: Six nebs in 24 hours

Acute asthma exacerbation

See NHLBI asthma exacerbation recommendations
Combivent Respimat®
NO/$$$$

Duoneb®
YES/$
  • Combivent Respimat® is good for 3 months after first use

  • See Combivent Respimat® patient insert for priming instructions
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Relief of bronchospasm

  • Ipratropium is a short-acting anticholinergic agent
  • Albuterol is a short-acting beta agonist
Drug Dosage form Dosage Generic/Price Other FDA-approved indications
Bevespi Aerosphere™

formoterol + glycopyrrolate
Inhaler
  • Device delivers 4.8 mcg of formoterol and 9 mcg of glycopyrrolate per actuation
  • Each inhaler contains 120 inhalations
COPD
  • Two inhalations twice a day
NO/$$$$

  • Inhaler must be primed. See package insert for instructions.
  • See Bevespi Aerosphere PI for complete prescribing information
  • Inhaler is good for 3 months after removal from foil pouch
  • Chronic Obstructive Pulmonary Disease (COPD)
  • NOT for relief of acute bronchospasm

  • Glycopyrrolate is a long-acting anticholinergic agent
  • Formoterol is a long-acting beta agonist
Drug Dosage form Dosage Generic Other FDA-approved indications
Utibron® Neohaler

indacaterol + glycopyrrolate
Utibron® Neohaler
  • Each capsule contains 27.5 mcg of indacaterol and 15.6 mcg of glycopyrrolate powder
  • Inhaler comes with 60 inhalation capsules
COPD
  • One inhalation twice a day
  • Use at the same time every day
NO/$$$$
  • See Utibron® PI for complete prescribing information
  • Use with caution in patients with severe milk allergy. Contains lactose.

  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)

  • NOT for relief of acute bronchospasm

  • Glycopyrrolate is a long-acting anticholinergic agent
  • Indacaterol is a long-acting beta agonist

Drug Dosage form Dosage Generic Other FDA-approved indications
Stiolto® Respimat

olodaterol + tiotropium
Stiolto® Respimat inhaler
  • Inhaler delivers tiotropium 3.124 mcg (equivalent to 2.5 mcg tiotropium) and olodaterol 2.736 mcg (equivalent to 2.5 mcg olodaterol) per spray
  • Inhaler comes with 60 actuations
COPD
  • Two inhalations once daily
  • Use at the same time every day
NO/$$$$
  • See Stiolto® PI for complete prescribing information

  • Inhaler should be primed. See patient instructions for details

  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)

  • NOT for relief of acute bronchospasm

  • Tiotropium is a long-acting anticholinergic agent
  • Olodaterol is a long-acting beta agonist
Drug Dosage form Dosage Generic/Price Other FDA-approved indications
Anoro Ellipta®

vilanterol + umeclidinium
Anoro Ellipta® inhaler
  • Each powder inhalation contains umeclidinium 62.5 mcg and vilanterol 25 mcg
  • Inhaler comes with 30 inhalations
COPD
  • One inhalation once daily
NO/$$$$
  • See Anoro Ellipta® PI for complete prescribing information

  • Discard inhaler 6 weeks after opening the foil tray

  • DO NOT USE in patients with severe milk allergy

  • Vilanterol is a CYP3A4 substrate. Use caution with strong CYP3A4 inhibitors.

  • DO NOT USE in patients with congenital long QT syndrome [4]
  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)

  • NOT for relief of acute bronchospasm

  • Umeclidinium is a long-acting anticholinergic agent
  • Vilanterol is a long-acting beta agonist
Drug Dosage form Dosage Generic/Price Other Indications
(FDA-approved)
Trelegy Ellipta®

fluticasone + vilanterol + umeclidinium
Trelegy Ellipta® inhaler
  • Inhaler delivers 100 mcg of fluticasone, 62.5 mcg of umeclidinium, and 25 mcg of vilanterol powder per inhalation
  • Inhaler comes with 30 inhalations
COPD
  • One inhalation once daily
NO/$$$$
  • See Trelegy Ellipta® PI for complete prescribing information

  • Discard inhaler 6 weeks after opening the foil tray

  • DO NOT USE in patients with severe milk allergy

  • Vilanterol is a CYP3A4 substrate. Use caution with strong CYP3A4 inhibitors.
  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • NOT for relief of acute bronchospasm