Dulera (mometasone furoate/formoterol fumarate)

Each 2-mL single-dose vial of formoterol fumarate oral inhalation solution contains 20 mcg of formoterol fumarate. The oral inhalation solution does not require dilution prior to administration by nebulization. The actual amount of drug delivered to the lungs will depend on patient factors and the type of nebulization system used and its performance.

Each actuation of the oral aerosol inhaler containing the fixed combination of formoterol fumarate dihydrate and budesonide delivers 5.1 mcg of formoterol fumarate dihydrate and 91 or 181 mcg of budesonide from the valve and delivers 4.5 mcg of formoterol fumarate dihydrate and 80 or 160 mcg of budesonide from the actuator per metered spray, depending on the preparation used. The strength of formoterol/budesonide preparations and dosage of the fixed combination are expressed in terms of drug delivered from the mouthpiece of the actuator. The actual amount of drug delivered to the lungs depends on factors such as the patient's coordination between the actuation of the inhaler and inspiration through the delivery system. The commercially available formoterol/budesonide aerosol inhaler delivers 60 metered sprays per 6- or 6.9-g canister and 120 metered sprays per 10.2-g canister.

After priming of the oral aerosol inhaler containing the fixed combination of formoterol fumarate and glycopyrrolate, each actuation of the oral aerosol inhaler (Bevespi(R) Aerosphere(R)) delivers 5.5 mcg of formoterol fumarate and 10.4 mcg of glycopyrrolate (equivalent to 8.3 mcg of glycopyrronium) from the valve. Dosage is expressed in terms of drug delivered from the mouthpiece; each actuation of the inhaler delivers 4.8 mcg of formoterol fumarate and 9 mcg of glycopyrrolate (equivalent to 7.2 mcg of glycopyrronium) from the actuator. The actual amount of drug delivered to the lungs depends on factors such as the patient's coordination between actuation of the device and inspiration through the delivery system. Commercially available formoterol/glycopyrrolate aerosol inhaler delivers 28 or 120 metered sprays per 5.9- or 10.7-g canister, respectively.

Each actuation of the oral aerosol inhaler containing the fixed combination of formoterol fumarate dihydrate and mometasone furoate delivers 5.5 mcg of formoterol fumarate dihydrate and 115 or 225 mcg of mometasone furoate from the valve and delivers 5 mcg of formoterol fumarate dihydrate and 100 or 200 mcg of mometasone furoate from the actuator per metered spray, depending on the preparation used. The strength of formoterol/mometasone preparations and dosage of the fixed combination are expressed in terms of drug delivered from the mouthpiece of the actuator. The actual amount of drug delivered to the lungs may depend on factors such as the patient's coordination between actuation of the device and inspiration through the delivery system. Commercially available formoterol/mometasone aerosol inhaler delivers 60 or 120 metered sprays per 8.8- or 13-g canister, respectively.

Dosage of mometasone furoate is expressed in terms of the salt.

Mometasone/formoterol is a fixed combination of mometasone furoate and formoterol fumarate dihydrate; dosage of the mometasone component is expressed in terms of the salt and dosage of the formoterol component is expressed in terms of the hydrated salt.

The strength and dosage of mometasone furoate administered as an oral inhalation powder (Asmanex(R) Twisthaler(R)) is expressed as the nominal (labeled) dose contained in the Twisthaler(R) device. The actual amount of drug delivered to the lungs depends on factors such as the patient's inspiratory flow. Based on standardized in vitro testing at a flow rate of 30 and 60 L/minute at a constant volume of 2 L, each actuation of the Twisthaler(R) inhaler labeled as containing 220 or 110 mcg of mometasone furoate delivers 200 or 100 mcg of mometasone furoate, respectively, from the mouthpiece. In adults and adolescents 12 years of age or older with asthma of varying severity, mean peak inspiratory flow through the Twisthaler(R) device was 69 L/minute. Mean peak inspiratory flow through the Twisthaler(R) device in pediatric patients 5-8 or 9-12 years of age exceeded 50 or 60 L/minute, respectively.

Each actuation of the mometasone furoate oral aerosol metered-dose inhaler (Asmanex(R) HFA) delivers 115 or 225 mcg of mometasone furoate from the valve and 100 or 200 mcg of mometasone furoate from the actuator, depending on the preparation used. The strength and dosage of these mometasone preparations are expressed in terms of drug delivered from the mouthpiece of the actuator. The actual amount of drug delivered to the lungs may depend on factors such as the patient's coordination between actuation of the device and inspiration through the delivery system. Commercially available Asmanex(R) HFA aerosol inhaler delivers 120 actuations per 13-g canister.

Each actuation of the oral aerosol inhaler containing the fixed combination of mometasone furoate and formoterol fumarate (Dulera(R)) delivers 115 or 225 mcg of mometasone furoate and 5.5 mcg of formoterol fumarate dihydrate from the valve and delivers 100 or 200 mcg of mometasone furoate and 5 mcg of formoterol fumarate dihydrate from the actuator per metered spray, depending on the preparation used. The strength and dosage of mometasone/formoterol preparations are expressed in terms of drug delivered from the mouthpiece of the actuator. The actual amount of drug delivered to the lungs may depend on factors such as the patient's coordination between actuation of the device and inspiration through the delivery system. Commercially available mometasone/formoterol aerosol inhaler delivers 60 or 120 metered sprays per 8.8- or 13-g canister, respectively.

No dosing information is available for this tab.

No dosing information is available for this tab.

No dosing information is available for this tab.

The following information addresses potential interactions with formoterol fumarate. When formoterol fumarate is used in fixed combination with budesonide, glycopyrrolate, or mometasone furoate, interactions associated with budesonide, glycopyrrolate, and mometasone also should be considered. No formal drug interaction studies have been performed to date with the fixed-combination preparations containing formoterol fumarate and budesonide, glycopyrrolate, or mometasone.

The following information addresses potential interactions with mometasone furoate. When mometasone furoate is used in fixed combination with formoterol fumarate (mometasone/formoterol), interactions associated with formoterol also should be considered. No formal drug interaction studies have been performed to date with the mometasone/formoterol fixed combination.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

Formoterol fumarate and fixed combinations containing formoterol fumarate are contraindicated in patients hypersensitive to the drug or any ingredient in the formulation.

Because of the risk of asthma-related death and hospitalization, use of formoterol for the treatment of asthma without concomitant use of long-term asthma controller therapy, such as inhaled corticosteroids, is contraindicated. (See Asthma-related Death and Serious Asthma-related Events under Warnings/Precautions: Warnings, in Cautions and also see Uses: Bronchospasm.)

Formoterol fumarate in fixed combination with budesonide (formoterol/budesonide; Symbicort(R)) and formoterol fumarate in fixed combination with mometasone furoate (formoterol/mometasone; Dulera(R)) are contraindicated as primary treatment of status asthmaticus or other acute episodes of asthma or chronic obstructive pulmonary disease (COPD) when intensive measures are required.

Formoterol fumarate in fixed combination with glycopyrrolate (formoterol/glycopyrrolate; Bevespi(R) Aerosphere(R)) is not indicated for the treatment of asthma.

Mometasone furoate and the fixed combination containing mometasone furoate and formoterol fumarate (mometasone/formoterol) are contraindicated for primary treatment of severe acute asthmatic attacks or status asthmaticus when intensive measures (e.g., oxygen, parenteral bronchodilators, IV corticosteroids ) are required.

Mometasone furoate is contraindicated in patients hypersensitive to the drug or any ingredient (e.g., milk proteins) in the formulation. Mometasone oral inhalation powder contains small amounts of lactose, which has trace amounts of milk proteins. Anaphylactic reactions in patients with milk protein allergy have been reported; therefore, patients with known milk protein allergy should not receive mometasone oral inhalation powder.

Mometasone/formoterol fixed combination is contraindicated in patients hypersensitive to mometasone, formoterol, or any ingredient in the formulation.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

Adverse effects occurring in 2% or more of adults in clinical trials receiving formoterol fumarate oral inhalation solution for the treatment of COPD include diarrhea, nausea, vomiting, nasopharyngitis, dry mouth, dizziness, and insomnia.

Adverse effects occurring in 3% or more of patients receiving formoterol fumarate in fixed combination with budesonide for the treatment of asthma include nasopharyngitis, headache, upper respiratory tract infection, pharyngolaryngeal pain, sinusitis, influenza, back pain, nasal congestion, stomach discomfort, vomiting, and oral candidiasis.

Adverse effects occurring in 3% or more of patients receiving formoterol fumarate in fixed combination with budesonide for the treatment of COPD include nasopharyngitis, oral candidiasis, bronchitis, sinusitis, and upper respiratory tract infection.

Adverse effects occurring in 2% or more of patients receiving formoterol fumarate in fixed combination with glycopyrrolate for the treatment of COPD and more frequently than in those receiving placebo include urinary tract infection and cough.

Adverse effects occurring in 3% or more of patients receiving formoterol fumarate in fixed combination with mometasone furoate for the treatment of asthma and more frequently than in those receiving placebo include nasopharyngitis, sinusitis, and headache.

Adverse effects occurring in 5% or more of patients receiving mometasone furoate oral inhalation powder for the treatment of asthma include headache, allergic rhinitis, pharyngitis, upper respiratory tract infection, sinusitis, oral candidiasis, dysmenorrhea, musculoskeletal pain, back pain, and dyspepsia.

Adverse effects occurring in 3% or more of patients receiving mometasone furoate oral inhalation aerosol for the treatment of asthma include nasopharyngitis, headache, sinusitis, bronchitis, and influenza.

Adverse effects occurring in 3% or more of patients receiving the mometasone/formoterol fixed combination for the treatment of asthma and more frequently than in those receiving placebo include nasopharyngitis, sinusitis, and headache.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

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Formoterol fumarate oral inhalation solution (Perforomist(R)) and formoterol fumarate in fixed combination with glycopyrrolate (Bevespi(R) Aerosphere(R)) are not indicated for use in children. Safety and efficacy of these preparations in children have not been established.

Safety and efficacy of formoterol fumarate in fixed combination with budesonide (Symbicort(R)) in pediatric patients 12 years of age or older with asthma have been established in studies of up to 12 months' duration. Safety and efficacy of formoterol/budesonide in pediatric patients 6 to less than 12 years of age with asthma have been established in studies of up to 12 weeks' duration; however, the manufacturer states that safety and efficacy of the fixed-combination preparation in children younger than 6 years of age with asthma have not been established.

Safety and efficacy of formoterol fumarate in fixed combination with mometasone furoate (Dulera(R)) in pediatric patients 12 years of age or older with asthma have been established in studies of up to 12 months' duration.

Available data from controlled clinical trials suggest that monotherapy with long-acting beta2-adrenergic agonists increases the risk of asthma-related hospitalization in pediatric and adolescent patients. (See Asthma-related Death and Serious Asthma-related Events under Warnings/Precautions: Warnings, in Cautions.)

Safety and efficacy of mometasone furoate oral inhalation powder have not been established in children younger than 4 years of age.

Safety and efficacy of mometasone furoate oral inhalation aerosol have not been established in children younger than 12 years of age.

Safety and efficacy of the mometasone/formoterol fixed combination have not been established in children younger than 12 years of age.

Use of corticosteroids may lead to suppression of growth in children and adolescents. Therefore, pediatric patients receiving prolonged therapy with orally inhaled mometasone should be monitored periodically (e.g., via stadiometry) for possible adverse effects on growth and development. The benefits of corticosteroid therapy should be weighed against the possibility of growth suppression and the availability of safe and effective alternative therapies. Pediatric patients should be maintained on the lowest possible dosage of mometasone that controls asthma symptoms.

Category C. (See Users Guide.) Formoterol may interfere with uterine contractility; carefully weigh benefit versus risk in labor.

There is an increased risk of adverse perinatal outcomes (e.g., preeclampsia, premature birth, low birth weight, and neonates small for gestational age) in women with poorly or moderately controlled asthma. Pregnant women with asthma should be closely monitored and therapy adjusted as necessary to maintain optimal asthma control.

The effects of formoterol fumarate in fixed combination with budesonide, glycopyrrolate, or mometasone furoate during labor and delivery are not known. Because of the potential for beta-agonist interference with uterine contractility, use of formoterol in fixed combination with budesonide, glycopyrrolate, or mometasone during labor should be restricted to those patients in whom the benefits clearly outweigh the risk.

Category C.

There are no adequate and well-controlled studies with mometasone furoate in pregnant women. The drug should be used during pregnancy only if potential benefits justify potential risks to the fetus.

There is an increased risk of adverse perinatal outcomes (e.g., preeclampsia, premature birth, low birth weight, neonates small for gestational age) in women with poorly or moderately controlled asthma. Pregnant women with asthma should be closely monitored and therapy adjusted as necessary to maintain optimal asthma control.

The effects of mometasone furoate in fixed combination with formoterol fumarate during labor and delivery are not known. Because of the potential for beta-agonist interference with uterine contractility, use of the mometasone/formoterol fixed combination during labor should be restricted to those patients in whom the benefits clearly outweigh the risks.

Hypoadrenalism may occur in infants of women who have received substantial oral corticosteroid dosages during pregnancy. These infants should be carefully monitored.

Formoterol is distributed into milk in rats; it is not known whether formoterol is distributed into human milk. Effects of formoterol fumarate on breast-fed infants or milk production also are not known.

The benefits of breast-feeding and the woman's clinical need for formoterol fumarate alone or in fixed combination with budesonide or mometasone should be considered along with any potential adverse effects on the breast-fed infant from the drug or from the underlying maternal condition.

Because many drugs are distributed into human milk, caution should be exercised when formoterol fumarate in fixed combination with glycopyrrolate is administered to nursing women. Since there are no data from controlled clinical studies, the manufacturer of formoterol/glycopyrrolate states that a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.

It is not known whether mometasone furoate is distributed into milk; however, other corticosteroids are distributed into milk. Data are not available on the effects of the drug on the breast-fed child or milk production. The benefits of breast-feeding and the importance of mometasone to the woman should be considered along with any potential adverse effects on the breast-fed infant from the drug or underlying maternal condition. The manufacturer of mometasone oral inhalation powder (Asmanex(R) Twisthaler(R)) states that caution is advised if mometasone furoate is administered in nursing women.

The manufacturer of the mometasone/formoterol fixed combination states that a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.

The manufacturers of formoterol fumarate and formoterol fumarate in fixed combination with budesonide, glycopyrrolate, or mometasone furoate state that dosage adjustment is not required in geriatric patients.

No substantial differences in safety and efficacy of formoterol alone or in fixed combination with budesonide, glycopyrrolate, or mometasone furoate have been observed in geriatric patients relative to younger adults. However, the manufacturers state that the possibility that some geriatric patients may exhibit increased sensitivity to formoterol or fixed combinations containing formoterol cannot be ruled out. (See Dosage and Administration: Special Populations.)

Although no overall differences in safety and efficacy of orally inhaled mometasone furoate were observed in geriatric patients relative to younger adults, the possibility that some older patients may exhibit increased sensitivity to the drug cannot be ruled out.