Brovana

Brovana Uses, Dosage, Side Effects, Food Interaction and all others data.

Brovana is indicated for long-term, twice daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.Important limitations of use: Brovana nebuliser solution is not indicated to treat acute deteriorations of COPD. People with asthma, who take long-acting beta2-adrenergic agonist (LABA) medicines, such as Brovana, have an increased risk of death from asthma problems

Brovana, the active (R,R)-enantiomer of formoterol, is a selective long-acting β2-adrenergic receptor agonist (beta2-agonist) that has two-fold greater potency than racemic formoterol (which contains both the (S,S) and (R,R)-enantiomers). The (S,S)-enantiomer is about 1,000-fold less potent as a β2-agonist than the (R,R)-enantiomer. Brovana seems to have little or no effect on β1-adrenergic receptors.

Trade Name Brovana
Availability Prescription only
Generic Arformoterol
Arformoterol Other Names Arformoterol
Related Drugs ProAir Digihaler, Symbicort, Breo Ellipta, Ventolin, Xopenex, Ventolin HFA, Spiriva
Weight 15mcg/2ml,
Type Inhalation solution
Formula C19H24N2O4
Weight Average: 344.4049
Monoisotopic: 344.173607266
Protein binding

The binding of arformoterol to human plasma proteins in vitro was 52-65% at concentrations of 0.25, 0.5 and 1.0 ng/mL of radiolabeled arformoterol.

Groups Approved, Investigational
Therapeutic Class
Manufacturer
Available Country United States,
Last Updated: September 19, 2023 at 7:00 am
Brovana
Brovana

Uses

Brovana tartrate is a salt of Brovana, the (R,R)-enantiomer of formoterol. Brovana is a selective beta 2-adrenergic bronchodilator. It has two-fold greater potency than racemic formoterol which contains both the (S,S) and (R,R)-enantiomers. The (S,S)-enantiomer is about 1,000-fold less potent as a beta2-agonist than the (R,R)-enantiomer. In vitro tests show that arformoterol is an inhibitor of the release of mast cell mediators, such as histamine and leukotrienes, from the human lung.

Brovana is also used to associated treatment for these conditions: Asthma, Chronic Obstructive Pulmonary Disease (COPD)

How Brovana works

While it is recognized that β2-receptors are the predominant adrenergic receptors in bronchial smooth muscle and β1-receptors are the predominant receptors in the heart, data indicate that there are also β2-receptors in the human heart comprising 10% to 50% of the total beta-adrenergic receptors. The precise function of these receptors has not been established, but they raise the possibility that even highly selective β2-agonists may have cardiac effects. The pharmacologic effects of β2-adrenoceptor agonist drugs, including arformoterol, are at least in part attributable to stimulation of intracellular adenyl cyclase, the enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3′,5′-adenosine monophosphate (cyclic AMP). Increased intracellular cyclic AMP levels cause relaxation of bronchial smooth muscle and inhibition of release of proinflammatory mediators from cells, especially from mast cells. In vitro tests show that arformoterol is an inhibitor of the release of mast cell mediators, such as histamine and leukotrienes, from the human lung. Brovana also inhibits histamine-induced plasma albumin extravasation in anesthetized guinea pigs and inhibits allergen-induced eosinophil influx in dogs with airway hyper-response.

Dosage

Brovana dosage

The recommended dose of Brovana nebuliser solution is one 15 mcg unit-dose ampoule administered twice daily (morning and evening) by nebulization. A total daily dose of greater than 30 mcg (15 mcg twice daily) is not recommended.Pediatric Use: COPD does not occur in children. The safety and efficacy of Brovana nebuliser solution in pediatric patients have not been established

Side Effects

Most common adverse reactions are pain, chest pain, back pain, diarrhea, sinusitis, leg cramps, dyspnea, rash, flu syndrome, peripheral edema and lung disorder. Brovana can cause serious side effects, including: People with asthma, who take LABA medicines, have an increased risk of death from asthma problems. Patient should get emergency medical care if:• Breathing problems worsen quickly• After the use of rescue inhaler medicine, it does not relieve breathing problems

Toxicity

A death was reported in dogs after a single oral dose of 5 mg/kg (approximately 4500 times the maximum recommended daily inhalation dose in adults on a mg/m2 basis). As with all inhaled sympathomimetic medications, cardiac arrest and even death may be associated with an overdose.

Precaution

Brovana nebuliser should not be initiated in acutely deteriorating patients. It should be used with caution in patients with cardiovascular or convulsive disorders, thyrotoxicosis, or with sensitivity to sympathomimetic drugs. Life-threatening paradoxical bronchospasm can occur.

Food Interaction

No interactions found.

Brovana Hypertension interaction

[Moderate] Adrenergic bronchodilators can stimulate cardiovascular beta- 1 and beta- 2 receptors, resulting in adverse effects such as tachycardia, palpitation, peripheral vasodilation, blood pressure changes, and ECG changes (e.g., flattening of the T wave; prolongation of the QT interval; ST segment depression).

Direct stimulation of cardiac tissues is mediated by beta- 1 receptors and thus less likely to occur with beta-2-selective agents such as albuterol.

However, beta-2-selectivity is not absolute and can be lost with larger doses.

High dosages of these agents have been associated with precipitation or aggravation of angina, myocardial ischemia, and cardiac arrhythmias.

Therapy with adrenergic bronchodilators should be administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, and

The recommended dosages should not be exceeded.

Half Life

In COPD patients given 15 mcg inhaled arformoterol twice a day for 14 days, the mean terminal half-life of arformoterol was 26 hours.

Clearance

  • renal cl=8.9 L/hr [Healthy male subjects]

Elimination Route

After administration of a single oral dose of radiolabeled arformoterol to eight healthy male subjects, 63% of the total radioactive dose was recovered in urine and 11% in feces within 48 hours. Direct glucuronidation of arformoterol is mediated by several UGT enzymes and is the primary elimination route.

Pregnancy & Breastfeeding use

Pregnancy Category C. Brovana nebuliser solution should be used during pregnancy, only if the potential benefit justifies the potential risk to the fetus. It is not known whether arformoterol is excreted in human milk.

Acute Overdose

As with all inhaled sympathomimetic medications, cardiac arrest and even death may be associated with an overdose of Brovana nebuliser solution.

Interaction with other Medicine

Other adrenergic drugs may potentiate effect. Xanthine derivatives, steroids, diuretics, or non-potassium sparing diuretics may potentiate hypokalemia or ECG changes. MAO inhibitors, tricyclic antidepressants and drugs that prolong the QTc interval may potentiate effect on the cardiovascular system. Beta-blockers may decrease effectiveness.

Storage Condition

Brovana nebuliser solution should be stored at 2-8°c, protected from light and excessive heat. Do not freeze. Keep out of the reach of children

Innovators Monograph

You find simplified version here Brovana

Brovana contains Arformoterol see full prescribing information from innovator Brovana Monograph, Brovana MSDS, Brovana FDA label

*** Taking medicines without doctor's advice can cause long-term problems.
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