When Arformoterol Isn't Available, You Still Have Options

If you depend on Arformoterol to keep your COPD symptoms under control and suddenly can't fill your prescription, it's understandably stressful. Missing doses of a long-acting bronchodilator can lead to increased breathlessness, reduced activity tolerance, and even COPD flare-ups.

But you're not stuck. There are several effective alternatives to Arformoterol that your doctor can prescribe — some that work through a nebulizer just like Arformoterol, and others that use different delivery methods. Let's walk through your options.

What Is Arformoterol and How Does It Work?

Arformoterol (brand name Brovana) is a long-acting beta-2 adrenergic agonist (LABA). It works by relaxing the muscles around your airways, opening them up so you can breathe more easily. The effect lasts approximately 12 hours, which is why it's taken twice daily.

What makes Arformoterol unique is its delivery method: it comes as an inhalation solution that you breathe in through a nebulizer. This is especially helpful for patients who have trouble using handheld inhalers — including many older adults and people with severe COPD or arthritis.

Arformoterol is specifically the active (R,R)-enantiomer of Formoterol, designed to deliver more targeted bronchodilation. For a complete explanation of the science, see our article on how Arformoterol works.

Why Might You Need an Alternative?

There are several reasons you might need to switch from Arformoterol:

• Availability: Arformoterol is a niche medication, and not all pharmacies stock it. Read more about why Arformoterol is hard to find.
• Cost: Without insurance, Arformoterol can cost $456 to over $1,000 per month.
• Insurance requirements: Some plans require step therapy — trying a different LABA before they'll cover Arformoterol.
• Side effects: If you're experiencing side effects from Arformoterol, your doctor may recommend a different medication.

Alternative 1: Formoterol (Perforomist) — Nebulized LABA

Perforomist (Formoterol Fumarate Inhalation Solution) is the closest alternative to Arformoterol because it's also a nebulized LABA. In fact, Arformoterol is the purified active enantiomer of Formoterol, so these two medications are closely related.

Key facts about Perforomist:

• Dose: 20 mcg via nebulizer, twice daily
• How it works: Same mechanism — relaxes bronchial smooth muscle through beta-2 receptor stimulation
• Delivery: Nebulizer solution, similar to Arformoterol
• Effectiveness: Clinical studies show significant improvements in FEV1 (a measure of lung function), breathlessness, and COPD exacerbation rates
• Best for: Patients who need to stay on a nebulized medication and can't use handheld inhalers

If your main reason for being on Arformoterol is the nebulizer delivery, Perforomist is likely your doctor's first choice as a substitute.

Alternative 2: Salmeterol (Serevent Diskus) — Dry Powder Inhaler LABA

Serevent Diskus (Salmeterol Xinafoate) is another long-acting beta-2 agonist, but it comes as a dry powder inhaler (DPI) rather than a nebulizer solution.

Key facts about Serevent Diskus:

• Dose: 50 mcg inhaled twice daily
• Delivery: Dry powder inhaler — requires a strong enough breath to activate
• Onset: Slower onset of action compared to Arformoterol and Formoterol (about 30–45 minutes)
• Best for: Patients who can generate adequate inspiratory flow and are comfortable with inhaler devices
• Consideration: Not ideal for patients with very severe COPD or those who struggle with inhaler technique

Salmeterol is widely available and often less expensive than nebulized LABAs. Generic versions are available, making it a cost-effective option.

Alternative 3: Olodaterol (Striverdi Respimat) — Soft Mist Inhaler LABA

Striverdi Respimat (Olodaterol) is a newer once-daily LABA that uses a soft mist inhaler. The soft mist technology creates a slow-moving aerosol that's easier to inhale than a traditional metered-dose inhaler.

Key facts about Striverdi Respimat:

• Dose: 5 mcg (two puffs of 2.5 mcg) once daily
• Delivery: Soft mist inhaler — doesn't require strong inspiratory effort
• Advantage: Once-daily dosing instead of twice daily
• Best for: Patients who want the convenience of once-daily dosing and can use an inhaler but struggle with DPIs

Olodaterol is also available in combination with Tiotropium (a long-acting muscarinic antagonist) as Stiolto Respimat, which can provide dual bronchodilation in a single inhaler.

Alternative 4: Indacaterol (Arcapta Neohaler) — Dry Powder Inhaler LABA

Arcapta Neohaler (Indacaterol Maleate) is another once-daily LABA option delivered via dry powder inhaler.

Key facts about Arcapta Neohaler:

• Dose: 75 mcg inhaled once daily
• Delivery: Dry powder capsule inhaler
• Onset: Rapid onset of action (within 5 minutes), similar to Formoterol
• Best for: Patients who want once-daily LABA therapy with a fast onset and can use a DPI device

How to Decide Which Alternative Is Right for You

The best alternative depends on your specific situation:

• Need a nebulizer? Perforomist (Formoterol) is your closest match.
• Can use an inhaler and want once-daily dosing? Olodaterol (Striverdi Respimat) or Indacaterol (Arcapta Neohaler).
• Cost is a concern? Generic Salmeterol is often the most affordable LABA option.
• Want combination therapy? Ask your doctor about LABA/LAMA combos like Stiolto Respimat (Olodaterol/Tiotropium).

Important: Never switch COPD medications on your own. Always talk to your doctor or pulmonologist before making any changes. They can evaluate your lung function, inhaler technique, and insurance coverage to find the best fit. Need help finding a prescriber? See our guide on how to find a doctor who can prescribe Arformoterol.

Final Thoughts

Not being able to fill your Arformoterol prescription is frustrating, but it doesn't mean you have to go without effective COPD treatment. From nebulized Formoterol (Perforomist) to once-daily inhaler options like Olodaterol and Indacaterol, there are real alternatives that can keep your airways open and your symptoms managed.

Before switching, try using Medfinder to see if Arformoterol is available at a pharmacy near you. If it's truly unavailable, your doctor can help you find the right substitute for your needs.