Perforomist Drug Interactions: What to Avoid and What to Tell Your Doctor

Perforomist (formoterol fumarate inhalation solution) is generally safe when used as prescribed, but it has several important drug interactions that every patient and caregiver should know. Some interactions can increase the risk of serious cardiovascular effects — so always give your doctor and pharmacist a complete list of every medication, supplement, and over-the-counter product you take.

Critical Interactions: Use With Extreme Caution or Avoid

MAO Inhibitors (MAOIs)

MAO inhibitors — used for depression and Parkinson's disease — can dramatically potentiate the cardiovascular effects of formoterol, including dangerous increases in heart rate and blood pressure. Examples include phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and rasagiline (Azilect).

What to do: Tell your doctor if you take or recently stopped an MAOI. There should typically be at least a 14-day washout period between MAOIs and formoterol.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants such as amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor), and doxepin interact with formoterol in two ways: they can potentiate the heart rate and blood pressure effects, and both drugs prolong the QTc interval (a measure of electrical activity in the heart), increasing the risk of dangerous arrhythmias (irregular heartbeats).

What to do: Use with extreme caution. Your doctor may order an EKG to monitor your QTc interval.

Other QTc-Prolonging Medications

Any medication that prolongs the QTc interval should be used with caution alongside Perforomist. This is a large category that includes:

• Antiarrhythmic medications (amiodarone, sotalol, quinidine)
• Certain antibiotics (azithromycin, clarithromycin, fluoroquinolones like ciprofloxacin)
• Antipsychotic medications (haloperidol, ziprasidone, clozapine)
• Methadone
• Cisapride, droperidol, pentamidine

What to do: Always inform all prescribers about Perforomist. EKG monitoring may be warranted when starting any new QTc-prolonging drug.

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Beta-Blockers — Opposing Effects

Beta-adrenergic receptor antagonists (beta-blockers) — used for heart disease, high blood pressure, and other conditions — work in the opposite way to Perforomist. They block beta receptors, which directly counteracts formoterol's bronchodilating effect and can even cause severe bronchospasm in COPD patients.

Examples include metoprolol, atenolol, propranolol, carvedilol, and bisoprolol.

What to do: Patients with COPD should not normally take non-selective beta-blockers. If a beta-blocker is medically necessary (e.g., after a heart attack), your cardiologist and pulmonologist should coordinate care. Cardioselective beta-blockers (metoprolol, bisoprolol) may be used with caution.

Diuretics (Water Pills) — Hypokalemia Risk

Formoterol can lower potassium levels (hypokalemia) by causing potassium to shift into cells. Non-potassium-sparing diuretics (furosemide, hydrochlorothiazide, chlorthalidone) also lower potassium. Used together, they can compound the risk of dangerously low potassium, which can cause irregular heartbeat, muscle weakness, and other problems.

What to do: Your doctor may monitor your potassium levels if you take both Perforomist and diuretics.

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Other LABAs — Do Not Combine

Never use Perforomist with another long-acting beta-agonist (arformoterol/Brovana, salmeterol/Serevent, olodaterol/Striverdi, indacaterol/Arcapta, or vilanterol). Combining two LABAs provides no additional benefit and significantly increases the risk of cardiovascular side effects and toxicity.

Stimulants, Caffeine, Decongestants

Sympathomimetic agents — including stimulants (amphetamines), decongestants (pseudoephedrine, phenylephrine), and high doses of caffeine — can add to formoterol's cardiovascular stimulant effects. Avoid excessive caffeine and check all cold medicines and decongestants for sympathomimetic ingredients.

What to Tell Your Doctor and Pharmacist

Always bring a complete, current medication list to every appointment — including:

• All prescription medications
• Over-the-counter medications (cold medicine, allergy meds, antacids, pain relievers)
• Vitamins and supplements
• Herbal products (ginseng, ephedra, and Ma Huang can interact with LABAs)

Also see:

Perforomist side effects and

what Perforomist is used for.