Zenhale

[Ciel]

Has anyone else been prescribed the new combination inhaler Zenhale (formoterol/mometasone)? My respirologist has decided to try me on the Zenhale MDI 200/5 twice daily instead of the Advair diskus 250/50 to try and alleviate dry mouth and hoarseness as these side effects have been bothering me lately. I had been on that dose twice daily for about 2.5 years and achieved pretty good control with the Advair.

I'm curious to know if anyone else has switched to Zenhale or has researched the drug because one potential interaction listed on this page is "sympathomimetic medications (e.g., epinephrine)" and I am not sure what this means in relation to an emergency dose such as that which is contained in the EpiPen. I won't be able to speak to my pharmacist until Wednesday so I'm wondering if anyone here has any insight in the meantime. Thanks!

[CMdeux]

Formoterol is a long acting beta-agonist.

This means that it acts at beta receptors, just as epinephrine (adrenaline) does.  Adrenaline is effectively the natural beta-agonist.

I'm not sure that this amounts to "intereference" so much, and in an inhaled formulation, the impact on systemically administered medications is usually rather minimal.  Inhaled medications are basically "topically applied" to the lungs, if that makes sense.

You might be thinking about the more serious impact that beta blockade has on the ability of epinephrine to affect blood pressure during anaphylaxis. More about that interaction here.  Basically, beta blockers turn OFF the receptors, and occupy the on-switch.  Epinephrine needs access to the on-switch to turn them ON, which is how it works to reverse anaphylaxis.

Two different beta-agonists should, if anything, prove additive.  By all means discuss with your pharmacist, but I would definitely not hesitate to use it personally.  Have you used symbicort or something similar with formoderol in it before?

[Ciel]

That makes sense, thanks. I was on Symbicort for about a year and was fine, and I am currently on Nasonex which is also mometasone so it should be fine. I will probably ask the pharmacist when I pick it up but there is probably no need to worry in the meantime. Beta blockers were listed separately from epinephrine in that list, if that makes any difference.