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Bevespi Aerosphere
glycopyrrolate/ formoterol inhaled
Adult Dosing .
Dosage forms: MDI: 9 mcg/4.8 mcg per actuation
COPD, maintenance tx
- [2 puffs inhaled bid]
- Max: 36 mcg/19.2 mcg/day; search 'gold' for epocrates COPD GOLD decision tools
renal dosing
- [see below]
- renal impairment: not defined; Info: caution advised if CrCl <30
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- asthma use
- COPD, acute deteriorating
- bronchospasm, acute
- caution: MAO inhibitor use within 14 days
- caution: TCA use within 14 days
- caution: electrolyte abnormalities
- caution: long QT syndrome, congenital
- caution: QT prolongation
- caution: QT prolongation family history
- caution: torsades de pointes history
- caution: arrhythmia
- caution: bradycardia
- caution: MI, recent
- caution: CHF
- caution: cardiovascular disease
- caution: patients unusually responsive to sympathomimetic amines
- caution: diabetes mellitus
- caution: seizure disorder
- caution: hyperthyroidism
- caution: labor and delivery
- caution: glaucoma, angle-closure
- caution: CrCl <30
- caution: urinary retention risk
- caution: prostatic hypertrophy
- caution: bladder neck obstruction
- caution: hepatic impairment
Drug Interactions .
Overview
formoterol inhaled
beta-2 agonist
- hypertensive effects
- hypokalemia
- prolongs QT interval (conditional)
- tachycardia
glycopyrrolate inhaled
anticholinergic inhaled
- anticholinergic effects
Contraindicated
- pimozide
- thioridazine
Avoid/Use Alternative
- aclidinium inhaled
- albuterol
- amantadine
- arformoterol inhaled
- arsenic trioxide
- atropine ophthalmic
- bedaquiline
- botulinum toxin
- carvedilol
- chlophedianol
- chlorcyclizine
- clozapine
- cocaine
- crizotinib
- cyclopentolate ophthalmic
- darifenacin
- desipramine
- dexbrompheniramine
- dexchlorpheniramine
- domperidone
- doxepin topical
- dronabinol
- dronedarone
- ephedra
- epinephrine
- epinephrine inhaled
- fesoterodine
- fexinidazole
- fluphenazine
- formoterol inhaled
- fosfomycin injection
- furosemide
- glucagon
- glycopyrrolate
- glycopyrronium topical
- hydroxychloroquine
- ipratropium nasal
- labetalol
- landiolol
- lefamulin
- lonafarnib
- midodrine
- mobocertinib
- molindone
- nadolol
- nebivolol
- olanzapine
- olodaterol inhaled
- oxybutynin
- phenelzine
- pindolol
- pramlintide
- propranolol
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quizartinib
- revefenacin inhaled
- rivastigmine
- salmeterol inhaled
- sofpironium topical
- sotalol
- thiothixene
- timolol
- tolterodine
- toremifene
- trihexyphenidyl
- tropicamide ophthalmic
- trospium
- vandetanib
- vilanterol inhaled
- ziprasidone
Monitor/Modify Tx
- abiraterone acetate
- acebutolol
- acetazolamide
- adagrasib
- albuterol inhaled
- aliskiren
- almotriptan
- aloe
- amiloride
- aminophylline
- amiodarone
- amitriptyline
- amlodipine
- amoxapine
- amphetamine
- amphotericin
- anagrelide
- angiotensin II
- apalutamide
- apomorphine
- aprocitentan
- armodafinil
- artemether/lumefantrine
- asciminib
- asenapine
- asparaginase
- atenolol
- atogepant
- atomoxetine
- atropine
- axitinib
- azilsartan medoxomil
- azithromycin
- benazepril
- benzphetamine
- benztropine
- betamethasone
- betaxolol
- bevacizumab
- bismuth subsalicylate
- bisoprolol
- brigatinib
- budesonide
- bumetanide
- bupropion
- cabozantinib
- caffeine
- caffeine citrate
- candesartan cilexetil
- cannabis
- captopril
- carfilzomib
- celecoxib
- ceritinib
- cetuximab
- chloroquine
- chlorothiazide
- chlorthalidone
- cisplatin
- citalopram
- clarithromycin
- clevidipine
- clofazimine
- clomipramine
- clonidine
- copanlisib
- corticotropin
- cortisone
- cyclosporine
- danazol
- darbepoetin alfa
- decitabine
- deflazacort
- degarelix
- desflurane
- desmopressin
- desvenlafaxine
- dexamethasone
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- diclofenac
- diclofenac topical
- dicyclomine
- diethylpropion
- diflunisal
- digoxin
- dihydroergotamine
- diltiazem
- dinutuximab
- disopyramide
- dobutamine
- dofetilide
- donepezil
- dopamine
- dordaviprone
- doxapram
- doxazosin
- doxepin
- droperidol
- droxidopa
- eletriptan
- emapalumab
- enalapril
- enalaprilat
- encorafenib
- ephedrine injection
- ephedrine oral
- epirubicin
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ergotamine
- eribulin
- erythromycin
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethanol (alcoholic beverage)
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fingolimod
- flecainide
- fludrocortisone
- fluorouracil
- flurbiprofen
- foscarnet
- fosinopril
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galcanezumab
- gilteritinib
- glasdegib
- goserelin
- guanfacine
- haloperidol
- histrelin
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydroxocobalamin IV
- hydroxyzine
- hyoscyamine
- ibrutinib
- ibuprofen
- ibutilide
- imipramine
- indapamide
- indomethacin
- inotuzumab ozogamicin
- insulin
- irbesartan
- isocarboxazid
- isoflurane
- isoproterenol
- isradipine
- ivosidenib
- ketamine
- ketoprofen
- ketorolac
- lanreotide
- leflunomide
- lenalidomide
- lenvatinib
- leuprolide
- levalbuterol inhaled
- levofloxacin
- levoketoconazole
- levomilnacipran
- levothyroxine
- licorice
- lifileucel
- linezolid
- liothyronine
- liraglutide
- lisdexamfetamine
- lisinopril
- lofexidine
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- macimorelin
- magnesium citrate
- magnesium salicylate
- mannitol
- meclofenamate
- mefenamic acid
- meloxicam
- methacholine inhaled
- methadone
- methamphetamine
- methazolamide
- methoxy polyethylene glycol-epoetin beta
- methscopolamine
- methyldopa
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- metoprolol
- mifepristone
- milnacipran
- minoxidil
- mirabegron
- modafinil
- moexipril
- motixafortide
- moxifloxacin
- nabumetone
- naproxen
- naratriptan
- naxitamab
- necitumumab
- nicardipine
- nicotine
- nifedipine
- nilotinib
- nimodipine
- niraparib
- nisoldipine
- norepinephrine
- nortriptyline
- obinutuzumab
- oliceridine
- olmesartan medoxomil
- ondansetron
- orphenadrine
- osilodrostat
- osimertinib
- oxaprozin
- oxymetazoline nasal
- oxytocin
- ozanimod
- pacritinib
- paliperidone
- palonosetron
- pamidronate
- panitumumab
- pasireotide
- pazopanib
- pentamidine
- perindopril
- pexidartinib
- phendimetrazine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- piroxicam
- polyethylene glycol
- polyethylene glycol/electrolytes
- ponatinib
- ponesimod
- posaconazole
- pralsetinib
- prazosin
- prednisolone
- prednisone
- procainamide
- procarbazine
- propafenone
- protriptyline
- pseudoephedrine
- quetiapine
- quinapril
- quinine
- ramipril
- ramucirumab
- rasagiline
- regorafenib
- revumenib
- ribociclib
- rimegepant
- ripretinib
- rizatriptan
- romidepsin
- ropinirole
- rotigotine transdermal
- rucaparib
- sacituzumab govitecan
- safinamide
- salsalate
- selegiline
- selegiline transdermal
- selinexor
- selpercatinib
- sevoflurane
- siponimod
- sirolimus albumin-bound
- sodium benzoate
- sodium phenylacetate
- sodium phenylbutyrate
- sodium polystyrene sulfonate
- sodium thiosulfate
- solriamfetol
- sorafenib
- spironolactone
- sulfate bowel prep
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tafasitamab
- tagraxofusp
- taletrectinib
- telavancin
- telmisartan
- terazosin
- terbutaline
- teriflunomide
- testosterone
- tetrabenazine
- theophylline
- thyroid
- tivozanib
- tolmetin
- topiramate
- torsemide
- tramadol
- trametinib
- trandolapril
- tranylcypromine
- triamcinolone
- triamterene
- triclabendazole
- trifluridine
- trimipramine
- triptorelin
- ubrogepant
- vadadustat
- valsartan
- vamorolone
- vasopressin
- vemurafenib
- venlafaxine
- verapamil
- viloxazine
- voclosporin
- yohimbe
- zavegepant
- ziftomenib
- ziv-aflibercept
- zolmitriptan
- zonisamide
Caution Advised
- aceclidine ophthalmic
- alfentanil
- alosetron
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- belladonna alkaloids
- bethanechol
- brexpiprazole
- brompheniramine
- buprenorphine
- butorphanol
- carbinoxamine
- cariprazine
- cevimeline
- chlorpheniramine
- chlorpromazine
- clemastine
- clidinium
- codeine
- cyclobenzaprine
- cyproheptadine
- difenoxin
- dihydrocodeine
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- doxylamine
- fentanyl
- flavoxate
- galantamine
- gepotidacin
- homatropine
- hydrocodone
- hydromorphone
- iloperidone
- ipratropium inhaled
- levorphanol
- loperamide
- loxapine
- lumateperone
- lurasidone
- meclizine
- meperidine
- milsaperidone
- mirtazapine
- morphine
- nalbuphine
- neostigmine
- oxycodone
- oxymorphone
- pentazocine
- perphenazine
- pheniramine
- pilocarpine
- pilocarpine ophthalmic
- prochlorperazine
- promethazine
- pyridostigmine
- pyrilamine
- remifentanil
- risperidone
- scopolamine
- solifenacin
- sufentanil
- tapentadol
- tiotropium inhaled
- trifluoperazine
- triprolidine
- umeclidinium inhaled
- vibegron
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- death, asthma-related (tx without concurrent inhaled corticosteroid)
- bronchospasm, paradoxical
- COPD exacerbation
- glaucoma, acute angle-closure
- HTN
- angina
- atrial fibrillation
- arrhythmia
- hypokalemia
- hyperglycemia
Common Reactions
- cough
- UTI
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Pregnancy/Lactation .
Pregnancy
Clinical Summary
glycopyrrolate inhaled: weigh risk/benefit during pregnancy; no human data available, though risk of fetal harm not expected based on limited human data with oral form; no known risk of teratogenicity based on animal data at 270x MRHD
formoterol inhaled: weigh risk/benefit during pregnancy, especially during labor and delivery; inadequate human data available; risk of fetal harm low, though possible risk of delayed ossification based on animal data at 50x MRHD; risk of interference with uterine contractility based on drug's mechanism of action
Lactation
Clinical Summary
glycopyrrolate inhaled: may use while breastfeeding; no human data available, though risk of infant harm not expected based on minimal systemic absorption in breastfeeding patients and drug properties; no human data available to assess effects on milk production
formoterol inhaled: may use while breastfeeding; no human data available, though risk of infant harm not expected based on minimal systemic absorption in breastfeeding patients; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for glycopyrrolate: unknown; CYP450: 2D6 substrate; for formoterol: liver extensively; CYP450: A26, 2C9/19, 2D6 substrate; UGT: 1A1, 1A8, 1A9, 2B7, 2B15 substrate; Info: minimal systemic absorption
Excretion: for glycopyrrolate: urine 85%, bile; Half-life: 11.8h; for formoterol: urine 62%, feces 24%; Half-life: 11.8h
Subclass: Beta-2 Agonists, Inhaled Long-Acting (LABAs) ; Muscarinic Antagonists, Inhaled Long-Acting (LAMAs)
Mechanism of Action
for glycopyrrolate: antagonizes acetylcholine receptors, producing bronchodilation; for formoterol: selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle
Formulary .
No Formulary Selected
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