Special Announcement

• Currently use nebulizer therapy and would benefit from the addition of a nebulized long-acting bronchodilator†
• Are not adequately controlled and who overuse short-acting beta-agonists†
• Prefer nebulized treatments
• Are candidates for initiating nebulizer therapy
• Those who have progressed to moderate severity level or above
• Those who have trouble using metered-dose or dry-powder inhalers

†BROVANA should not be used in conjunction with other inhaled long-acting beta₂-agonists or with other medications containing long-acting beta₂-agonists.  Patients who have been taking inhaled short-acting beta₂-agonists on a regular basis should be instructed to discontinue their regular use and to use them only for symptomatic relief of acute respiratory symptoms.

• Brovana™ (arformoterol tartrate) Inhalation Solution is indicated for the long term, twice daily (morning and evening) maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.  BROVANA is for use by nebulization only.

• BROVANA provided rapid onset¹ of bronchodilation
• Median time to onset was 6.7 minutes when defined as a 15% increase in FEV₁, and 20 minutes when defined as a 12% and 200 mL increase in FEV₁ after the first dose.  Peak bronchodilator effect was generally seen within 1 to 3 hours of dosing¹
• BROVANA is not indicated for the treatment of acute episodes of bronchospasm
• BROVANA provided sustained bronchodilation over the 12-hour dosing interval throughout the 12-week study period¹
• BROVANA decreased the use of rescue albuterol and supplemental ipratropium bromide vs placebo¹
• BROVANA 15 mcg was well tolerated¹
• The percentages of patients who reported adverse events were comparable in the BROVANA 15 mcg BID and placebo groups 
• BROVANA, like other beta₂-agonists, can produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, blood pressure, and/or symptoms
• BROVANA (15 mcg/2 mL) provides twice-daily dosing by jet nebulizer

¹BROVANA prescribing information

Important Safety Information:

Long acting beta2- adrenergic agonists may increase the risk of asthma-related death. Data from a large placebo-controlled US study that compared the safety of another long-acting beta2- adrenergic agonist (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma related deaths in patients receiving salmeterol. This finding with salmeterol may apply to arfomoterol (a long-acting beta-adrenergic agonist), the active ingredient in BROVANA.

• BROVANA should not be used in conjunction with other inhaled, long-acting beta₂-agonists.  BROVANA should not be used with other medications containing long-acting beta₂-agonists.
• As with other inhaled beta₂-agonists, BROVANA can produce paradoxical bronchospasm occurs, BROVANA should be discontinued immediately and alternative therapy instituted.
• BROVANA should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension; in patients with conclusive disorders or thyrotoxicosis; and in patients who are unusually responsive to sympathomimetic amines.
• BROVANA, as with other beta-agonists, should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors, tricyclic antidepressants, or drugs known to prolong the QTc interval because the action of adrenergic agonists on the cardiovascular system may be potentiated by these agents.
• Overall efficacy of BROVANA was maintained throughout the 12-week trial duration.  Some tolerance to the bronchodilator effect of BROVANA was observed after 6 weeks of dosing (at the end of the dosing interval), although the FEV₁ improvement remained statistically significant.  This was not accompanied by other clinical manifestations of tolerance.
• The most common adverse events reported in patients taking BROVANA, and occuring more frequently than in patients taking placebo, were pain (8% vs 5%), chest pain (7% vs 6%), back pain (6% vs 2%), diarrhea (6% vs 4%), and sinusitis (5% vs 4%).

• 15 mcg twice daily by jet nebulizer. Brovana 15mcg/2mL can be nebulized in only 5-10 minutes.

• Store BROVANA in the protective foil pouch under refrigeration at 36°-46°F (2°-8°C).  Protect from light and excessive heat.  Once the foil pouch is opened, the contents of the vial should be used immediately.  Discard any vial if the solution is not colorless.  Unopened foil pouches of BROVANA can also be stored at room temperature 68°-77°F, (20°-25°C) for up to 6 weeks. If stored at room temperature, discard if not used after 6 weeks or if past the expiration date, whichever is sooner.

• 63402-911-30

Wholesale Acquisition Cost:

• $4.61 per vial

• 30 unit-dose individually pouched vials

• Company	Item
  AmeriSourceBergen Corp.	752586
  Bellco Drug Corp.	220071
  Cardinal Health Corp.	3950227
  DIK Drug Company	286955
  FW Kerr Company	O83824
  Harvard Drug- Livonia	743000
  HD Smith Company	2047611
  King Drug	169680
  Kinray Inc.	O96149
  McKesson Corp	116270
  McQueary Brothers Inc.	746746
  Miami Luken Inc.	69005
  Morris & Dickson	727693
  NC Mutual Wholesale Drug Company	601542
  Pharmacy Buying Association	63402091130
  Prescription Supply	413294
  QK Healthcare	78768
  Rochester Drug	10149144
  Valley Wholesale Drug Company	359547
  Value Drug Company	591628

Click here to see complete BROVANA Prescribing Information including Boxed Warning