Dr changed inhaler again

[Ferry1973]

I have had my asthma medication changed again.i have now been prescribed fostair NEXThaler 200/6. 2 puffs twice a day. I am having a lot of palpitations and heart flutters since I started this. Has anyone else having side effects to this inhaler?

[elanaoali]

Hi Ferry1973 I am on the same inhaler and strength for the last 4 years. I haven't had these side effects but get the shakes in my hands after taking it. My I asked how long have been taking this new inhaler? The side effects can be temporary so I would talk to your doctors or ring asthma + Lung uk helpline. Speak to one of our helpline team on 0300 222 5800 (Monday to Friday, 9am to 5pm)

Or message us on WhatsApp

[emmmzy73 in reply to elanaoali]

Hi. I did ! It went away after about 2 weeks though. X

[Ferry1973 in reply to elanaoali]

Hi elanaoali.thanks for your reply. I was prescribed fostair next on the 02march.It does help with my asthma all the wheezing and short of breath has stopped.

[elanaoali]

I glad it has improved your asthma. Please contact your doctors if you still getting these symptoms.

[Lizziep25]

Hi Ferry1973I was prescribed this inhaler last summer and suffered palpitations I would recommend that you contact your GP immediately this combination inhaler is well known for causing heart arrhythmia especially if it is given with Montelukast I ended up having a holter monitor (portable ecg) and heart investigations which resulted in having a pacemaker fitted. I had no heart symptoms whatsoever before the Fostair inhaler, Fostair caused my lungs to fill with mucous gave me an awful cough, nausea and extreme vomiting which caused a heart block my heart paused for 10.93 seconds.

I wish GPS read the drug information and drug interactions before they prescribe, Fostair nexthaler contains formoterol which is what causes the palpitations I too was told they would settle down but they didn’t they got worse and it took ages after I stopped the inhaler for the side effects to disappear can you afford to risk heart problems see your GP.

[Lysistrata Administrator Community Ambassador in reply to Lizziep25]

I'm very sorry you experienced this, and agree that it's safest for Ferry1973 to check with their GP about palpitations (and anyone else struggling with significant and/or long-lasting side effects).

However, I wanted to say that plenty of people (including me) take Fostair even on the highest dose and don't end up with heart block or needing a pacemaker. I'm saying this as a counterbalance as people reading may be very alarmed and worried about this. Fostair can cause cardiac problems and I'm not disputing your experience, but they are not common or universal.

I'm also wondering about the source for what you said about montelukast increasing the risk of cardiac problems if taken alongside Fostair? The official information that your GP would use is in the drug's summary of product characteristics (the official label for the drug written for healthcare professionals), or the BNF (British National Formulary, the NICE guide to medications that doctors use in the UK). There is nothing there for either Fostair or montelukast saying that there is an increased risk of cardiac problems when taken together. Montelukast can potentially cause palpitations, but this is rare; cardiac problems can be part of Churg-Strauss syndrome alongside other signs and symptoms, but that is extremely rare.

Both drugs have been around for a while so I would imagine any problems from combining them would have been observed by now, as they're often taken together. If it's something your cardiologist has observed then hopefully they've reported it as needed.

To anyone else reading who is worried by this - please don't stop your inhalers 'just in case' if you're worried about potential heart problems - that is dangerous in itself for your asthma. (And since we're talking about hearts, a severe asthma attack can cause significant tachycardia in itself, as your heart has to work harder when you're struggling to breathe).

As above, do ask for advice if you're concerned, from your GP or other doctor, or you can talk to the Asthma UK nurses on 0300 222 5800 M-F 9-5 (WhatsApp - 07378 606728).

[Lizziep25 in reply to Lysistrata]

The information regarding arrhythmia is actually in the patient leaflets with Fostair and montelukast under side effects which patients should read. In the BNF the side effects of Beta2 agonists are clearly described including palpitations, tachycardia, arrhythmias and hypotension amongst others. The BNF states prescribers should be aware of cardiac complications regarding Montelukast. So check your facts thoroughly before commenting.

[Lysistrata Administrator Community Ambassador in reply to Lizziep25]

The patient leaflets are the patient-friendly version of the summary of product characteristics (SPC) - it's mostly the same information, presented differently and with more detail for healthcare professionals (and I've just looked at the patient leaflets too).

I haven't actually disagreed at any point that beta-agonists such as formoterol can cause palpitations and other cardiac problems - as you say, they're in the patient leaflets, SPC and BNF. I specifically acknowledged that you can get those effects, but as I said, they're not inevitable, and your experience and level of severity is not one that people taking these medications are especially likely to have. Again, I'm not disputing *your* experience here nor the fact that cardiac problems can occur. I'm just putting it into context for people taking these drugs who may have been worried reading what you said.

I have checked again and I agree it does say and I should have included that cardiac problems (palpitations) are possible but rare with montelukast alone. I have amended my previous response to say this. I've also amended my response to say more clearly that the BNF and the product labels do not mention an increased risk of cardiac complications from combining montelukast with Fostair (I do think the wording may have been unclear there that I was talking about the combination of the two increasing the risk of cardiac complications).

The fact that two drugs may both have some similar potential side effects does not automatically mean those side effects will be worse or you're at higher risk if they're taken together. The BNF general interactions page says: Two or more drugs given at the same time can exert their effects independently or they can interact...Many interactions are harmless, and even those that are potentially harmful can often be managed, allowing the drugs to be used safely together.

The SPC (the one aimed at your GP) for montelukast has a section on drug interactions, which specifically says montelukast can be taken alongside other asthma medications (the Fostair SPC interactions section doesn't mention montelukast at all). The patient leaflet lists some medications that you should mention to your doctor before taking montelukast - none of them is even an asthma medication. The patient leaflet for Fostair does mention 'other asthma medications' in the list of medications to mention to your doctor, but doesn't specifically mention montelukast. The BNF has a section on interactions for each drug - the page for montelukast doesn't mention anything about interaction with formoterol and the page for formoterol doesn't mention montelukast.

In terms of the BNF saying prescribers should be aware of cardiac complications with montelukast, do you mean this statement?

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) has occurred very rarely in association with the use of montelukast; in many of the reported cases the reaction followed the reduction or withdrawal of oral corticosteroid therapy. Prescribers should be alert to the development of eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy.

This does mention being alert to cardiac complications, but it's in the context of symptoms of a very rare syndrome which *may* be related to montelukast (the SPC mentions this too, but also says it isn't currently clear if it's actually related to montelukast or not).

Of course healthcare professionals should be alert to the possibility of serious side effects, but that's not the same as saying that they should avoid prescribing montelukast and Fostair together due to an increased risk of cardiac complications, or that cardiac complications like those you experienced are a common risk with montelukast.

[Ferry1973 in reply to Lizziep25]

Hi lizziep25. Thank you for your reply.I have just rang the doctors surgery and spoken to the receptionist to tell the doctor about the side effects I am having.and to ask for a different preventer inhaler.

[Speedbuggy]

Hello Ferry1973, I was put on fostair too and had the irregular heart while on it so I had to stop (I had a heart attack dec 2021) . My gp said there was nothing else I could try. Did the Dr try you on something different?

[Ferry1973 in reply to Speedbuggy]

Hi Speedbuggy. I had a conversation with my GP about all the different types of inhalers for treating asthma, and i also did quite a bit of my own research on the side effects of them.i am now using Clenil modulite100micrograms,2puffs twice a day and this is controlling my asthma very well.clenil is safer to use .I think you need to go back to your GP and discuss an alternative to fostair.Also you can ring Asthma UK and speak to one of the asthma nurses,they can answer all your questions and give you some good advice.Sorry ,I also take ventolin inhaler when needed.Good luck! Hope you can get it all sorted.

[Speedbuggy]

Thank you, I will make a note of that and go back to my gp