fluticasone furoate + vilanterol trifenatate: clinical use

Prescribing considerations

• Confirm that combination treatment is appropriate and that the patient has a separate strategy for acute symptoms.
• Assess inhaler technique, adherence, symptom control and reliance on quick-acting bronchodilation.
• Use caution with severe cardiovascular disease, arrhythmias, thyrotoxicosis, uncorrected hypokalaemia, diabetes, pulmonary tuberculosis, chronic infection or hepatic impairment.
• Consider increased systemic corticosteroid exposure with hepatic impairment or strong CYP3A4 inhibition.
• The dry-powder device contains lactose; consider restrictions for rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.

Contraindications and cautions

• Hypersensitivity to fluticasone furoate, vilanterol trifenatate or an excipient.

Monitoring

• Asthma control, exacerbations and increased use of quick-acting reliever treatment
• Inhaler technique and mouth or throat candidiasis
• Immediate paradoxical bronchospasm
• Pneumonia symptoms
• Cardiovascular symptoms and potassium where clinically indicated
• Blood glucose in patients with diabetes
• Systemic corticosteroid effects when exposure may be increased
• New blurred vision or other visual disturbance

Clinical pharmacology

Fluticasone furoate is a synthetic inhaled corticosteroid and vilanterol is a selective long-acting beta₂-agonist. Both are mainly metabolised by CYP3A4. Low oral bioavailability limits exposure from swallowed medicine, while systemic exposure primarily follows pulmonary absorption.

Formulation and product differences

• Pre-dispensed dry powder in a light-grey Ellipta device with a yellow mouthpiece cover and dose counter.
• Excipients include lactose monohydrate and magnesium stearate.
• The selected presentation's indication is asthma and does not include COPD.

Inhaled preparation

Route: Inhaled

Strengths: 92 micrograms + 22 micrograms, 184 micrograms + 22 micrograms