glycopyrronium + indacaterol acetate + mometasone: clinical use

Prescribing considerations

• Confirm that the patient meets the adult asthma indication, including inadequate control on combination inhaled treatment and a recent exacerbation.
• Assess adherence, inhaler technique, asthma control, reliever use and modifiable triggers.
• Do not use for acute symptoms; ensure an appropriate written asthma action plan and reliever strategy.
• Avoid abrupt unsupervised withdrawal because symptoms may recur.
• Use caution with cardiovascular disease, arrhythmia or QT prolongation, thyrotoxicosis, seizure disorders, diabetes, hypokalaemia, narrow-angle glaucoma, urinary retention, severe renal impairment, pulmonary tuberculosis or chronic untreated infection.

Contraindications and cautions

• Hypersensitivity to indacaterol, glycopyrronium, mometasone furoate or any excipient.
• The lactose-containing formulation should not be used in rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.

Monitoring

• Review symptoms, exacerbations, reliever use, adherence and device technique.
• Monitor plasma glucose more closely after initiation in patients with diabetes.
• Consider potassium and cardiovascular assessment where severe asthma, hypoxia, cardiac disease or interacting treatment increases risk.
• Ask about palpitations, urinary retention, eye pain or visual disturbance.
• Check for oral candidiasis, dysphonia and other local corticosteroid effects; remain alert to systemic corticosteroid effects during prolonged exposure.

Clinical pharmacology

Indacaterol is a LABA that promotes cAMP-mediated bronchial smooth-muscle relaxation; glycopyrronium is a LAMA that inhibits muscarinic bronchoconstriction; mometasone is an inhaled glucocorticoid that suppresses airway inflammation. Systemic exposure after correct inhalation is limited, particularly for mometasone.

Formulation and product differences

• The product is an inhalation powder in hard capsules, not an oral capsule.
• Use capsules only with the Breezhaler supplied with the pack.
• The formulation contains lactose and must be protected from moisture until use.