indacaterol maleate: clinical use

Prescribing considerations

• Confirm COPD and explain that this is maintenance rather than rescue treatment.
• Assess whether the patient can load the capsule and inhale quickly and deeply through the device.
• Use caution with cardiovascular disease, arrhythmias, hypertension, QT prolongation, thyrotoxicosis, seizure disorders or unusual beta-2 agonist sensitivity.
• Review treatment if symptoms deteriorate or rescue-medicine use increases.
• Clinical data are lacking in severe hepatic impairment.

Contraindications and cautions

• Hypersensitivity to indacaterol or any excipient.
• Do not use this LABA-only product to treat asthma.
• The lactose-containing formulation should not be used with rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.

Monitoring

• Check inhaler technique and adherence, including whether capsules are mistakenly swallowed.
• Monitor COPD symptoms, exercise limitation, exacerbations and reliance on rescue treatment.
• Assess pulse, blood pressure and cardiac symptoms when clinically indicated.
• Monitor plasma glucose more closely after initiation in people with diabetes.
• Consider serum potassium monitoring with hypoxia, severe COPD or interacting hypokalaemic treatment.

Clinical pharmacology

Indacaterol is a selective, long-acting beta-2 adrenoceptor partial agonist. Bronchial receptor activation increases cyclic AMP and produces sustained airway relaxation. Clearance involves CYP3A4 and P-glycoprotein; exposure increases seen in interaction studies were not considered clinically concerning.

Formulation and product differences

• The products are lactose-containing inhalation-powder hard capsules used with a single-dose Breezhaler.
• Capsules have differently coloured printed markings and must never be swallowed.
• The device supplied with each new prescription replaces the previous inhaler and must be kept dry.

Capsule

Route: Oral

Strengths: 300 micrograms