umeclidinium bromide + vilanterol trifenatate: clinical use

Prescribing considerations

• Confirm COPD and suitability for maintenance LAMA/LABA therapy; this product is not licensed for asthma or acute bronchospasm.
• Assess ability to generate an effective inhalation through a dry-powder device and check technique regularly.
• Use caution with severe cardiovascular disease, urinary retention, narrow-angle glaucoma, thyrotoxicosis, convulsive disorders, diabetes, hypokalaemia or severe hepatic impairment.
• Review worsening symptoms or increasing reliance on short-acting bronchodilators.

Contraindications and cautions

• Hypersensitivity to either active substance or an excipient.
• The lactose-containing product should not be used in rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.

Monitoring

• Symptoms, exacerbations, reliever use, adherence and inhaler technique.
• Pulse and rhythm when clinically indicated, especially with cardiovascular disease or palpitations.
• Plasma glucose more closely after initiation in patients with diabetes.
• Potassium where other risk factors or potassium-lowering medicines are present.
• New ocular or urinary-retention symptoms.

Clinical pharmacology

An inhaled LAMA/LABA combination acting mainly within the airways. Umeclidinium competitively inhibits airway muscarinic receptors, particularly M3-mediated bronchoconstriction; vilanterol activates beta-2 receptors, increases cyclic AMP and relaxes bronchial smooth muscle.

Formulation and product differences

• The selected product is a pre-dispensed Ellipta dry-powder inhaler with separate blister strips for the active substances.
• It contains lactose monohydrate and magnesium stearate.
• Keep it protected from moisture in the sealed tray until first use, record the discard date after opening, and follow the product storage instructions.

Inhaled preparation

Route: Inhaled

Strengths: 55 micrograms + 22 micrograms