umeclidinium bromide: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
umeclidinium bromide: clinical details
Prescribing considerations
- Confirm that treatment is for maintenance of adult COPD symptoms, not asthma or acute bronchospasm.
- Check inhaler technique, inspiratory ability, adherence and understanding of the dose counter.
- Review promptly if symptoms deteriorate or use of a short-acting bronchodilator increases.
- Use caution with severe cardiovascular disease, particularly cardiac arrhythmias; narrow-angle glaucoma; urinary retention; or severe hepatic impairment.
- Consider the lactose-containing dry-powder formulation in patients with relevant rare hereditary carbohydrate disorders.
Contraindications and cautions
- Hypersensitivity to umeclidinium or any excipient.
- Rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption because the selected product contains lactose.
Monitoring
- COPD symptoms, functional benefit and exacerbation history
- Inhaler technique and adherence
- Increasing reliance on rescue bronchodilator
- Antimuscarinic effects, including urinary retention and ocular symptoms
- Palpitations, tachycardia or arrhythmia in susceptible patients
Clinical pharmacology
Umeclidinium is an inhaled long-acting competitive muscarinic receptor antagonist with slow reversibility at M3 receptors. Systemic exposure is low; peak plasma concentrations occur soon after inhalation, oral absorption contributes negligibly, and metabolism principally involves CYP2D6 with P-glycoprotein transport.
Formulation and product differences
- The selected product is a single-ingredient, pre-dispensed dry-powder Ellipta inhaler with a dose counter.
- It contains lactose monohydrate and magnesium stearate; the lactose may contain milk protein.
- The device is supplied in a moisture-protective tray with a desiccant and is available in different inhaler pack sizes.
umeclidinium bromide preparations and strengths
Inhaled preparation
Route: Inhaled
Strengths: 55 micrograms
umeclidinium bromide interactions
Clinically important metabolic interactions are considered unlikely after inhalation, but medicine reconciliation remains important.
Other long-acting antimuscarinic inhalers, such as tiotropium
Concurrent use is not recommended because antimuscarinic adverse effects may be increased.
CYP2D6 inhibitors
Available pharmacokinetic evidence suggests no clinically relevant interaction is expected.
P-glycoprotein inhibitors, including verapamil
Exposure may increase modestly, but a clinically relevant interaction is considered unlikely.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.