Umeclidinium + Vilanterol


Concise Prescribing Info
Indications/Uses
Maintenance therapy in COPD.
Dosage/Direction for Use
Adult : Inhalation Each actuation contains umeclidinium (mcg)/vilanterol (mcg): 62.5/25, 55/22: 1 inhalation once daily.
Dosage Details
Inhalation/Respiratory
Maintenance therapy in chronic obstructive pulmonary disease
Adult: Available preparations:
Dry powder inhaler releasing Umeclidinium 62.5 mcg and vilanterol 25 mcg per actuation
Dry powder inhaler releasing Umeclidinium 55 mcg and vilanterol 22 mcg per actuation

1 inhalation once daily.
Contraindications
Asthma. Acute episodes of bronchospasm or acutely deteriorating COPD. Concomitant use with other long-acting β2-agonists.
Special Precautions
Patient with CV disease (e.g. cardiac insufficiency, arrhythmias, hypertension), diabetes mellitus, narrow-angle glaucoma, hypokalaemia, prostatic hyperplasia/bladder neck obstruction, seizure disorders, thyrotoxicosis. Concomitant use with other long-acting muscarinic antagonists. Not indicated for the relief of acute bronchospasm or for asthma treatment. Pregnancy and lactation.
Adverse Reactions
Significant: Hypersensitivity reactions (e.g. anaphylaxis, angioedema, rash, urticaria), blood pressure and tachycardia, atrial fibrillation, hyperglycaemia, diabetes mellitus and ketoacidosis exacerbation; hypokalaemia, urinary retention, narrow-angle glaucoma, bladder outlet obstruction, CNS stimulation/excitation; thyrotoxicosis exacerbation.
Gastrointestinal disorders: Constipation, dry mouth, diarrhoea, abdominal pain, nausea, toothache.
Musculoskeletal and connective tissue disorders: Muscle pain, pain in extremity, neck pain.
Nervous system disorders: Headache, vertigo, tremor, dysgeusia.
Renal and urinary disorders: UTI.
Respiratory, thoracic and mediastinal disorders: Sinusitis, nasopharyngitis, pharyngitis, upper respiratory tract infection, cough, pleuritic chest pain.
Potentially Fatal: Increased risk of asthma-related deaths. Rarely, paradoxical bronchospasm.
Inhalation/Respiratory: C
MonitoringParameters
Monitor pulmonary function test (e.g. FEV1, peak flow). Obtain blood pressure and heart rate. Assess ocular changes and signs of CNS stimulation.
Drug Interactions
Umeclidinium: Additive effect with other anticholinergic drugs.
Vilanterol: Increased exposure with strong CYP3A4 inhibitors (e.g. ketoconazole, clarithromycin). Increased risk of hypokalaemia with methylxanthine derivative, steroids or non-K-sparing diuretics. Diminished bronchodilatory effect with β-adrenergic blockers. Increased risk of CV adverse effects with MAOIs, and TCAs.
Potentially Fatal: Enhanced adverse effect with other long-acting β2-adrenergic agonists (e.g. formoterol, salmeterol).
Action
Description: Umeclidinium is a long-acting quaternary ammonium antimuscarinic agent. It competitively and reversibly inhibits acetylcholine at type 3 muscarinic (M3) receptors in the bronchial smooth muscles thereby causing bronchodilation.
Vilanterol is a selective, long-acting β2-adrenergic agonist. It stimulates the production of cyclic adenosine-3’,5’-monophosphate (cAMP) by activation of adenyl cyclase which results in the relaxation of bronchial smooth muscle.
Pharmacokinetics:
Absorption: Rapidly absorbed via lungs. Time to peak plasma concentration: 5-15 minutes.
Umeclidinium: Absolute bioavailability: Approx 13%.
Vilanterol: Absolute bioavailability: Approx 27%.
Distribution: Umeclidinium: Volume of distribution: 86 L. Plasma protein binding: Approx 89%.
Vilanterol: Volume of distribution: 165 L. Plasma protein binding: Approx 94%.
Metabolism: Umeclidinium: Metabolised in the liver by CYP2D6 by oxidation via hydroxylation and O-dealkylation, followed by glucuronidation into metabolites and is a substrate of P-glycoprotein transporter.
Vilanterol: Undergoes extensive 1st pass metabolism in the liver by CYP3A4 via O-dealkylation into metabolites.
Excretion: Umeclidinium: Mainly via faeces (92%); urine (<1%). Plasma elimination half-life: 11 hours.
Vilanterol: Mainly via urine (70% as metabolites); faeces (30% as metabolites). Plasma elimination half-life: Approx 11 hours.
Chemical Structure

Chemical Structure Image

Source: National Center for Biotechnology Information. PubChem Database. Umeclidinium, CID=11519070, https://pubchem.ncbi.nlm.nih.gov/compound/Umeclidinium (accessed on Jan. 23, 2020)


Chemical Structure Image
Vilanterol

Source: National Center for Biotechnology Information. PubChem Database. Vilanterol, CID=10184665, https://pubchem.ncbi.nlm.nih.gov/compound/Vilanterol (accessed on Jan. 23, 2020)

Storage
Store between 20-25°C. Protect from direct heat or sunlight.
ATC Classification
R03AL03 - vilanterol and umeclidinium bromide ; Belongs to the class of combination of adrenergics with anticholinergics, that may also include a corticosteroid. Used in the treatment of obstructive airway diseases.
References
Anon. Umeclidinium and Vilanterol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/03/2018.

Anon. Umeclidinium. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/03/2018.

Anoro Ellipta Powder (GlaxoSmithKline LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/03/2018.

Buckingham R (ed). Umeclidinium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/03/2018.

Buckingham R (ed). Vilanterol Trifenatate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/03/2018.

Joint Formulary Committee. Umeclidinium with Vilanterol. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/03/2018.

McEvoy GK, Snow EK, Miller J et al (eds). Umeclidinium Bromide. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 05/03/2018.

McEvoy GK, Snow EK, Miller J et al (eds). Vilanterol Trifenatate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 05/03/2018.

Disclaimer: This information is independently developed by MIMS based on Umeclidinium + Vilanterol from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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