Fluticasone Vilanterol

Fluticasone Vilanterol Brand Name– BREO ELLIPTA

What is Fluticasone Vilanterol

Fluticasone vilanterol is a combination of an inhaled corticosteroid, fluticasone, and a long-acting beta-2 adrenergic agonist (LABA), vilanterol, that is used once a day.

The combination is indicated in adults for the maintenance treatment of chronic obstructive pulmonary disease (COPD), and to reduce COPD exacerbations. Fluticasone; vilanterol is also indicated for the maintenance treatment of asthma in adults.

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, fluticasone vilanterol may be used as as initial therapy in group D (those with a high risk of exacerbation).

Combination of a LABA with an ICS has the greatest likelihood of reducing COPD exacerbations in patients with blood eosinophil counts of 200 cells/microliter and higher.

An ICS combined with a LABA is more effective than the individual components in improving lung function and health status and reducing exacerbations in patients with exacerbations and moderate to very severe COPD; however clinical trials failed to demonstrate a statistically significant effect on survival.

At follow-up, if the patient is still experiencing dyspnea, consider switching inhaler device and investigate for other causes of dyspnea.

If the patient has exacerbations, consider triple therapy with a long-acting muscarinic antagonists (LAMA), a LABA, and ICS.

Fluticasone vilanterol has been shown to significantly improve lung function in adults with asthma compared to fluticasone furoate monotherapy.

The use of LABAs alone to treat asthma, without an ICS to treat lung inflammation, is associated with an increased risk of asthma-related death; therefore, LABAs are contraindicated in patients with asthma without the use of an asthma controller medication (i.e., an ICS).

Fluticasone vilanterol was first FDA-approved in 2013.

Indications

  1. asthma
  2. chronic bronchitis
  3. chronic obstructive pulmonary disease (COPD)
  4. emphysema

For the maintenance treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis or emphysema, and to to reduce exacerbations of COPD

Side Effects

  1. adrenocortical insufficiency
  2. anaphylactoid reactions
  3. angioedema
  4. anxiety
  5. arrhythmia exacerbation
  6. arthralgia
  7. asthma-related death
  8. back pain
  9. bone fractures
  10. candidiasis
  11. cataracts
  12. Churg-Strauss syndrome
  13. cough
  14. diarrhea
  15. eosinophilia
  16. fatigue
  17. fever
  18. growth inhibition
  19. headache
  20. hyperglycemia
  21. hypertension
  22. hypokalemia
  23. hypothalamic-pituitary-adrenal (HPA) suppression
  24. infection
  25. influenza
  26. insomnia
  27. malaise
  28. muscle cramps
  29. myocardial infarction
  30. ocular hypertension
  31. osteoporosis
  32. palpitations
  33. peripheral edema
  34. pharyngitis
  35. QT prolongation
  36. rash
  37. sinus tachycardia
  38. sinusitis
  39. ST-T wave changes
  40. tremor
  41. urticaria
  42. vasculitis
  43. wheezing

Monitoring Parameters

  • blood glucose
  • pulmonary function tests (PFTs)
  • serum potassium

Contraindications

  • acute bronchospasm
  • alcoholism
  • asthma-related death
  • bradycardia
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cataracts
  • children
  • coronary artery disease
  • diabetes mellitus
  • females
  • geriatric
  • glaucoma
  • growth inhibition
  • heart failure
  • hepatic disease
  • hypertension
  • hyperthyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothalamic-pituitary-adrenal (HPA) suppression
  • immunosuppression
  • increased intraocular pressure
  • infants
  • labor
  • long QT syndrome
  • malnutrition
  • MAOI therapy
  • milk protein hypersensitivity
  • myocardial infarction
  • neonates
  • osteoporosis
  • paradoxical bronchospasm
  • pheochromocytoma
  • pregnancy
  • QT prolongation
  • respiratory insufficiency
  • seizure disorder
  • seizures
  • status asthmaticus
  • thyroid disease
  • thyrotoxicosis
  • tobacco smoking
  • tuberculosis

Interactions

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