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
- asthma
- chronic bronchitis
- chronic obstructive pulmonary disease (COPD)
- 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
- adrenocortical insufficiency
- anaphylactoid reactions
- angioedema
- anxiety
- arrhythmia exacerbation
- arthralgia
- asthma-related death
- back pain
- bone fractures
- candidiasis
- cataracts
- Churg-Strauss syndrome
- cough
- diarrhea
- eosinophilia
- fatigue
- fever
- growth inhibition
- headache
- hyperglycemia
- hypertension
- hypokalemia
- hypothalamic-pituitary-adrenal (HPA) suppression
- infection
- influenza
- insomnia
- malaise
- muscle cramps
- myocardial infarction
- ocular hypertension
- osteoporosis
- palpitations
- peripheral edema
- pharyngitis
- QT prolongation
- rash
- sinus tachycardia
- sinusitis
- ST-T wave changes
- tremor
- urticaria
- vasculitis
- 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
- Abarelix
- Abatacept
- Acebutolol
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Pseudoephedrine
- Acetazolamide
- Acetohexamide
- Aclidinium; Formoterol
- Acrivastine; Pseudoephedrine
- Adalimumab
- Albiglutide
- Aldesleukin, IL-2
- Alemtuzumab
- Alfuzosin
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Alogliptin; Metformin
- Alpha-glucosidase Inhibitors
- Altretamine
- Ambenonium Chloride
- Amifampridine
- Amiloride; Hydrochlorothiazide, HCTZ
- Aminolevulinic Acid
- Aminosalicylate sodium, Aminosalicylic acid
- Amiodarone
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphotericin B
- Amphotericin B cholesteryl sulfate complex (ABCD)
- Amphotericin B lipid complex (ABLC)
- Amphotericin B liposomal (LAmB)
- Anagrelide
- Antithymocyte Globulin
- Antitumor antibiotics
- Apomorphine
- Aprepitant, Fosaprepitant
- Argatroban
- Aripiprazole
- Arsenic Trioxide
- Artemether; Lumefantrine
- Articaine; Epinephrine
- Asenapine
- Asparaginase Erwinia chrysanthemi
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Atenolol
- Atenolol; Chlorthalidone
- Atomoxetine
- Atracurium
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azathioprine
- Azilsartan; Chlorthalidone
- Azithromycin
- Basiliximab
- Bedaquiline
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Benazepril; Hydrochlorothiazide, HCTZ
- Bendroflumethiazide; Nadolol
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Bepridil
- Beta-adrenergic blockers
- Betaxolol
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Bivalirudin
- Bortezomib
- Brimonidine; Timolol
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Budesonide; Formoterol
- Bumetanide
- Buprenorphine
- Buprenorphine; Naloxone
- Bupropion
- Bupropion; Naltrexone
- Butabarbital
- Caffeine
- Caffeine; Ergotamine
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Canagliflozin
- Canagliflozin; Metformin
- Candesartan; Hydrochlorothiazide, HCTZ
- Captopril; Hydrochlorothiazide, HCTZ
- Carbamazepine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Carmustine, BCNU
- Carteolol
- Carvedilol
- Ceritinib
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chlorambucil
- Chloramphenicol
- Chloroquine
- Chlorothiazide
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorpropamide
- Chlorthalidone
- Chlorthalidone; Clonidine
- Choline Salicylate; Magnesium Salicylate
- Cimetidine
- Ciprofloxacin
- Cisapride
- Cisatracurium
- Citalopram
- Clarithromycin
- Clindamycin
- Clofarabine
- Clofazimine
- Clomipramine
- Clozapine
- Cobicistat
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Conivaptan
- Crizotinib
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasatinib
- Deferasirox
- Degarelix
- Delavirdine
- Denileukin Diftitox
- Denosumab
- Desipramine
- Desloratadine; Pseudoephedrine
- Desmopressin
- Deutetrabenazine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextran
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diethylpropion
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dipeptidyl Peptidase-4 Inhibitors
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Phenylephrine
- Disopyramide
- Dobutamine
- Dofetilide
- Dolasetron
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Dopamine
- Dorzolamide; Timolol
- Doxacurium
- Doxepin
- Dronedarone
- Droperidol
- Dulaglutide
- Echinacea
- Econazole
- Efalizumab
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elbasvir; Grazoprevir
- Eliglustat
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Enalapril; Hydrochlorothiazide, HCTZ
- Encorafenib
- Enflurane
- Entrectinib
- Ephedrine
- Epinephrine
- Eprosartan; Hydrochlorothiazide, HCTZ
- Eribulin
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Esmolol
- Estramustine
- Estrogens
- Ethacrynic Acid
- Exenatide
- Ezogabine
- Fexofenadine; Pseudoephedrine
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluoxymesterone
- Fluphenazine
- Fluvoxamine
- Formoterol
- Formoterol; Mometasone
- Fosamprenavir
- Foscarnet
- Fosinopril; Hydrochlorothiazide, HCTZ
- Furosemide
- Gallium Ga 68 Dotatate
- Gemcitabine
- Gemifloxacin
- Gemtuzumab Ozogamicin
- Gentamicin
- Gilteritinib
- Glasdegib
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Glycerol Phenylbutyrate
- Glycopyrrolate; Formoterol
- Goserelin
- Granisetron
- grapefruit juice
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Halofantrine
- Haloperidol
- Halothane
- Hemin
- Heparin
- Hetastarch
- Histrelin
- Hydantoins
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Olmesartan
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrochlorothiazide, HCTZ; Valsartan
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydroxychloroquine
- Hydroxyurea
- Hydroxyzine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibritumomab Tiuxetan
- Ibuprofen; Pseudoephedrine
- Ibutilide
- Idelalisib
- Iloperidone
- Imipramine
- Incretin Mimetics
- Indacaterol
- Indacaterol; Glycopyrrolate
- Indapamide
- Indinavir
- Inebilizumab
- Inotuzumab Ozogamicin
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Isavuconazonium
- Isocarboxazid
- Isoflurane
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Isoproterenol
- Isotretinoin
- Itraconazole
- Ivosidenib
- Ketoconazole
- L-Asparaginase Escherichia coli
- Labetalol
- Lapatinib
- Lefamulin
- Lenvatinib
- Letermovir
- Leuprolide
- Leuprolide; Norethindrone
- Levetiracetam
- Levobetaxolol
- Levobunolol
- Levofloxacin
- Levomethadyl
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linagliptin; Metformin
- Linezolid
- Liothyronine
- Liraglutide
- Lisdexamfetamine
- Lithium
- Lixisenatide
- Lofexidine
- Lomefloxacin
- Lomustine, CCNU
- Loop diuretics
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Loratadine; Pseudoephedrine
- Lumacaftor; Ivacaftor
- Macimorelin
- Magnesium Salicylate
- Mannitol
- Maprotiline
- Mecasermin rinfabate
- Mecasermin, Recombinant, rh-IGF-1
- Mefloquine
- Meglitinides
- Melphalan
- Mepenzolate
- Meperidine; Promethazine
- Mephobarbital
- Mepivacaine; Levonordefrin
- Mesoridazine
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methacholine
- Methadone
- Methamphetamine
- Methazolamide
- Methenamine; Sodium Acid Phosphate
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methoxsalen
- Methyclothiazide
- Methylphenidate
- Metolazone
- Metoprolol
- Metronidazole
- Metyrapone
- Micafungin
- Midodrine
- Midostaurin
- Mifepristone
- Mirtazapine
- Mitotane
- Mitoxantrone
- Mivacurium
- Monoamine oxidase inhibitors
- Moxifloxacin
- Muromonab-CD3
- Nadolol
- Naproxen; Pseudoephedrine
- Natalizumab
- Nateglinide
- Nebivolol
- Nebivolol; Valsartan
- Nefazodone
- Nelarabine
- Nelfinavir
- Neostigmine
- Netupitant, Fosnetupitant; Palonosetron
- Neuromuscular blockers
- Nicardipine
- Nilotinib
- Nonsteroidal antiinflammatory drugs
- Norepinephrine
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxymetholone
- Ozanimod
- Paliperidone
- Pancuronium
- Panobinostat
- Pasireotide
- Pazopanib
- Pegaspargase
- Pemoline
- Penbutolol
- Penicillamine
- Pentamidine
- Perphenazine
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenelzine
- Phenobarbital
- Phentermine
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Photosensitizing agents (topical)
- Physostigmine
- Pimavanserin
- Pimozide
- Pindolol
- Pitolisant
- Posaconazole
- Potassium
- Potassium Chloride
- Potassium Phosphate; Sodium Phosphate
- Potassium-sparing diuretics
- Pramlintide
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Prilocaine; Epinephrine
- Primaquine
- Primidone
- Procainamide
- Procarbazine
- Prochlorperazine
- Promethazine
- Propafenone
- Propranolol
- Protriptyline
- Pseudoephedrine
- Purine analogs
- Pyridostigmine
- Quetiapine
- Quinidine
- Quinine
- Racepinephrine
- Ranolazine
- Rapacuronium
- Rasagiline
- Regular Insulin
- Repaglinide
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifamycins
- Rifapentine
- Rilpivirine
- Risperidone
- Ritodrine
- Ritonavir
- Rituximab
- Rituximab; Hyaluronidase
- Rocuronium
- Romidepsin
- Salicylates
- Salsalate
- Sapropterin
- Saquinavir
- Sargramostim, GM-CSF
- Selegiline
- Selpercatinib
- Semaglutide
- Sertraline
- Sevoflurane
- SGLT2 Inhibitors
- Siponimod
- Sodium Benzoate; Sodium Phenylacetate
- Sodium Chloride
- Sodium Phenylbutyrate
- Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Solifenacin
- Somatropin, rh-GH
- Sorafenib
- Sotalol
- Succinylcholine
- Sulfonylureas
- Sunitinib
- Sympathomimetics
- Tacrolimus
- Tamoxifen
- Telaprevir
- Telavancin
- Telbivudine
- Telithromycin
- Telotristat Ethyl
- Testosterone
- Tetrabenazine
- Theophylline, Aminophylline
- Thiazide diuretics
- Thiazolidinediones
- Thioridazine
- Thyroid hormones
- Timolol
- Tipranavir
- Tobramycin
- Tolazamide
- Tolbutamide
- Tolterodine
- Toremifene
- Torsemide
- Tositumomab
- Tranexamic Acid
- Tranylcypromine
- Trazodone
- Tretinoin, ATRA
- Triclabendazole
- Tricyclic antidepressants
- Trifluoperazine
- Trimipramine
- Triptorelin
- Tuberculin Purified Protein Derivative, PPD
- Tubocurarine
- Tucatinib
- Vancomycin
- Vandetanib
- Vardenafil
- Vecuronium
- Vemurafenib
- Venlafaxine
- Vigabatrin
- Vincristine Liposomal
- Voriconazole
- Vorinostat
- Warfarin
- Zafirlukast
- Ziprasidone