Names and pronunciation
(floo-tic′a-sone/vye-lan′ter-ol) Breo Ellipta
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Drug reference
(floo-tic′a-sone/vye-lan′ter-ol) Breo Ellipta
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Func. class.: Corticosteroid, long- acting/beta-2-Adrenergic Agonists
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Do not confuse: Flonase/Flovent F
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ACTION: Decreases inflammation by inhibiting mast cells, macrophages, and leukotrienes; anti- inflammatory and vasoconstrictor proper- ties; vilanterol relaxes smooth muscles in the respiratory tract, inhibits mast cells
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USES: Asthma, COPD
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CONTRAINDICATIONS Hypersensitivity to this product or milk protein, primary treatment in status asth- maticus, acute bronchospasm Precautions: Pregnancy, breastfeeding, active infections, glaucoma, diabetes, immunocompromised patients
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SIDE EFFECTS CNS: Fatigue, fever, headache, dizziness EENT: Pharyngitis, sinusitis, rhinitis, laryngitis GI: Diarrhea, abdominal pain MISC: Flulike symptoms MS: Back pain, arthralgia RESP: Upper respiratory infection, dys- pnea, COPD, pneumonia, cough, bronchitis
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INTERACTIONS Increase: fluticasone levels—CYP3A4 inhibitors (ketoconazole, itraconazole), darunavir, nelfinavir, ritonavir, amprena- vir, fosamprenavir, atazanavir, delavir- dine, saquinavir Increase: cardiac toxicity—isoprotere- nol (asthma patients) Increase: hypokalemia—thiazide and thiazide-like diuretics Increase: adverse reactions—tricyclic antidepressants NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Asthma • Adult: INH 1 inhalation, 100 mcg fluticasone/vilanterol 25 mcg or 200 mcg fluticasone/vilanterol 25 mcg daily Maintenance treatment of COPD • Adult: 1 inhalation, 100 mcg flutica- sone/vilanterol 25 mcg
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Available forms: Powder for inhalation Blister 100 mcg fluticasone/vilanterol 25 mcg, 200 mcg fluticasone/vilanterol 25 mcg
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Administer: • Give 1 inhalation in 24 hr • Discard device 6 wk after it is re- moved from the foil tray or when the dose counter reads “0” (whichever comes first) • Do not open the cover of the inhaler until ready for use; each time cover is opened, 1 dose of medicine is prepared • Exhale fully before taking one long, steady, deep breath through the mouth- piece (do not breathe through nose); hold breath for 3 to 4 sec and exhale slowly and gently • Patient should rinse mouth with water after inhalation and expectorate rinse solution
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Assess: • Respiratory status: lung sounds, pulmonary function tests during, for sev- eral months after change from systemic to inhalation corticosteroids • Use a short-acting beta 2 agonist • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; use caution in breastfeeding, excretion unknown
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Evaluate: • Therapeutic response: decreased se- verity of asthma, COPD Evaluate: • Therapeutic response: decreased se- verity of asthma, COPD
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Patient and caregiver information: • Withdrawal symptoms from oral cortico- steroids: depression, pain in joints, fatigue • Adrenal insufficiency: nausea, weakness, fatigue, hypotension, hypo- glycemia, anorexia; may occur when changing from systemic to inhalation corticosteroids; may be life-threatening; adrenal function tests periodically: hypo- thalamic–pituitary–adrenal axis sup- pression in long-term treatment • Blood glucose, serum potassium for all patients • Beers: avoid use in older adults with delirium or at high risk of delirium; may worsen the condition • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; use caution in breastfeeding, excretion unknown Patient and caregiver information: • To use bronchodilator first, before using inhalation, if taking both • Not to use for acute asthmatic attack; acute asthma may require oral cortico- steroids • To avoid smoking, smoke-filled rooms, those with URIs, those not im- munized against chickenpox or mea- sles • To rinse mouth after inhaled product to decrease risk of oral candidiasis • To report immediately cushingoid symptoms: no appetite, nausea, weak- ness, fatigue, decreased B/P • How to use, and when it may be empty • To use medical ID identifying cortico- steroid use
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PHARMACOKINETICS Fluticasone: Onset unknown, peak 30-60 min, duration unknown Vilanterol: Onset unknown, peak 10 min, duration unknown
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• Adult: INH 1 inhalation, 100 mcg fluticasone/vilanterol 25 mcg or 200 mcg fluticasone/vilanterol 25 mcg daily Maintenance treatment of COPD
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• Adult: 1 inhalation, 100 mcg flutica- sone/vilanterol 25 mcg
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