Names and pronunciation
(in-da-kat′er-ol) Arcapta Neohaler, Onbrez Breezhal ER
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Drug reference
(in-da-kat′er-ol) Arcapta Neohaler, Onbrez Breezhal ER
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Func. class.: β-2 agonist, long-acting respiratory
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Chem. class.: Indene
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ACTION: An agonist at β-2 receptors. Stimulation of β-2 receptors in the lung causes relaxation of bronchial smooth muscle, which produces bronchodilation and an increase in bronchial airflow
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USES: Bronchitis, chronic obstructive pulmonary disease (COPD), emphysema
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CONTRAINDICATIONS: Acute bronchospasm, acute asthma attack, status asthmaticus, acute respiratory insufficiency, monotherapy of asthma, hypersensitivity, child <18 yr Precautions: Ischemic cardiac disease (coronary artery disease), hypertension, cardiac arrhythmias, tachycardia, QT prolongation, congenital long QT syn- drome, torsades de pointes history, hyper- thyroidism (thyrotoxicosis, thyroid dis- ease), pheochromocytoma, unusual responsiveness to other sympathomimetic amines, seizure disorder, diabetes mellitus, hypokalemia, milk protein hypersensitivity, severe hepatic disease, pregnancy, breastfeeding
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Black Box Warning: Asthma-related deaths Black Box Warning: Asthma-related death; not to be used in asthma • COPD, emphysema, bronchospasm: monitor pulmonary function tests, respi- ratory status (dyspnea, rate, breath sounds before and during treatment) • QT prolongation: monitor ECG, ejec tion fraction for QT prolongation • Paradoxical bronchospasm: if para doxical bronchospasm occurs, discon tinue product immediately, use a short- acting β-agonist for rescue therapy, as appropriate • Pregnancy/breastfeeding: use only if benefit outweighs fetal risk; use caution in breastfeeding, excretion unknown Teach patient/family • To report dyspnea, wheezing, bron- chospasm • Not to use with other products unless ap proved by prescriber; there are many inter actions; it is always prescribed with a short- acting beta-2 inhaler or steroidal inhaler Black Box Warning: Do not use for asthma • How to use Neohaler; not to stop treat- ment unless approved by prescriber • The symptoms of allergic reactions • To inform other providers of use
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SIDE EFFECTS CNS: Headache, dizziness CV: Tachycardia, palpitations, peripheral edema ENDO: Hyperglycemia GI: Nausea, dry mouth MS: Muscle cramps/spasm, musculo- skeletal pain RESP: Paradoxical bronchospasm, cough, dyspnea, upper respiratory tract infection, sputum purulence/volume, wheezing, pneumonia, URI EENT: Oropharyngeal pain, nasopharyngi- tis, sinusitis INTEG: Rash, pruritus
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INTERACTIONS: Increase: QT prolongation—class IA/III antiarrhyth mics, flecainide, propafenone, some anti psychotics (phenothiazines, pimozide, haloperidol risperiDONE, sertindole, zipra sidone), amoxapine, arsenic trioxide, astemizole, bepridil, cisapride, citalopram, chloroquine, clarithromycin, dasatinib, dolasetron, dronedarone, droperidol, erythromycin, halofantrine, halogenated anesthetics, levomethadyl, maprotiline, methadone, some quinolones (ofloxacin, gatifloxacin, gemifloxacin, grepafloxacin, levoFLOXacin, moxifloxacin, sparfloxacin), ondansetron, paliperidone, palonosetron, pentamidine, probucol, propafenone, ranolazine, SUNItinib, terfenadine, thio ridazine, tricyclic antidepressants, trole andomycin, vorinostat, tetrabenazine Increase: cardiovascular reactions— MAOIs
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DOSAGE AND ROUTES • Adult: INH 75 mcg (contents of 1 capsule) inhaled once daily; max 1 dose in 24 hours
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Available forms: Powder in capsules for inhalation 75 mcg
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Administer: Inhalation route • For oral inhalation use only; DO NOT swallow the capsules; always use the Neo- haler Inhaler; DO NOT use with a spacer • Use dry hands to remove a capsule from the blister pack immediately before use and place into the capsule chamber of the Neohaler Inhaler; click closed; holding the inhaler upright, depress buttons fully once; have patient breathe out fully away from inhaler, place inhaler in the mouth with buttons positioned to the left and right, close lips around mouthpiece, then breathe deeply; check the chamber to see if any powder remains; repeat inhalation steps until no powder remains
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CLINICAL CONSIDERATIONS Assess
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PHARMACOKINETICS: Protein binding 94%-96%, metabolized by CYP3A4, CYP1A1, CYP2D6, UGT1A1; half-life of 45.5- 126 hours; excreted renally (2%-6%), fecally (>90%); onset 5 min, peak 15 min
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• Adult: INH 75 mcg (contents of 1 capsule) inhaled once daily; max 1 dose in 24 hours
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