Indacaterol and Glycopyrrolate (Inhalation)

Overview

Indacaterol and glycopyrrolate is a combination medicine that is prescribed to patients suffering from COPD, chronic bronchitis, and emphysema to treat the effects of these chronic respiratory conditions. It is used for a long period of time to gradually treat the symptoms and help to open up the airway of the patient by having a bronchodilation effect that increases the flow of air through the lungs and increases the flow of oxygen to the bloodstream. The combination medication is marketed under the name Utibron Neohaler and is taken by the patient by breathing it in through the mouth with a handheld inhaler.

Indacaterol and Glycopyrrolate is a potent medication that is available only with a prescription and must be used only as directed by the prescribing physician. It is not meant to be used to treat respiratory conditions other than those it is specifically prescribed for and is notably not a treatment for Asthma. Failure to use it as directed can lead to significant side effects that can be of great detriment to the health of the patient.

Condition treated

  • Chronic obstructive pulmonary disease (COPD)
  • Chronic bronchitis
  • Emphysema

Type Of Medicine

  • Bronchodilator

Side Effects

When using Indacaterol and Glycopyrrolate as an inhaled medicine a patient may notice certain side effects that come along with the intended result of enabling easier respiration. Not all patients will be affected by these side effects, but some can be serious enough to merit medical attention if they do occur. If any of the following serious side effects are observed, medical attention should be sought:

  • Blurred vision
  • Dizziness
  • Headache
  • Nervousness
  • Pounding in the ears
  • Slow or fast heartbeat
  • Abdominal or stomach pain
  • Blindness
  • Convulsions
  • Decrease in the frequency of urination
  • Decrease in urine volume
  • Decreased vision
  • Difficulty in passing urine (dribbling)
  • Dry mouth
  • Eye pain
  • ainting
  • Flushed, dry skin
  • Fruit-like breath odor
  • Hives or welts, itching, or skin rash
  • Increased hunger
  • Increased thirst
  • Increased urination
  • Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • Loss of appetite
  • Mood changes
  • Muscle pain or cramps
  • Nausea or vomiting
  • Nosebleeds
  • Numbness or tingling in the hands, feet, or lips
  • Painful urination
  • Redness of the skin
  • Sweating
  • Tearingroubled breathing
  • Unexplained weight loss
  • Unusual tiredness or weakness
  • Vision problems

Certain side effects that have been associated with indacaterol and glycopyrrolate are not likely to require medical attention and are considered temporary in nature. Usually, these symptoms will subside as the patient adjusts to having the medication in their system. Patients should be informed that when they begin to take the medication they may experience the following temporary side effects:

  • Fever
  • Back pain
  • Muscle aches
  • Sore throat
  • Stuffy or runny nose

If any side effect that is not listed is experienced while taking indacaterol and glycopyrrolate, the primary care provider should be informed as this may indicate a more serious medical condition.

Dosage

Indacaterol and glycopyrrolate should only be used as directed by the physician for the specific respiratory condition that it is prescribed for. It is also important to only use it for the indicated duration of time and to not cease its use unless directed to by the prescribing physician or as a result of a medical emergency. Failure to use this medication as directed can lead to a dramatic worsening of the respiratory condition of the patient. When this medication is prescribed the doctor who writes the prescription should instruct the patient in its use and warn against any use of the capsule other than breathing it through the inhaler. The capsule is loaded into the inhaler and the contents are breathed in through the mouthpiece that is provided.

Indacaterol and Glycopyrrolate are taken 2 times daily and should be taken at about the same time each day. Before using the inhaler, the patient needs to dry their hands before handing the capsule and should handle the capsule with care. It is not to be pushed through the foil of the blister pack but rather removed after peeling back the foil. The capsule needs to be placed properly in the inhaler or there is a danger of swallowing it or allowing it to slip into the mouth. When the inhaler is properly closed there will be a distinct clicking noise to indicate the inhaler is ready to use. The patient needs to push both buttons on the inhaler at the same time and exhale a breath fully before inhaling the medication. The inhalation needs to be a quick deep breath to maximize the dose and the patient needs to hold their breath with the dose as long as they can so that the medicine can work. After exhaling the breath the empty capsule should be immediately discarded and the inhaler needs to be closed until it is time for the next dose.

The dose of Indacaterol and Glycopyrrolate may vary depending on the condition of the patient, so it is important that the prescribing physician's orders are followed in regards to the dosage. While average dosages may be included in the instructions for the medication, the prescription may account for medical information that the manufacturer is not taking into consideration. The average adult patient being treated for COPD with this medication will inhale one capsule two times per day in the morning and evening time, but the individual condition may require up to three daily doses. Use of this medication by children is not recommended.

If a dose of indacaterol and glycopyrrolate is missed the dose should be skipped and the next dose on the schedule should be taken. This medication is potentially dangerous if it is taken as a double dose. In general, more than two capsules in a 24 hour period should not be taken unless directed by a physician.

Interactions

Some medicines should not be used in tandem and the indacaterol and glycopyrrolate combination has been known to interact with certain medications to create potentially dangerous conditions. If it is possible to stop using these medications that option must be strongly considered, but if no option other than to use them both is possible every precaution should be taken to minimize the possibility of drug interactions. The prescribing physician may be able to take additional steps such as changing doses or the times the doses are taken. This medication should not be taken with potassium and extreme caution should be observed when beginning a new regimen of this medication after taking potassium for a significant period of time.

The following medications are not recommended, but in some cases may be required for the good of the patient. In any case, the prescribing physician should be made aware of any of the following that are currently being taken:

  • Bupropion
  • Donepezil
  • Oxymorphone
  • Tiotropium

There may be certain foods, drink, vitamins, and supplements that should be avoided when taking Indacaterol and Glycopyrrolate. In general, it is not recommended that a patient taking indacaterol and glycopyrrolate smoke while taking this medication. Additionally, certain medical conditions may prevent the medication from working as intended or it may make the condition worse. The doctor should be informed of a history of the following conditions or if any of them are currently being experienced:

  • Allergy to milk proteins
  • Bladder problems
  • Diabetes
  • Enlarged prostate
  • Glaucoma
  • Heart or blood vessel disease
  • Heart rhythm problems
  • Hyperglycemia
  • Hypertension
  • Hyperthyroidism
  • Hypokalemia
  • Seizures
  • Trouble urinating

Warnings

The decision to use indacaterol and glycopyrrolate should be weighed against certain risks to the wellbeing of the patient. There is a risk of a potentially serious allergic reaction, and if the patient has any history of allergies an examination should be scheduled for testing prior to prescribing this medication. Allergies to milk proteins are the most common complication, but allergies to other foods, dyes, or animals may also be a contributing factor.

This medication should not be prescribed to children as its safety and efficacy for treating their respiratory disorders have not been established in a clinical environment. If used by women who are pregnant or may become pregnant they should be advised that there is an inadequate amount of research regarding whether or not this medication is safe for the fetus.

Indacaterol and glycopyrrolate are used for a long period of time and while taking this medication it will be necessary for the patient to attend regular doctor visits in order to test whether or not the medication is working as intended. The examinations will determine whether progress is being made by taking the medication and whether there are any side effects or drug interactions that are being experienced by the patient. This is a medication for a chronic condition and should not be used directly after experiencing a sudden COPD attack. Other short-acting medications will be administered by a doctor or emergency medical personnel in this event. If the short-acting medication is not working the medical professional should be immediately informed as this may indicate there is a more serious respiratory problem. immediate medical care should be sought if symptoms of COPD do not improve after using indacaterol and glycopyrrolate for the first few days or if the symptoms become more intense when taking it. If the rescue inhaler stops working as well as it did before taking this medication the prescribing physician should be immediately informed.

Indacaterol and glycopyrrolate should not be used at the same time as the following medications that are normally prescribed for COPD:

  • Arformoterol
  • Budesonide/formoterol
  • Formoterol
  • Salmeterol
  • Vilanterol

Patients should be advised that taking indacaterol and glycopyrrolate may result in a condition called paradoxical bronchospasm which can result in a significant increase in wheezing and coughing. As this is a potentially life-threatening condition emergency medical attention should be summoned if using this medication results in coughing, wheezing, or shortness of breath. If a skin rash or hives is experienced when using this medication, especially around the mouth area, this could indicate that a serious allergic reaction is being experienced and medical attention may be necessary.

Indacaterol and glycopyrrolate may cause a sudden increase in heart rate or blood pressure in some patients. This should be brought to a doctor's attention as soon as possible as it could have long-term effects on the health of the patient. Patients could experience a change in vision while using this medication including blurred vision or seeing halos around lights. The patient's eyes should be checked by an ophthalmologist if there are any concerns regarding vision while taking indacaterol and glycopyrrolate. Another indication that something may be wrong when taking this medication is a decrease in the flow of urine as well as any change in its volume or frequency. If pain or difficulty is experienced during urination a medical professional should be informed. All medications taken while taking this medication need to be discussed with the prescribing physician, to include prescription, non-prescription, vitamins, herbs, and supplements. Some of these may interfere in how this medication works and make treatment more difficult.

Storage

Indacaterol and glycopyrrolate capsules need to be stored at room temperature and kept away from sources of heat, moisture, and direct light. Storing them in a bathroom or in an outdoor area such as an automobile is not recommended. The capsules should not be refrigerated and should never be allowed to freeze. This medication needs to be stored securely away from the reach of children as exposure or swallowing of the medication could be extremely harmful.

When the medication is expired or no longer needed it should be disposed of in adherence to local regulations pertaining to the disposal of medical waste. Ask a doctor or pharmacist if you are unsure about how to properly dispose of this prescription. When stored, the mouthpiece of the inhaler should be closed and the cover should be in place. The inhaler should not be washed and needs to be kept dry at all times.

Summary

Even among chronic respiratory conditions, COPD is considered a very debilitating and long-lasting malady that needs to be treated over a long period of time. A combination of indacaterol and glycopyrrolate may represent the best possible long-term treatment for a patient suffering from this condition. The main concern when prescribing this medication is ensuring that it is not taken by a patient suffering from asthma as this medication is not considered a reliable treatment for that condition. For the respiratory conditions that it is intended for, indacaterol and glycopyrrolate can be a very effective bronchodilator that provides a more open airway and relief from breathing difficulties. While there is a certain amount of risk of potential side effects, drug interactions, and allergies, when used properly it can provide patients with a longer life where they can breath easier.