Vilanterol
Generic Name: Vilanterol
Brand Names: Breo Ellipta (with fluticasone), Anoro Ellipta (with umeclidinium)
Vilanterol is a once-daily long-acting beta-agonist available in combination inhalers for asthma and COPD.
Drug Class
Long-Acting Beta-2 Adrenergic Agonist (LABA)
Pregnancy
Not formally categorized – Limited human data; animal studies at supratherapeutic doses showed some fetal effects. Use only if benefit outweighs risk.
Available Forms
25 mcg vilanterol / 100 mcg fluticasone furoate inhalation powder (Breo Ellipta), 25 mcg vilanterol / 200 mcg fluticasone furoate inhalation powder (Breo Ellipta), 25 mcg vilanterol / 62.5 mcg umeclidinium / 100 mcg fluticasone furoate inhalation powder (Trelegy Ellipta), 25 mcg vilanterol / 62.5 mcg umeclidinium inhalation powder (Anoro Ellipta)
What It's Used For
Dosage Quick Reference
These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Typical Maintenance Dose |
|---|---|---|
| Asthma (Breo Ellipta 100/25) | 1 inhalation once daily | 1 inhalation once daily (do not exceed) |
| COPD (Breo Ellipta 100/25) | 1 inhalation once daily | 1 inhalation once daily |
| COPD (Anoro Ellipta, umeclidinium/vilanterol) | 1 inhalation once daily | 1 inhalation once daily |
| COPD (Trelegy Ellipta, triple therapy) | 1 inhalation once daily | 1 inhalation once daily |
Side Effects
Common Side Effects:
- Nasopharyngitis
- Upper respiratory tract infection
- Headache
- Oropharyngeal candidiasis (with ICS)
- Dysphonia (with ICS)
Serious Side Effects:
- Asthma-related death (without ICS)
- Paradoxical bronchospasm
- Cardiovascular effects (tachycardia, arrhythmias, hypertension)
- Hypokalemia
- Hypersensitivity reactions
Drug Interactions
Major Drug & Food Interactions
- Other long-acting beta-agonists (salmeterol, formoterol): Do not use vilanterol with another LABA due to risk of cardiovascular side effects including arrhythmias and prolonged QT interval.
- Beta-blockers (propranolol, metoprolol, atenolol): May diminish the bronchodilatory effect of vilanterol. Non-selective beta-blockers are especially problematic; cardioselective agents are preferred if necessary.
- Strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir): Can increase vilanterol systemic exposure, raising the risk of cardiovascular adverse effects. Use with caution.
- Non-potassium-sparing diuretics (furosemide, hydrochlorothiazide): Beta-agonists can worsen diuretic-induced hypokalemia, potentially increasing arrhythmia risk.
- MAO inhibitors and tricyclic antidepressants: May potentiate the cardiovascular effects of beta-agonists; use with extreme caution.
Additional Information
Vilanterol is a long-acting beta-2 adrenergic agonist (LABA) used in combination with other medications for maintenance treatment of COPD and asthma. It is only available in combination products due to safety concerns with LABA monotherapy in asthma.
Mechanism of Action
Vilanterol provides sustained bronchodilation:
- Beta-2 receptor agonism: Activates beta-2 adrenergic receptors on bronchial smooth muscle
- Increased cyclic AMP: Stimulates adenylyl cyclase, raising intracellular cAMP
- Bronchial relaxation: cAMP-dependent protein kinase mediates smooth muscle relaxation
- 24-hour duration: Lipophilic tail allows prolonged receptor engagement
- Fast onset: Bronchodilation begins within 15 minutes
Available Formulations
Vilanterol is only available in combination products:
- Breo Ellipta: Fluticasone furoate/vilanterol (100/25 mcg, 200/25 mcg)
- Anoro Ellipta: Umeclidinium/vilanterol (62.5/25 mcg)
- Trelegy Ellipta: Fluticasone furoate/umeclidinium/vilanterol (100/62.5/25 mcg, 200/62.5/25 mcg)
All are 30-dose dry powder inhalers.
Medical Uses
FDA-Approved Indications (in combination):
- COPD maintenance treatment (all combinations)
- Asthma maintenance treatment in patients ≥18 years (ICS/LABA combinations only)
- Asthma in adolescents ≥12 years (fluticasone/vilanterol at lower strength only for asthma control)
Not for:
- Primary treatment of acute bronchospasm
- Asthma without concurrent ICS
Dosing Guidelines
COPD (All combinations):
- One inhalation once daily
Asthma (ICS/vilanterol):
- One inhalation once daily
- Use lowest effective ICS dose
Administration:
- Same time each day
- Do not exceed one inhalation daily
- Rinse mouth after use (ICS-containing products)
Important Safety Information
Black Box Warning:
- LABAs increase the risk of asthma-related death
- Only use vilanterol for asthma in combination with ICS
- Not for asthma in patients adequately controlled on ICS alone
Contraindications:
- Severe hypersensitivity to milk proteins
- Known hypersensitivity to vilanterol or any component
- Asthma without concurrent ICS
Warnings and Precautions:
- Not for acute symptoms (not a rescue medication)
- Paradoxical bronchospasm
- Cardiovascular effects (increased pulse, blood pressure, arrhythmias)
- Hypokalemia
- Hyperglycemia
Drug Interactions
- Strong CYP3A4 inhibitors (ketoconazole, ritonavir): May increase vilanterol exposure; use with caution
- Beta-blockers: May antagonize effects; use cardioselective beta-blockers with caution
- Non-potassium-sparing diuretics: May worsen hypokalemia
- MAOIs, tricyclic antidepressants: May potentiate cardiovascular effects
- Other LABAs: Avoid concomitant use
Special Populations
- Hepatic Impairment: Use with caution; fluticasone/vilanterol may have increased exposure in severe impairment
- Renal Impairment: No adjustment expected
- Elderly: No adjustment needed
- Pregnancy: Limited data; use only if benefit outweighs risk
- Lactation: Unknown if excreted in milk
- Pediatric: Asthma approved ≥12 years (ICS/LABA); COPD products not for children
Frequently Asked Questions
Questions to Ask Your Doctor
Consider discussing these topics at your next appointment:
- ✓Am I using the Ellipta inhaler correctly—can you watch my technique?
- ✓Do I still need a separate rescue inhaler, and how often is too often to use it?
- ✓Are any of my heart or blood pressure medications interacting with vilanterol?
- ✓Should I be on a single, dual, or triple inhaler combination for my condition?
Related Health Conditions
This medication is commonly used to treat or manage the following conditions:
Asthma
Asthma, a chronic lung disease, causes airway inflammation and narrowing, resulting in wheezing, coughing, and shortness of breath, triggered by allergens, irritants, infections, or stress.
Chronic Obstructive Pulmonary Disease (COPD)
COPD, a progressive lung disease causing irreversible airflow limitation, encompassing emphysema and chronic bronchitis, is primarily driven by irritant exposure like smoking, leading to shortness of breath and chronic cough.
Osteoarthritis
Osteoarthritis, a common degenerative joint disease, causes pain, stiffness, and reduced motion due to cartilage breakdown from aging, genetics, obesity, injuries, or repetitive stress.
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.
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Questions About This Medication?
Talk to your doctor or pharmacist about whether Vilanterol is right for you.
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