Yupelri (Revefenacin) Dosing for COPD Maintenance Treatment
The recommended dose of Yupelri (revefenacin) for maintenance treatment of chronic obstructive pulmonary disease (COPD) is 175 mcg (one 175 mcg unit-dose vial) administered by oral inhalation once daily via a standard jet nebulizer. 1
Administration Details
- Yupelri should be administered using a standard jet nebulizer connected to an air compressor
- Safety and efficacy have been established using the PARI LC® Sprint nebulizer with a mouthpiece and the PARI Trek® S compressor 1
- The unit-dose vial should only be removed from the foil pouch and opened immediately before use
- The vial and any residual content should be discarded after use
- Administration is via oral inhalation using a mouthpiece (not a face mask)
Important Clinical Considerations
Dosage Adjustments
- No dosage adjustment is required for:
- Geriatric patients
- Patients with renal impairment 1
- Avoid use in patients with hepatic impairment 1
Efficacy Profile
- Revefenacin 175 μg demonstrated significant improvements in trough FEV1 compared to placebo (146-147 mL improvement) 2
- The therapeutic effect is maintained over 52 weeks with trough FEV1 improvements ranging from 52.3-124.3 mL 3
- Onset of bronchodilation occurs as early as 5 minutes post-dose and is sustained for up to 24 hours 4
Drug Interactions
- Avoid administration with other anticholinergic-containing drugs as they may interact additively 1
- Coadministration with OATP1B1 and OATP1B3 inhibitors (e.g., rifampicin, cyclosporine) is not recommended as it may increase exposure of the active metabolite 1
Contraindications and Warnings
- Contraindicated in patients with hypersensitivity to revefenacin or any component of the product 1
- Should not be initiated during acutely deteriorating or potentially life-threatening episodes of COPD 1
- Not for relief of acute symptoms (not a rescue therapy)
- Use with caution in patients with:
- Narrow-angle glaucoma
- Prostatic hyperplasia or bladder-neck obstruction 1
Clinical Pearls
- Revefenacin is the only once-daily LAMA approved for delivery via standard jet nebulizer 5
- Particularly useful for patients who cannot properly use handheld inhalers or prefer nebulized therapy 6
- Can be used concomitantly with long-acting beta2-agonists (LABAs) with or without inhaled corticosteroids 3
- Common adverse events include cough, nasopharyngitis, upper respiratory tract infection, headache, and back pain 1
By providing a once-daily nebulized LAMA option, Yupelri offers an alternative delivery method that may improve medication adherence in appropriate COPD patients, particularly those with physical limitations or cognitive impairments that affect proper inhaler technique.