Can Wixela (fluticasone/salmeterol) and Incruse (umeclidinium) be taken together?

Using Wixela (Fluticasone/Salmeterol) and Incruse (Umeclidinium) Together for COPD

Yes, Wixela (fluticasone/salmeterol) and Incruse (umeclidinium) can be safely and effectively used together, particularly in patients with moderate to severe COPD who remain symptomatic or experience frequent exacerbations despite optimal therapy with either medication alone.

Medication Classes and Mechanisms

• Wixela Inhub: A generic equivalent of Advair Diskus containing:

  • Fluticasone propionate (inhaled corticosteroid/ICS)
  • Salmeterol (long-acting beta-agonist/LABA) 1, 2

• Incruse: Contains umeclidinium (long-acting muscarinic antagonist/LAMA)

Evidence Supporting Combination Therapy

The combination of these medications represents a form of "triple therapy" (ICS + LABA + LAMA), which is supported by clinical evidence for specific COPD patient populations:

• The UPLIFT study demonstrated that adding a LAMA (tiotropium) to existing therapy (which often included ICS/LABA combinations) reduced exacerbation rates (HR 0.86), increased time to first exacerbation (16.7 vs 12.5 months), and reduced respiratory failure incidence 3

• Triple therapy has shown superior benefits in:

  • Improving lung function
  • Reducing symptom burden
  • Enhancing quality of life
  • Decreasing exacerbation rates in patients with moderate to severe COPD 3, 4

Patient Selection for Triple Therapy

Triple therapy with Wixela and Incruse is most appropriate for:

1. Patients with severe COPD who remain symptomatic despite dual therapy 5
2. Patients with FEV₁ <50-60% predicted 3
3. Patients with frequent exacerbations (≥2 per year) despite optimal bronchodilator therapy 3, 5
4. Patients with high symptom burden (mMRC score ≥3) 5

Safety Considerations

When using these medications together, monitor for:

• Pneumonia risk: ICS components (like fluticasone in Wixela) are associated with increased pneumonia risk (OR 1.38-1.56) 3
• Anticholinergic side effects from umeclidinium: dry mouth, urinary retention, potential worsening of narrow-angle glaucoma 5
• Cardiovascular effects: Monitor for tachycardia or other cardiovascular events, though studies show the safety profile of triple therapy is generally good without excess cardiovascular effects 4

Administration Approach

• Both medications use different devices and mechanisms, so proper inhaler technique for each device is essential
• Administer according to their individual dosing schedules:
  • Wixela: Typically twice daily
  • Incruse: Once daily
• No specific timing sequence between the two medications is required

Monitoring Recommendations

When using this combination, regularly assess:

1. Symptom improvement (dyspnea scores)
2. Exacerbation frequency
3. Exercise tolerance
4. Quality of life measures
5. Adverse effects, particularly monitoring for pneumonia

Conclusion

The combination of Wixela (fluticasone/salmeterol) and Incruse (umeclidinium) represents a valid therapeutic approach for patients with moderate to severe COPD who remain symptomatic or experience frequent exacerbations despite optimal therapy with either medication alone. This approach aligns with current guidelines that recommend escalation to triple therapy in appropriate patients.