Can you take Incruse Ellipta (Umeclidinium) and Wixela Inhale (Fluticasone/Salmeterol) together?

Using Incruse Ellipta and Wixela Inhub Together for COPD Management

Yes, Incruse Ellipta (umeclidinium) and Wixela Inhub (fluticasone/salmeterol) can be safely and effectively used together as part of a combination therapy approach for COPD management, particularly for patients with FEV1 <60% predicted who continue to have symptoms or exacerbations despite monotherapy.

Medication Overview

Incruse Ellipta (Umeclidinium)

• Classification: Long-acting muscarinic antagonist (LAMA)
• Mechanism: Bronchodilation through muscarinic receptor blockade
• Dosing: Once daily

Wixela Inhub (Fluticasone/Salmeterol)

• Classification: Combination of inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA)
• Mechanism: Anti-inflammatory effect (fluticasone) plus bronchodilation (salmeterol)
• Dosing: Twice daily

Evidence Supporting Combination Therapy

Current COPD management guidelines support the use of combination therapy for patients with persistent symptoms and exacerbations:

• For patients with FEV1 <60% predicted, combination therapy with long-acting inhaled medications is recommended 1
• Triple therapy (LAMA + LABA + ICS) has shown benefits in reducing exacerbations and improving quality of life in patients with moderate to severe COPD 2
• The UPLIFT study demonstrated that adding a LAMA (tiotropium) to existing therapy reduced exacerbation rates and improved lung function 1

Benefits of Using These Medications Together

1. Complementary mechanisms of action:

   • LAMA (umeclidinium): Targets muscarinic receptors for bronchodilation
   • LABA (salmeterol): Targets beta-2 receptors for bronchodilation
   • ICS (fluticasone): Reduces airway inflammation

2. Improved clinical outcomes:

   • Greater improvement in lung function than either medication alone 1
   • Reduced exacerbation rates 1, 2
   • Improved quality of life measures 1

Administration Considerations

• Timing: Space the medications apart when possible

  • Incruse Ellipta: Administer once daily
  • Wixela Inhub: Administer twice daily

• Device technique: Both use dry powder inhaler technology but with different devices

  • Ensure proper technique for each device separately
  • The Ellipta device has proven easy to use and is preferred by patients 3
  • Wixela Inhub has been shown to be robust and easy to use 4, 5

Potential Concerns and Monitoring

1. Adverse effects:

   • Monitor for potential overlapping side effects:
     • Dry mouth (more common with LAMAs)
     • Cardiovascular effects (tachycardia, palpitations)
     • Tremor (more common with LABAs)
   • Increased risk of pneumonia with ICS component 1, 2

2. Efficacy monitoring:

   • Assess symptom control
   • Track exacerbation frequency
   • Monitor lung function periodically

Patient Selection for Combination Therapy

This combination is particularly appropriate for:

• Patients with FEV1 <60% predicted 1, 2
• Those with persistent symptoms despite monotherapy
• Patients with frequent exacerbations (≥2 per year) 2
• Those with features of asthma-COPD overlap syndrome 2

Conclusion

Using Incruse Ellipta (umeclidinium) and Wixela Inhub (fluticasone/salmeterol) together provides complementary mechanisms for COPD management through triple therapy (LAMA + LABA + ICS). This approach is supported by guidelines for patients with moderate to severe COPD who remain symptomatic on monotherapy or have frequent exacerbations.