What is the proper dosing for fluticasone-vilanterol (Fluticasone-Vilanterol)

Proper Dispensing of Fluticasone-Vilanterol

Fluticasone-vilanterol (Breo Ellipta) should be dispensed as 1 actuation once daily by oral inhalation, with the patient rinsing their mouth with water afterward without swallowing to reduce the risk of oral candidiasis. 1

Dosage Forms and Strengths

Fluticasone-vilanterol is available as an inhalation powder in three strengths:

• 50 mcg fluticasone furoate/25 mcg vilanterol (50/25 mcg) per actuation
• 100 mcg fluticasone furoate/25 mcg vilanterol (100/25 mcg) per actuation
• 200 mcg fluticasone furoate/25 mcg vilanterol (200/25 mcg) per actuation 1

Dosing by Indication

For COPD:

• The recommended dosage is Breo Ellipta 100/25 mcg (containing fluticasone furoate 100 mcg and vilanterol 25 mcg): 1 actuation once daily by oral inhalation 1

For Asthma:

• Adults (≥18 years):

  • Breo Ellipta 100/25 mcg or 200/25 mcg: 1 actuation once daily
  • Maximum recommended dosage: 1 inhalation of 200/25 mcg once daily 1

• Adolescents (12-17 years):

  • Breo Ellipta 100/25 mcg: 1 actuation once daily 1

• Children (5-11 years):

  • Breo Ellipta 50/25 mcg: 1 actuation once daily 1

Administration Instructions

1. Administer at the same time every day
2. Do not use more than once every 24 hours
3. After inhalation, the patient should rinse their mouth with water without swallowing
4. Do not administer more frequent inhalations or a greater number of inhalations than prescribed 1

Proper Technique and Device Use

• The medication is delivered via the Ellipta dry powder inhaler 2
• For optimal delivery, patients should:
  • Use slow, deep inhalation followed by a 10-second breath hold immediately after actuation 3
  • Ensure proper seal between the mouthpiece and lips
  • Rinse mouth after administration to prevent oral thrush 3

Important Cautions and Contraindications

Fluticasone-vilanterol is contraindicated in:

• Primary treatment of status asthmaticus or other acute episodes of COPD or asthma
• Severe hypersensitivity to milk proteins or demonstrated hypersensitivity to fluticasone furoate, vilanterol, or any excipients 1

Monitoring and Side Effects

• Common side effects include nasopharyngitis, headache, and upper respiratory tract infections 2
• More serious concerns include increased risk of pneumonia, particularly with long-term use 4
• For children using inhaled corticosteroids, regular growth monitoring is recommended 3

Efficacy Considerations

• The combination of fluticasone furoate and vilanterol has been shown to be effective in improving lung function in both asthma and COPD patients 5, 6
• The once-daily dosing may improve treatment adherence compared to twice-daily regimens 2

Remember that fluticasone-vilanterol is indicated for maintenance treatment only and is NOT indicated for the relief of acute bronchospasm. Patients should be advised to use a short-acting beta2-agonist (rescue medication) for immediate relief of symptoms 1.