How do I incorporate Yupelri (revefenacin) into a Chronic Obstructive Pulmonary Disease (COPD) management routine?

Incorporating Yupelri (Revefenacin) into COPD Management

Direct Answer

Yupelri 175 mcg should be administered once daily via standard jet nebulizer with mouthpiece as maintenance therapy for patients with moderate to very severe COPD who require or prefer nebulized delivery, but must never be combined with other long-acting muscarinic antagonists (LAMAs) such as those in Trelegy, Incruse, or tiotropium. 1

Patient Selection Criteria

Appropriate Candidates for Yupelri

• Patients who are elderly, cognitively impaired, or unable to generate sufficient inspiratory force for dry powder inhalers 2
• Patients with difficulty coordinating hand-breath activity required for metered-dose inhalers 2
• Patients who are too dyspneic to hold their breath for sufficient time with traditional inhalers 2
• Patients who prefer nebulized therapy or have established nebulizer use at home 3, 4

Contraindications and Precautions

• Do not initiate Yupelri during acutely deteriorating COPD or potentially life-threatening episodes 1
• Contraindicated in patients with hypersensitivity to revefenacin or any component 1
• Avoid use in patients with hepatic impairment 1
• Use with caution in narrow-angle glaucoma and prostatic hyperplasia/bladder-neck obstruction 1

Administration Protocol

Dosing and Device Requirements

• The recommended dose is 175 mcg (one unit-dose vial) administered once daily via standard jet nebulizer with mouthpiece connected to air compressor 1
• Remove vial from foil pouch immediately before use; discard vial and residual content after use 1
• Safety and efficacy established using PARI LC Sprint nebulizer with mouthpiece and PARI Trek S compressor 1
• Non-compressor based nebulizer systems have not been validated for Yupelri delivery 1

Critical Drug Interaction Management

• Immediately discontinue any concurrent LAMA therapy (tiotropium, umeclidinium, aclidinium, glycopyrrolate) before starting Yupelri to avoid additive anticholinergic effects 5, 1
• If patient is on triple therapy (e.g., Trelegy containing umeclidinium/vilanterol/fluticasone), do NOT add Yupelri—the existing LAMA provides adequate coverage 5
• Avoid coadministration with OATP1B1 and OATP1B3 inhibitors (rifampicin, cyclosporine) as they increase active metabolite exposure 1
• Review all anticholinergic medications to minimize additive anticholinergic burden 5, 1

Integration with Existing COPD Therapy

Combination with Other Bronchodilators

• Yupelri can be combined with long-acting beta-agonists (LABAs) or LABA/ICS combinations for enhanced symptom control 6, 7
• In the 52-week trial, patients using Yupelri 175 mcg with concurrent LABA showed no increased incidence of adverse events compared to Yupelri alone 7
• LABA + LAMA combination provides superior improvements in pulmonary function, symptoms, and exacerbation reduction compared to monotherapy 6

Rescue Therapy Considerations

• Yupelri is maintenance therapy only—not for acute symptom relief 1
• Patients must have a short-acting beta-agonist (SABA) available for rescue therapy 1
• If rescue SABA becomes less effective or is needed more frequently, re-evaluate the entire COPD treatment regimen 1

Monitoring and Follow-Up

Initial Assessment (2-4 Weeks)

• Verify proper nebulizer technique at prescription and check at every follow-up visit 5
• Assess trough FEV1 improvement (expect 52-124 mL increase from baseline based on 52-week trial data) 8
• Evaluate symptom control using validated tools (CAT, mMRC dyspnea scale, SGRQ) 8

Ongoing Safety Monitoring

• Monitor for anticholinergic side effects: dry mouth, urinary retention, constipation, blurred vision 1, 2
• Watch for paradoxical bronchospasm—if occurs, discontinue immediately and institute alternative therapy 1
• Screen for worsening narrow-angle glaucoma symptoms (eye pain, vision changes) 1
• Assess for urinary retention symptoms, especially in men with prostatic hyperplasia 1
• Avoid beta-blocking agents including ophthalmic preparations in all COPD patients on bronchodilator therapy 5, 9

Long-Term Efficacy Assessment

• Sustained trough FEV1 improvements maintained over 52 weeks in clinical trials 8
• Statistically significant improvements in health status outcomes (SGRQ, CAT, CCQ, BDI/TDI) observed from 3 months onward 8
• Numerically fewer COPD exacerbations observed with 175 mcg dose (21.8%) compared to 88 mcg (29.4%) or tiotropium (28.1%) 7

Common Pitfalls to Avoid

• Never duplicate LAMA therapy—this is the most critical error when incorporating Yupelri 5, 1
• Do not mix Yupelri with other drugs in the nebulizer—compatibility has not been established 1
• Do not use for acute exacerbations or as rescue therapy 1
• Do not increase dosing frequency beyond once daily—extra doses are inappropriate for worsening symptoms 1
• Ensure patients understand nebulizer cleaning and maintenance to prevent infections 5