Is Trelegy a Beta Blocker?
No, Trelegy is not a beta blocker—it is a triple combination inhaler containing an inhaled corticosteroid (fluticasone furoate), a long-acting muscarinic antagonist (umeclidinium), and a long-acting beta-2 agonist (vilanterol), which actually stimulates rather than blocks beta receptors. 1, 2
What Trelegy Actually Contains
Trelegy Ellipta is specifically composed of three distinct drug classes for COPD maintenance treatment 1:
- Fluticasone furoate: An inhaled corticosteroid (ICS) that reduces airway inflammation 1, 2
- Umeclidinium bromide: A long-acting muscarinic antagonist (LAMA) that provides bronchodilation by blocking acetylcholine receptors 2, 3
- Vilanterol trifenatate: A long-acting beta-2 adrenergic agonist (LABA) that stimulates beta-2 receptors to cause bronchodilation 1, 3
Critical Distinction: Beta Agonist vs Beta Blocker
The vilanterol component in Trelegy is a beta-2 agonist, which has the opposite pharmacological effect of a beta blocker 1, 3:
- Beta agonists (like vilanterol) stimulate beta receptors, causing bronchodilation and increased heart rate 1
- Beta blockers (like metoprolol, bisoprolol) block beta receptors, causing bronchoconstriction risk and decreased heart rate 4, 5
Important Clinical Implications for Patients with Hypertension
For your patient with both COPD and hypertension, this distinction matters significantly:
Trelegy will not treat hypertension—it contains no antihypertensive agents and the beta-2 agonist component may actually cause cardiovascular stimulation including tachycardia and hypertension as potential side effects 1
If beta blocker therapy is needed for hypertension, it can generally be used safely alongside Trelegy in COPD patients, though cardioselective agents are strongly preferred 4
Cardioselective beta-1 blockers (metoprolol, bisoprolol) are safe in COPD and do not significantly affect the bronchodilator action of Trelegy's beta-2 agonist component, though they may reduce the heart rate acceleration caused by vilanterol 4
Common Pitfall to Avoid
Do not withhold beta blockers in COPD patients who need them for cardiovascular indications (hypertension, heart failure, coronary disease) due to outdated fears about bronchospasm 4. Meta-analyses demonstrate that cardioselective beta-1 blockers are not only safe in COPD but actually reduce all-cause mortality and may even reduce COPD exacerbations 4. However, avoid non-selective beta blockers in patients with asthma, as these can cause dangerous bronchoconstriction 4.