What is the recommended dosage of Bevespi Aerosphere (glycopyrrolate and formoterol fumarate) for a patient with Chronic Obstructive Pulmonary Disease (COPD) or asthma?

Bevespi Aerosphere Dosing for COPD

The recommended dosage of Bevespi Aerosphere (glycopyrrolate/formoterol fumarate 18/9.6 mcg) is two inhalations twice daily (morning and evening), delivering a total daily dose of 36/19.2 mcg. 1, 2

Standard Dosing Regimen

• Administer 2 inhalations of Bevespi Aerosphere twice daily (approximately 12 hours apart), which delivers glycopyrrolate 18 mcg and formoterol fumarate 9.6 mcg per dose 1, 2
• The maximum recommended daily dose is 2 inhalations twice daily; do not exceed this dose or use more frequently than prescribed 3
• This medication is indicated specifically for maintenance treatment of COPD only—it is NOT approved for asthma treatment 3, 1

Critical Safety Considerations

Not for Acute Symptoms

• Bevespi Aerosphere should never be used for relief of acute bronchospasm or as rescue therapy—it has not been studied for acute symptom relief 3
• Always prescribe a short-acting beta2-agonist (such as albuterol) concurrently for acute symptom management 3
• For acute COPD exacerbations requiring immediate bronchodilation, use nebulized short-acting bronchodilators (salbutamol 2.5-5 mg with ipratropium 250-500 mcg every 4-6 hours) instead 4, 5

Contraindications and Warnings

• Do not initiate Bevespi Aerosphere in patients with acutely deteriorating COPD—this is inappropriate and potentially life-threatening 3
• Never use in conjunction with other long-acting beta2-agonists (LABAs) to avoid overdose and cardiovascular complications 3
• Long-acting beta2-agonists carry a class-wide increased risk of asthma-related death, which is why this medication is contraindicated in asthma 3

Administration Technique

• Patients may use Bevespi Aerosphere with or without the Aerochamber Plus Flow-Vu valved holding chamber (VHC)—both methods provide equivalent bronchodilatory efficacy 1
• The VHC option is particularly useful for patients who have difficulty coordinating MDI actuation with inhalation 1
• When using the VHC, there is slightly higher systemic exposure to glycopyrronium (approximately 16% increase in AUC), but this does not alter the safety profile 1

Monitoring and Dose Adjustment

• Do not increase the dose beyond 2 inhalations twice daily even if symptoms worsen—increasing frequency is inappropriate and dangerous 3
• If Bevespi Aerosphere no longer controls symptoms or the patient requires more frequent use of rescue short-acting beta2-agonist, this signals disease deterioration requiring immediate re-evaluation 3
• In such cases, consider escalation to triple therapy (adding an inhaled corticosteroid) rather than increasing Bevespi dose 6, 7

Pharmacokinetic Profile

• Glycopyrronium accumulates approximately 2.3-fold at steady state (Week 12) compared to Day 1 2
• Formoterol accumulates approximately 1.6-fold at steady state compared to Day 1 2
• There are no clinically significant pharmacokinetic interactions between glycopyrronium and formoterol when delivered via the co-suspension delivery technology 2

Common Pitfalls to Avoid

• Never substitute Bevespi Aerosphere for nebulized bronchodilators during acute exacerbations—the onset and route make nebulized therapy superior for immediate relief 5
• Do not prescribe for patients with asthma, even if they also have COPD features—the LABA component carries unacceptable asthma-related mortality risk 3
• Avoid use in patients with cardiovascular disorders (coronary insufficiency, arrhythmias, hypertension) without careful risk-benefit assessment, as beta-agonists can cause clinically significant cardiovascular effects 3
• Monitor for paradoxical bronchospasm, which requires immediate discontinuation if it occurs 3