What is the recommended dosage for a patient using Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol)?

Trelegy Ellipta Dosing

Trelegy Ellipta is administered as one inhalation once daily, with the specific strength determined by the indication: 100/62.5/25 mcg for COPD and either 100/62.5/25 mcg or 200/62.5/25 mcg for asthma depending on disease severity. 1

COPD Dosing

• Standard dose: Fluticasone furoate/umeclidinium/vilanterol 100/62.5/25 mcg, one inhalation once daily 1
• This is the only approved strength for COPD maintenance treatment 1
• Use a short-acting beta2-agonist (e.g., albuterol) for breakthrough shortness of breath between doses 1

Asthma Dosing

Adults (≥18 years)

• Starting options: Either 100/62.5/25 mcg OR 200/62.5/25 mcg, one inhalation once daily 1
• Choose the starting strength based on disease severity, prior ICS dose, current symptom control, and exacerbation risk 1
• Dose escalation: If inadequate response on 100/62.5/25 mcg, increase to 200/62.5/25 mcg once daily 1
• Maximum dose: 200/62.5/25 mcg once daily 1
• If symptoms persist on maximum dose, re-evaluate and consider alternative therapeutic regimens 1

Adolescents (12-17 years)

• Dose: 100/62.5/25 mcg, one inhalation once daily 1

Children (5-11 years)

• Dose: 50/62.5/25 mcg, one inhalation once daily 1

Administration Instructions

• Timing: Administer at the same time every day 1
• Frequency: Never use more than once every 24 hours 1
• Post-inhalation: Rinse mouth with water without swallowing to reduce oropharyngeal candidiasis risk 1
• Onset: Median time to 100-mL FEV1 improvement is approximately 15 minutes, though individual response varies 1

Clinical Context

• Trelegy is indicated for COPD patients not adequately controlled on ICS/LABA dual therapy 2, 3
• The American Thoracic Society recommends triple therapy for patients with persistent moderate-to-severe dyspnea despite dual therapy or those at high exacerbation risk 2
• The ELLIPTA device delivers >80% of nominal blister content across flow rates of 30-90 L/min, making it suitable for patients with all COPD and asthma severity levels 4
• Dose emission occurs rapidly and is near-complete before reaching peak inspiratory flow 4

Critical Warnings

• Do not exceed one inhalation per 24 hours - higher doses increase adverse effect risk without additional benefit 1
• Use rescue inhalers (short-acting beta2-agonists) for acute symptom relief, not additional Trelegy doses 1