What is the recommended dosage of Ellipta (fluticasone furoate and vilanterol) for a patient with chronic obstructive pulmonary disease (COPD) or asthma?

Ellipta Dosage Recommendations

For COPD, use fluticasone furoate/vilanterol (Ellipta) 100/25 mcg once daily; for asthma, use 100/25 mcg or 200/25 mcg once daily depending on disease severity and prior treatment. 1

COPD Dosing

The FDA-approved dosage for COPD maintenance treatment is fluticasone furoate/vilanterol 100/25 mcg (100 mcg fluticasone furoate and 25 mcg vilanterol) administered as one inhalation once daily. 1

• This once-daily regimen provides sustained 24-hour bronchodilation with significant improvements in lung function (220-236 mL increase in FEV1 compared to placebo). 2
• The combination demonstrates superior efficacy compared to fluticasone propionate/salmeterol 250/50 mcg twice daily for pulmonary function. 3
• Administer at the same time each day; do not use more than once every 24 hours. 1

Asthma Dosing

Adults (≥18 years)

Start with fluticasone furoate/vilanterol 100/25 mcg once daily, or 200/25 mcg once daily for patients requiring higher ICS doses. 1

• Base the starting strength on disease severity, previous asthma therapy (including prior ICS dosage), current symptom control, and future exacerbation risk. 1
• For inadequate response to 100/25 mcg, escalate to 200/25 mcg once daily for additional asthma control. 1
• Maximum dosage is 200/25 mcg once daily. 1
• Onset of action occurs within approximately 15 minutes (median time to 100-mL FEV1 increase). 1

Adolescents (12-17 years)

Use fluticasone furoate/vilanterol 100/25 mcg once daily. 1

Children (5-11 years)

Use fluticasone furoate/vilanterol 50/25 mcg once daily. 1

Administration Guidelines

• Rinse mouth with water after inhalation without swallowing to reduce oropharyngeal candidiasis risk. 1
• Administer at the same time every day for optimal efficacy. 1
• Use short-acting beta2-agonists (e.g., albuterol) for acute symptom relief between doses. 1

Clinical Efficacy Evidence

• Once-daily fluticasone furoate/vilanterol 100/25 mcg demonstrates non-inferior efficacy to twice-daily fluticasone propionate/salmeterol 250/50 mcg in asthma patients. 4
• The combination is well-tolerated with low systemic exposure and no clinically significant effects on serum glucose, potassium, vital signs, or cortisol levels. 2
• In COPD patients with cardiovascular risk factors, fluticasone furoate/vilanterol shows comparable efficacy to tiotropium with similar cardiovascular safety profiles. 5

Important Safety Considerations

• Monitor for increased pneumonia risk with long-term use in COPD patients, as observed with all ICS-containing regimens. 3
• Not indicated for acute bronchospasm relief. 1
• Treatment-related adverse events occur in <15% of patients, most commonly oral candidiasis, dysphonia, extrasystoles, and cough. 6