Trelegy Ellipta Dosing for COPD and Asthma
For COPD, the recommended dosage is Trelegy Ellipta 100/25 mcg (fluticasone furoate 100 mcg/umeclidinium 62.5 mcg/vilanterol 25 mcg) as one inhalation once daily. 1
For asthma in adults (≥18 years), start with either Trelegy Ellipta 100/25 mcg or 200/25 mcg as one inhalation once daily, based on disease severity and prior ICS dosage. 1
COPD Dosing
Single strength available: Trelegy Ellipta 100/25 mcg (containing fluticasone furoate 100 mcg, umeclidinium 62.5 mcg, and vilanterol 25 mcg) administered once daily by oral inhalation 1
Timing: Administer at the same time every day; do not use more than once every 24 hours 1
Indications for triple therapy: The American Thoracic Society recommends Trelegy for patients with persistent moderate to severe dyspnea despite dual therapy and for patients at high risk of COPD exacerbations 2
Patient selection criteria: Consider triple therapy for patients with FEV1 <60% predicted and ≥2 exacerbations requiring antibiotics/oral steroids in the previous year 3
Asthma Dosing
Adults (≥18 years)
Starting dosage options: Either 100/25 mcg OR 200/25 mcg once daily 1
Dosage selection factors: Base the starting strength on disease severity, previous asthma therapy (including prior ICS dosage), current symptom control, and future exacerbation risk 1
Dose escalation: For patients inadequately controlled on 100/25 mcg once daily, increase to 200/25 mcg once daily for additional asthma control 1
Maximum dosage: One inhalation of 200/25 mcg once daily 1
Adolescents (12-17 years)
- Recommended dosage: 100/25 mcg once daily by oral inhalation 1
Children (5-11 years)
- Recommended dosage: 50/25 mcg (fluticasone furoate 50 mcg/vilanterol 25 mcg) once daily by oral inhalation 1
Administration Instructions
Mouth rinsing: After inhalation, rinse mouth with water without swallowing to reduce oropharyngeal candidiasis risk 1
Consistent timing: Use at the same time every day 1
Frequency warning: Do not use more than once every 24 hours; more frequent administration or multiple inhalations daily increases adverse effect risk 1
Onset of action: Median time to 100-mL FEV1 increase is approximately 15 minutes, though individual response varies 1
Clinical Context and Evidence
Single-inhaler advantage: The European Respiratory Journal notes that Trelegy uses the Ellipta inhaler device for once-daily administration, which may improve adherence compared to multiple-inhaler regimens 2
Non-inferiority data: Single-inhaler FF/UMEC/VI 100/62.5/25 mcg is non-inferior to using two separate inhalers (FF/VI + UMEC) for lung function improvement at 24 weeks 4
Mortality benefit: The European Respiratory Society suggests that single-inhaler triple therapy may reduce mortality in individuals with moderate-severe COPD compared to dual therapy options 2
Critical Safety Considerations
Contraindications: Do not use for primary treatment of status asthmaticus or acute COPD/asthma episodes where intensive measures are required 1
Hypersensitivity: Contraindicated in patients with severe hypersensitivity to milk proteins or demonstrated hypersensitivity to fluticasone furoate, vilanterol, or any excipients 1
Pneumonia risk: ICS-containing regimens increase pneumonia risk by approximately 4%, with odds ratios of 1.38-1.48 for adverse events 3
Not for acute relief: Trelegy is NOT indicated for relief of acute bronchospasm; use a short-acting beta2-agonist (e.g., albuterol) for rescue therapy 1
Common Pitfalls to Avoid
Excessive dosing: Never exceed one inhalation per 24-hour period, as higher doses increase adverse effects without additional benefit 1
Inappropriate indication: Do not use ICS monotherapy in COPD; ICS should only be used in combination with long-acting bronchodilators 3
Abrupt discontinuation: Withdrawing ICS can increase moderate-severe exacerbation risk, particularly in patients with blood eosinophils ≥300 cells/μL 3
Forgetting mouth rinsing: Failure to rinse mouth after use increases risk of oral candidiasis 1