Starting Dose for Anoro Inhaler
The recommended starting dose of Anoro (umeclidinium/vilanterol) is 62.5 µg/25 µg (equivalent to a delivered dose of 55 µg/22 µg) administered once daily via the Ellipta dry powder inhaler for maintenance treatment of COPD in adults. 1, 2
Standard Dosing Regimen
- One inhalation once daily is the only approved dose for Anoro, with no titration required 1, 3
- The 62.5 µg/25 µg dose (umeclidinium/vilanterol) has been extensively studied in large multicenter trials of up to 24 weeks and demonstrated superior efficacy compared to placebo, individual components, and tiotropium monotherapy 1, 3
- This fixed-dose combination delivers umeclidinium (a long-acting muscarinic antagonist/LAMA) and vilanterol (a long-acting β2-agonist/LABA) in a single device 1, 4
No Dose Adjustments Required
- No dose adjustments are necessary based on patient demographics including age, body weight, or creatinine clearance, as population pharmacokinetic studies showed minimal effects of these covariates on drug exposure 5
- A 10% increase in age results in only a 7% decrease in umeclidinium clearance and 4% decrease in vilanterol clearance—clinically insignificant changes 5
- Renal impairment (10% decrease in creatinine clearance) produces only a 3% decrease in umeclidinium clearance 5
Clinical Context and Positioning
- Anoro is indicated for maintenance treatment of COPD in adults with moderate to very severe disease who require dual bronchodilation 1, 2
- This combination is not for acute bronchospasm or exacerbations—acute COPD exacerbations require nebulized short-acting bronchodilators (salbutamol 2.5-5 mg or terbutaline 5-10 mg plus ipratropium 250-500 µg every 4-6 hours) 6, 7
- The once-daily dosing via the Ellipta inhaler offers convenience and is regarded as easy to use compared to multiple-dose regimens 1
Safety Profile
- The most common adverse events in clinical trials were headache and nasopharyngitis 1
- Pooled data from multiple trials showed no clinically relevant increased risk of cardiovascular adverse events in COPD patients 1
- There are no pharmacokinetic interactions between umeclidinium and vilanterol when co-administered 5
Common Pitfalls to Avoid
- Do not use Anoro for acute symptom relief—patients need a separate short-acting rescue inhaler 6, 7
- Do not attempt dose escalation—the 62.5 µg/25 µg dose is the only approved strength, and higher doses (125 µg/25 µg studied in trials) are not commercially available or recommended 3
- Ensure proper inhaler technique with the Ellipta device, as technique must be demonstrated and checked periodically for optimal drug delivery 6