Vilanterol

Chronic Obstructive Pulmonary Disease (COPD)

Vilanterol is used for the long-term maintenance treatment of airflow obstruction in patients with COPD. This includes conditions such as:

• Chronic bronchitis: A condition involving long-term inflammation and swelling of the airways.
• Emphysema: A condition where the air sacs in the lungs are damaged.

In patients with COPD, vilanterol helps to improve lung function and can reduce the frequency of flare-ups or exacerbations where symptoms suddenly worsen.

Asthma

When used in combination with an inhaled corticosteroid, vilanterol is indicated for the long-term treatment of asthma. It is typically prescribed for patients whose asthma is not well-controlled on a long-term asthma control medication alone. It helps keep the airways open to prevent symptoms such as wheezing, chest tightness, and shortness of breath.

Maintenance vs. Rescue Use

Vilanterol is a maintenance medication, meaning it must be taken every day at the same time to be effective. It is not a rescue medication and will not work fast enough to treat a sudden asthma attack or a sudden episode of breathlessness. Patients should always have a separate rescue inhaler available for emergency symptoms.

Mechanism of Action

Vilanterol belongs to a class of drugs called long-acting beta2-adrenergic agonists (LABAs). It works by stimulating specific receptors in the lungs known as beta2-receptors. These receptors are located on the smooth muscles that surround the airways.

When vilanterol attaches to these receptors, it causes the muscles to relax. This relaxation allows the airways to widen, a process called bronchodilation. Wider airways make it easier for air to flow into and out of the lungs, which helps reduce symptoms such as:

• Wheezing
• Shortness of breath
• Coughing
• Chest tightness

Long-Term Maintenance

Vilanterol is designed to provide long-lasting relief, typically working for up to 24 hours with a single dose. Because it takes time to start working and its effects are prolonged, it is used as a maintenance treatment to prevent breathing difficulties from occurring. It is not a rescue medication and should not be used to treat a sudden onset of severe breathing problems or an asthma attack.

Common Side Effects

Vilanterol may cause mild side effects as the body adjusts to the medication. These often include:

• Headache
• Runny or stuffy nose
• Sore throat and cough
• Back, joint, or stomach pain
• Sinus irritation or pain
• Hoarseness or voice changes
• Diarrhea

Serious Side Effects

Some side effects can be severe. Contact a healthcare provider immediately if you experience:

• Sudden, severe breathing problems or wheezing immediately after using the inhaler
• Chest pain or a fast, pounding, or irregular heartbeat
• Tremors, shakiness, or feeling nervous
• Signs of an allergic reaction, such as a rash, hives, or swelling of the face, lips, or tongue
• Vision changes, eye pain, or seeing halos around lights
• Signs of high blood sugar, such as increased thirst or frequent urination
• Signs of low potassium, such as muscle cramps or weakness
• Signs of a lung infection, including fever, chills, or changes in mucus color

Asthma-Related Risks

Vilanterol belongs to a class of drugs known as long-acting beta2-adrenergic agonists (LABAs). When used alone to treat asthma, LABAs may increase the risk of asthma-related death. Because of this, vilanterol is only used in combination with other medications, such as inhaled corticosteroids, and is not prescribed as a single-ingredient treatment for asthma.

Not for Acute Symptoms

Vilanterol is a maintenance medication and is not a rescue inhaler. It will not work fast enough to stop a sudden asthma attack or a flare-up of chronic obstructive pulmonary disease (COPD). A separate, fast-acting rescue inhaler must be used for sudden shortness of breath.

Paradoxical Bronchospasm

Like other inhaled medicines, vilanterol can cause paradoxical bronchospasm. This is a condition where breathing or wheezing suddenly gets worse immediately after using the medication. This can be life-threatening and requires immediate medical intervention.

Cardiovascular and Metabolic Effects

Vilanterol can affect the heart and blood pressure. Caution is recommended for individuals with certain underlying health conditions, including:

• Heart Disease: It may cause increased heart rate, elevated blood pressure, or irregular heart rhythms (arrhythmias).
• Seizure Disorders: Use with caution if there is a history of seizures.
• Thyroid Problems: It may worsen symptoms of an overactive thyroid (hyperthyroidism).
• Diabetes: Vilanterol may increase blood sugar levels.
• Low Potassium: It may cause a decrease in blood potassium levels (hypokalemia), which can affect heart function.

Allergic Reactions and Milk Protein Allergy

Severe allergic reactions, including anaphylaxis, hives, and swelling, can occur. Many inhalers containing vilanterol use lactose as a carrier, which may contain trace amounts of milk proteins. Individuals with a severe milk protein allergy should discuss this with a healthcare provider before use.

Other Considerations

When vilanterol is used in combination with other medications, such as anticholinergics or steroids, additional precautions may apply. These include an increased risk of pneumonia in patients with COPD, worsening of narrow-angle glaucoma, or increased difficulty with urination in those with prostate or bladder issues.

Pregnancy

There are no adequate or well-controlled studies of vilanterol in pregnant women. Because vilanterol belongs to a class of drugs called long-acting beta2-agonists (LABAs), it may potentially interfere with uterine contractions during labor and delivery. Healthcare providers typically only prescribe this medication during pregnancy if the potential benefit to the patient outweighs the potential risk to the fetus.

Breastfeeding

It is not known whether vilanterol passes into human breast milk. Because many drugs are excreted in human milk, caution is advised when vilanterol is administered to someone who is breastfeeding. A healthcare provider can help determine if the benefits of treatment outweigh the potential risks to the nursing infant.

Available Forms

Vilanterol is not available as a single-ingredient medication. It is exclusively found in combination products designed for oral inhalation. These products use a dry powder inhaler device that delivers a pre-measured dose of medication when the patient breathes in through the mouthpiece.

Common Combinations

• Dual Therapy: Vilanterol is commonly combined with either an inhaled corticosteroid or a long-acting muscarinic antagonist.
• Triple Therapy: It is also available in a single inhaler that contains three active ingredients: an inhaled corticosteroid, a long-acting muscarinic antagonist, and vilanterol.

Strengths

While the dose of vilanterol remains consistent in most combination products, the strengths of the other active ingredients may vary. Healthcare providers select the specific combination and strength based on whether the patient is treating asthma, chronic obstructive pulmonary disease (COPD), or both.

FDA Approval and Indications

Vilanterol is approved by the U.S. Food and Drug Administration (FDA) only as a component of combination inhalation products. It is not available as a single-ingredient medication. These combination products are approved for the following indications:

• Chronic Obstructive Pulmonary Disease (COPD): Long-term maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and emphysema. It is also used to reduce exacerbations of COPD in some patients.
• Asthma: Maintenance treatment of asthma in patients where the use of a combination product is appropriate.

Regulatory Safety and Requirements

The FDA has established specific regulatory requirements and safety guidelines for the use of vilanterol:

• Combination Use in Asthma: When used for asthma, vilanterol must be used in combination with an inhaled corticosteroid. Using a long-acting beta2-adrenergic agonist (LABA) alone for asthma is associated with an increased risk of asthma-related death.
• Not for Acute Symptoms: Vilanterol is not approved for the treatment of acute bronchospasm or as a rescue medication. It does not replace the need for a fast-acting rescue inhaler for sudden breathing problems.
• Maintenance Therapy: It is approved strictly for daily maintenance therapy. It should be used at the same time every day and not more frequently than prescribed.

The FDA has approved vilanterol in combination with fluticasone (a corticosteroid), umeclidinium (an anticholinergic), or both, depending on the specific respiratory condition being treated.

How Vilanterol Affects Breathing

Vilanterol belongs to a class of medications known as long-acting beta2-adrenergic agonists (LABAs). It works by stimulating receptors in the smooth muscles of the airways, causing them to relax. This action opens the air passages in the lungs, making it easier for air to flow in and out. This helps to prevent and reduce symptoms such as:

• Wheezing
• Shortness of breath
• Chest tightness
• Coughing

Long-Term Management

This medication is designed for the long-term maintenance of airflow obstruction in people with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. In some combination products, it is also used to manage asthma. Because its effects last for an extended period, it is typically used once every 24 hours to keep the airways open consistently throughout the day and night.

Important Safety Considerations

It is important to understand how to use vilanterol safely in relation to breathing symptoms:

• Not a rescue medication: Vilanterol does not work quickly enough to stop a sudden attack of breathlessness or wheezing. A separate fast-acting rescue inhaler must be used for sudden symptoms.
• Paradoxical bronchospasm: Like other inhaled medicines, vilanterol can sometimes cause a sudden worsening of breathing problems (bronchospasm) immediately after use. If breathing becomes suddenly difficult after inhalation, a rescue inhaler should be used immediately.
• Regular use: To effectively manage breathing, the medication must be used every day as prescribed, even if the person feels their breathing has improved.