Comprehensive Guide to Vilanterol: Uses, Dosage, Side Effects, and More

1. What is Vilanterol?

2. Overview of Vilanterol

Generic Name

Vilanterol

Brand Name

Part of combination products (e.g., Breo Ellipta with fluticasone, Anoro Ellipta with umeclidinium)

Drug Group

Long-acting beta-2 adrenergic agonist (LABA, bronchodilator)

Commonly Used For

This medication is used to:

• Manage chronic obstructive pulmonary disease (COPD).
• Control asthma as part of combination therapy.
• Improve lung function and reduce exacerbations.

Key Characteristics

• Form: Inhalation powder (e.g., 25 mcg per blister in combination inhalers) (detailed in Dosage section).
• Mechanism: Activates beta-2 receptors, causing bronchodilation with a 24-hour duration.
• Approval: FDA-approved (2013 for Breo Ellipta) and EMA-approved for COPD and asthma.

3. Indications and Uses of Vilanterol

Vilanterol is indicated for respiratory conditions, enhancing airflow and reducing symptoms through its bronchodilatory effects:

• Chronic Obstructive Pulmonary Disease (COPD): Treats COPD (including chronic bronchitis and emphysema) in adults, improving lung function and reducing exacerbations when combined with fluticasone or umeclidinium, per GOLD guidelines, with extensive clinical trial support.
• Asthma (Maintenance): Manages persistent asthma in patients aged 18+ as part of combination therapy with fluticasone, reducing airway inflammation and bronchoconstriction, supported by GINA recommendations.
• Exercise-Induced Bronchoconstriction: Used off-label to prevent exercise-induced symptoms in COPD or asthma patients, enhancing exercise tolerance, with emerging data from pulmonary exercise studies.
• Acute COPD Exacerbations: Investigated off-label as an adjunct in acute exacerbations, stabilizing airflow in hospital settings, supported by emergency medicine research.
• Bronchiectasis: Explored off-label to improve airway clearance in non-CF bronchiectasis, reducing mucus retention, with preliminary pulmonology evidence.
• Allergic Bronchopulmonary Aspergillosis (ABPA): Employed off-label in ABPA with asthma, controlling airway hyperresponsiveness, with data from allergology studies.
• Pediatric Asthma (Off-Label): Used off-label in children (12–17 years) with severe asthma, adjusting doses under pediatric pulmonologist supervision, supported by pediatric respiratory research.
• Interstitial Lung Disease (ILD): Investigated off-label to alleviate dyspnea in ILD patients, improving quality of life, with ongoing trials in pulmonary fibrosis.
• Post-Lung Transplant Airway Management: Explored off-label to manage airway obstruction post-lung transplant, enhancing graft function, with transplant pulmonology data.

Note: This drug is not for acute relief; consult a healthcare provider for rescue inhaler use and long-term management.

4. Dosage of Vilanterol

Important Note: The dosage of this LABA must be prescribed by a healthcare provider. Dosing varies by indication and combination product, with adjustments based on clinical evaluation.

Dosage for Adults

• COPD (Breo Ellipta):
  • 25 mcg Vilanterol with 100 mcg or 200 mcg fluticasone once daily via inhalation.
• COPD (Anoro Ellipta):
  • 25 mcg Vilanterol with 62.5 mcg umeclidinium once daily via inhalation.
• Asthma (Breo Ellipta):
  • 25 mcg Vilanterol with 100 mcg or 200 mcg fluticasone once daily, for patients not controlled on other therapies.

Dosage for Children

• Asthma (12–17 years, off-label):
  • 25 mcg Vilanterol with 100 mcg fluticasone once daily, under pediatric pulmonologist supervision.
  • Not recommended under 12 years.

Dosage for Pregnant Women

• Pregnancy Category C: Limited data; use only if benefits outweigh risks (e.g., severe COPD/asthma). Consult an obstetrician, with fetal monitoring.

Dosage Adjustments

• Renal Impairment: No adjustment needed; monitor in severe cases (CrCl <30 mL/min).
• Hepatic Impairment:
  • Mild (Child-Pugh A): No adjustment; moderate (Child-Pugh B): Use caution with 25 mcg; severe (Child-Pugh C): Avoid.
• Elderly: Start with standard dose (25 mcg); monitor for side effects.
• Concomitant Medications: Adjust if combined with beta-blockers, which may reduce efficacy.

Additional Considerations

• Inhale this active ingredient once daily using the Ellipta device, following proper technique (e.g., exhale fully, inhale deeply).
• Rinse mouth after use to prevent oral thrush.

5. How to Use Vilanterol

• Administration:
  • Use the Ellipta inhaler as directed, inhaling 25 mcg Vilanterol (with fluticasone or umeclidinium) once daily; do not shake the device.
  • Take at the same time daily, preferably in the morning, with or without food.
• Timing: Use once daily, ensuring consistent use for optimal control.
• Monitoring: Watch for increased heart rate, tremors, or signs of bronchospasm (e.g., wheezing).
• Additional Tips:
  • Store at 20–25°C (68–77°F), keeping the inhaler dry and away from heat.
  • Keep out of reach of children due to overdose risk.
  • Report severe shortness of breath, chest pain, or signs of allergic reaction immediately.

6. Contraindications for Vilanterol

This drug is contraindicated in:

• Hypersensitivity: Patients with a known allergy to Vilanterol, LABAs, or inhaler components.
• Severe Asthma Without ICS: Contraindicated as monotherapy due to increased mortality risk.
• Status Asthmaticus: Avoid in acute asthma attacks requiring immediate relief.

7. Warnings & Precautions for Vilanterol

General Warnings

• Paradoxical Bronchospasm: Risk of worsening breathing; discontinue if occurs.
• Cardiovascular Effects: Increased heart rate or hypertension; monitor in at-risk patients.
• Hypokalemia: Risk of low potassium levels; check electrolytes regularly.
• Hyperglycemia: May elevate blood sugar; monitor in diabetics.
• Asthma-Related Death: Risk with LABA monotherapy; use only with ICS.

Additional Warnings

• Seizures: Rare risk in predisposed patients; monitor neurological status.
• Ocular Effects: Potential glaucoma or cataracts with long-term use; eye exams recommended.
• Bone Density Loss: Risk with prolonged corticosteroid combination; assess osteoporosis.
• Thyrotoxicosis: Worsens with beta-agonist use; monitor thyroid function.
• Hypersensitivity Reactions: Rare anaphylaxis; discontinue if swelling occurs.

Use in Specific Populations

• Pregnancy: Category C; use only if essential with fetal monitoring.
• Breastfeeding: Excreted in breast milk; monitor infant for effects.
• Elderly: Higher risk of side effects; start with standard dose.
• Children: Limited to 12+ years off-label; supervise closely.
• Renal/Hepatic Impairment: Adjust dose; avoid in severe cases.

Additional Precautions

• Inform your doctor about heart disease, diabetes, or medication history before starting this medication.
• Avoid abrupt cessation; taper if combined with corticosteroids.

8. Overdose and Management of Vilanterol

Overdose Symptoms

Overdose may cause:

• Tremors, palpitations, or tachycardia.
• Severe cases: Hypokalemia, seizures, or cardiac arrest.
• Anxiety, headache, or muscle cramps as early signs.
• Respiratory depression with extremely high doses.

Immediate Actions

• Contact the Medical Team: Seek immediate medical help.
• Supportive Care: Administer IV fluids, monitor vital signs, and correct electrolytes (e.g., potassium).
• Specific Treatment: Use beta-blockers (e.g., propranolol) cautiously for severe tachycardia; no specific antidote.
• Monitor: Check heart rate, potassium levels, and respiratory status for 24–48 hours.

Additional Notes

• Overdose risk is low with proper use; store securely.
• Report persistent symptoms (e.g., severe chest pain, confusion) promptly.

9. Side Effects of Vilanterol

Common Side Effects

• Nasopharyngitis (10–15%, manageable with hydration)
• Headache (5–12%, relieved with rest)
• Cough (4–10%, transient)
• Voice Hoarseness (3–8%, reduced with technique adjustment)
• Throat Irritation (2–7%, decreases with tolerance)
  These effects may subside with dose adjustment.

Serious Side Effects

Seek immediate medical attention for:

• Cardiovascular: Tachycardia, arrhythmias, or hypertension.
• Respiratory: Paradoxical bronchospasm or worsening dyspnea.
• Metabolic: Hypokalemia, hyperglycemia, or lactic acidosis.
• Neurological: Seizures or tremors.
• Allergic: Rash, angioedema, or anaphylaxis.

Additional Notes

• Regular monitoring for heart rate, potassium, and lung function is advised.
• Report any unusual symptoms (e.g., severe chest pain, breathing difficulty) immediately to a healthcare provider.

10. Drug Interactions with Vilanterol

This active ingredient may interact with:

• Beta-Blockers: Reduces efficacy (e.g., propranolol); avoid or monitor.
• MAO Inhibitors: Increases cardiovascular risk; use caution.
• Tricyclic Antidepressants: Enhances side effects; adjust dose.
• Diuretics: Potentiates hypokalemia; monitor electrolytes.
• CYP3A4 Inhibitors: Increases levels (e.g., ketoconazole); monitor closely.

Action: Provide your healthcare provider with a complete list of medications.

11. Patient Education or Lifestyle

• Medication Adherence: Take this LABA as prescribed to manage COPD or asthma, following the exact schedule.
• Monitoring: Report increased heart rate, tremors, or breathing issues immediately.
• Lifestyle: Avoid smoking; engage in light exercise as tolerated.
• Diet: Take with proper inhalation technique; avoid cold air exposure if sensitive.
• Emergency Awareness: Know signs of bronchospasm or heart issues; seek care if present.
• Follow-Up: Schedule regular check-ups every 3–6 months to monitor lung function, heart health, and side effects.

12. Pharmacokinetics of Vilanterol

• Absorption: Rapidly absorbed via inhalation (peak at 5–10 minutes); minimal systemic absorption.
• Distribution: Volume of distribution ~670 L; 94% protein-bound.
• Metabolism: Hepatic via CYP3A4 to inactive metabolites.
• Excretion: Primarily fecal (70%) as metabolites; renal (<2%); half-life 11 hours.
• Half-Life: 11 hours, with sustained bronchodilation over 24 hours.

13. Pharmacodynamics of Vilanterol

This drug exerts its effects by:

• Stimulating beta-2 receptors in the lungs, causing relaxation of bronchial smooth muscle.
• Providing 24-hour bronchodilation, improving airflow in COPD and asthma.
• Demonstrating dose-dependent cardiovascular and metabolic effects.
• Exhibiting synergy with inhaled corticosteroids for inflammation control.

14. Storage of Vilanterol

• Temperature: Store at 20–25°C (68–77°F); protect from moisture and heat.
• Protection: Keep in original Ellipta device, away from direct sunlight.
• Safety: Store out of reach of children due to overdose risk.
• Disposal: Dispose of used inhalers per local regulations or consult a pharmacist.

15. Frequently Asked Questions (FAQs)

Q: What does Vilanterol treat?
A: This medication treats COPD and asthma.

Q: Can this active ingredient cause tremors?
A: Yes, tremors may occur; report if severe.

Q: Is Vilanterol safe for children?
A: Yes, for 12+ years off-label with a doctor’s guidance.

Q: How is this drug taken?
A: Via inhalation once daily using an Ellipta device, as directed.

Q: How long is Vilanterol treatment?
A: Long-term for COPD or asthma management.

Q: Can I use Vilanterol if pregnant?
A: Yes, with caution; consult a doctor.

16. Regulatory Information

This medication is approved by:

• U.S. Food and Drug Administration (FDA): Approved in 2013 (Breo Ellipta) for COPD and asthma.
• European Medicines Agency (EMA): Approved for COPD and asthma management.
• Other Agencies: Approved globally for respiratory conditions; consult local guidelines.

17. References

1. U.S. Food and Drug Administration (FDA). (2023). Breo Ellipta (Vilanterol/Fluticasone) Prescribing Information.
   • Official FDA documentation detailing the drug’s approved uses, dosage, and safety.
2. European Medicines Agency (EMA). (2023). Vilanterol Summary of Product Characteristics.
   • EMA’s comprehensive information on the medication’s indications and precautions in Europe.
3. National Institutes of Health (NIH). (2023). Vilanterol: MedlinePlus Drug Information.
   • NIH resource providing detailed information on the drug’s uses, side effects, and precautions.
4. Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2023). GOLD Guidelines: Vilanterol.
   • GOLD’s recommendations for Vilanterol in COPD management.
5. European Respiratory Journal. (2022). Vilanterol in Asthma Control.
   • Peer-reviewed article on Vilanterol efficacy (note: access may require a subscription).