Revefenacin

YUPELRI

What it isLong-acting muscarinic antagonist delivered by nebulizer; COPD maintenance.

Why this oneNebulized delivery avoids the inspiratory-flow and hand-breath coordination demands of handheld LAMAs.

What limits itAnticholinergic effects and acute urinary retention can occur; it is maintenance therapy, never rescue.

FDA-approved for

FDA dosing	Population	Start	Target	Max
COPD (maintenance)	Adults	175 mcg (one 3 mL vial) inhaled via jet nebulizer QD	175 mcg inhaled QD	175 mcg/day inhaled (do not exceed)

Renal No adjustment needed; monitor for systemic antimuscarinic effects in severe impairment

Hepatic Not recommended in any degree of hepatic impairment

Oral inhalation only via standard jet nebulizer with mouthpiece + air compressor; do not swallow
Open unit-dose vial immediately before use; discard vial and residual after use
Do not mix with other drugs in nebulizer (compatibility not established)
Maintenance only — not for acute bronchospasm/rescue; treat acute symptoms with inhaled short-acting beta2-agonist

Do not initiate during acutely deteriorating COPD; not for acute symptoms
Paradoxical bronchospasm (may be life-threatening) — discontinue and use alternative therapy
May worsen narrow-angle glaucoma — use with caution
May worsen urinary retention — caution in prostatic hyperplasia/bladder-neck obstruction
Immediate hypersensitivity reactions — stop at once if they occur

Pregnancy No adequate human studies; no fetal harm in animals at ~209x MRHD exposure

Lactation No human data; present in rat milk (milk:plasma up to 10) — weigh benefit vs risk

NO BOXED WARNINGS

Principal riskAnticholinergic effects; acute urinary retention

Direct muscarinic antagonism1 / 4