Umeclidinium
INCRUSE
What it isLong-acting muscarinic antagonist; maintenance bronchodilation in COPD.
Why this oneIts once-daily Ellipta formulation simplifies COPD maintenance, but it has no asthma indication.
What limits itAnticholinergic effects can precipitate urinary retention or angle-closure glaucoma; it is never a rescue inhaler.
FDA-approved for
- COPD (2013)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Maintenance treatment of COPD | Adults | 62.5 mcg (1 actuation) QD inhaled | 62.5 mcg QD | 62.5 mcg QD |
Renal No adjustment needed (including severe renal impairment)
Hepatic No adjustment for moderate impairment; severe not studied
Instructions
- For oral inhalation only
- One inhalation once daily at the same time each day
- Do not use more than once every 24 hours
- Not for relief of acute symptoms/rescue therapy
Contraindications
- Severe hypersensitivity to milk proteins
Cautions
- Do not initiate in acutely deteriorating COPD; not for acute symptoms
- Paradoxical bronchospasm — discontinue and treat
- Hypersensitivity/anaphylaxis (including severe milk protein allergy)
- Worsening of narrow-angle glaucoma
- Worsening of urinary retention (prostatic hyperplasia, bladder-neck obstruction)
Adverse reactions
- Nasopharyngitis
- Upper respiratory tract infection
- Cough
- Arthralgia
- Pharyngitis, tachycardia (<2%)
Pregnancy Insufficient human data; no adverse embryofetal effects in animals
Lactation No human data; detected in rat milk; weigh benefits/risks
NO BOXED WARNINGS
Principal riskAnticholinergic effects; acute urinary retention
Cost, est. cash$200–$900/month
Generic entry2030 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.
Mechanism of action: Umeclidinium ballicule
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Memory aids: mascots and interaction avatars
“Red as a beet” crimson color theme → anticholinergic
Llama → long-acting muscarinic antagonist (LAMA)