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Indacaterol and glycopyrronium inhalation


Inhalation powder hard capsules containing indacaterol maleate and glycopyrronium bromide.

Drugs List

  • indacaterol 85microgram and glycopyrronium 43microgram inhalation powder hard capsules with device
  • ULTIBRO BREEZHALER 85microgram+43microgram inhalation powder hard capsules with device
  • Therapeutic Indications


    Chronic obstructive pulmonary disease



    Inhalation of one capsule once daily (at the same time of day), using the inhalation device provided. Patients should be advised not to take more than one dose in a day.

    Additional Dosage Information

    If a dose is missed, it should be taken as soon as possible on the same day.


    Children under 18 years
    Long QT syndrome
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Cardiac arrhythmias
    Cardiovascular disorder
    Coronary arteriosclerosis
    Diabetes mellitus
    Electrolyte imbalance
    Glucose-galactose malabsorption syndrome
    History of myocardial infarction
    History of torsade de pointes
    Ischaemic heart disease
    Lactose intolerance
    Left ventricular dysfunction
    Myocardial infarction
    Narrow angle glaucoma
    Renal impairment - glomerular filtration rate below 30ml/minute/1.73m sq
    Severe hepatic impairment
    Urinary retention

    Correct electrolyte disorders before treatment
    May decrease glucose tolerance in patients with diabetes mellitus
    Not suitable for acute treatment of asthma
    Ensure patient has a fast acting bronchodilator available
    Contains lactose
    Check patient is using correct inhaler technique
    Consider monitoring ECG in patients at risk of QT prolongation
    Monitor blood glucose closely in patients with diabetes mellitus
    Monitor serum electrolytes
    Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
    Monitor serum potassium in hypoxic patients
    Risk of narrow angle glaucoma
    May reduce serum potassium levels
    Prolonged treatment may lead to dental caries
    Discontinue if allergic reaction occurs
    Discontinue if paradoxical bronchospasm occurs
    Advise patient not to use for relief of acute attacks
    Advise patient to seek medical advice if treatment is ineffective
    Use regularly to maintain freedom from symptoms

    Pregnancy and Lactation


    Use the combination of indacaterol with glycopyrronium with caution in pregnancy.

    The manufacturer notes that this medication should only be considered if the expected benefit to the mother is greater than any risk to the foetus. There is little data on the use of this medication in pregnant women but animal studies do not indicate any direct/indirect harmful effects to reproductive toxicity at clinically relevant exposure.

    Indacaterol may inhibit labour due to the relaxant effect on the uterine smooth muscle.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use the combination of indacaterol with glycopyrronium with caution in breastfeeding.

    The manufacturer notes that this medication should only be considered if the expected benefit to the mother is greater than any risk to the breastfed infant. It is not known whether indacaterol, glycopyrronium and their metabolites are excreted in human milk but data has shown excretion in the milk of lactating rats.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Atrial fibrillation
    Bladder outflow obstruction
    Bronchospasm (paradoxical)
    Chest pain
    Dental decay
    Diabetes mellitus
    Dry mouth
    Hypersensitivity reactions
    Muscle spasm
    Musculoskeletal pain
    Myocardial ischaemia
    Oropharyngeal pain
    Painful extremities
    Peripheral oedema
    Throat irritation
    Upper respiratory tract infection
    Urinary retention
    Urinary tract infections


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: November 2018

    Reference Sources

    Summary of Product Characteristics: Ultibro Breezhaler 85micrograms/43micrograms inhalation powder hard capsules. Novartis Pharmaceuticals Ltd. Revised July 2018.

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.