COPD Medications

Pharmacy and Therapeutics, PULMONARY & CRITICAL CARE

Related Article: COPD Exacerbation Treatment.

COPD Medications available in the United States

Anticholinergics

Short-acting anticholinergics

  • Ipratropium (Atrovent).Two sprays four times per day (MDI).

Long-acting anticholinergics

  • Tiotropium (Spiriva). One puff per day (DPI).
  • Aclidinium bromide (Tudorza Pressair). One puff two times per day (DPI)

Side effects for all anticholinergics are the same: “Anaphylaxis, angle-closure glaucoma, hypersensitivity reaction, paradoxical bronchospasm”

Beta-agonists

Short-acting beta-agonists

  • Albuterol 2 to 4 mg orally, BID to TID. Albuterol comes as MDI & DPI, solution for a nebulizer, oral pills of 2, 4, 5, mg or ER tab of 8 mg. Also comes as syrup.
  • Levalbuterol (Xopenex) as a nebulizer. 0.63 to 1.25 mg  q6-8h PRN (nebulizer)
  • Terbutaline

Long-acting beta-agonists

  • Arformoterol (Brovana). One vial two times per day (nebulizer)
  • Formoterol. One puff two times per day (DPI)
  • Indacaterol (Arcapta Neohaler). One puff per day (DPI)
  • Salmeterol (Serevent). One puff every 12 hours (DPI)
  • Olodaterol

Combination Short-acting anticholinergic and short-acting beta2 agonist

  • Ipratropium / Albuterol (Duoneb)

Combination Long-acting anticholinergic and long-acting beta2 agonist

  • Tiotropium / Olodaterol (Stiolto Respimat). Two puffs per day (MDI)
  • Umeclidinium/Vilanterol (Anoro Ellipta). One puff per day (DPI)

Combination corticosteroid and long-acting beta2 agonist

  • Budesonide/formoterol (Symbicort). Two puffs two times per day (MDI)
  • Fluticasone/salmeterol (Advair Diskus). One puff every 12 hours (DPI)
  • Fluticasone/vilanterol (Breo Ellipta). One puff per day (DPI)

Phosphodiesterase-4 inhibitor

  • Roflumilast (Daliresp) 500 mcg orally, once per day

Methylxanthine

  • Theophylline, extended release. 300 to 600 mg orally per day, in one or two doses

 

 

DPI = dry powder inhaler; MDI = metered dose inhaler

 

References

Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report, Pocket Guide, Page 15.

Am Fam Physician. 2017 Apr 1;95(7):433-441. https://www.aafp.org/afp/2017/0401/p433.html

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