Trelegy Ellipta dosage, forms, and strengths

Trelegy Ellipta (fluticasone/umeclidinium/vilanterol) is a brand-name powder inhalant that combines three medications that provide triple therapy for asthma or COPD. These active ingredients include an inhaled corticosteroid (fluticasone), a long-acting anticholinergic (umeclidinium), and a long-acting beta-agonist (vilanterol). Taken as a single daily maintenance dose, Trelegy Ellipta helps to prevent asthma and COPD attacks as well as reduce the severity of the symptoms when they do occur. The dose prescribed will depend on the severity of the condition and the person’s response to the medication. Trelegy Ellipta is an oral inhaler.

Trelegy Ellipta forms and strengths

The Trelegy Ellipta powder inhaler comes in two dosage strengths. There are three medications in the powder, so dosage strengths written on the packaging use the following order: fluticasone dose, umeclidinium dose, and vilanterol dose. Only the fluticasone dose varies between the two.

• Dry powder inhaler (DPI): 100 micrograms (mcg)/62.5 mcg /25 mcg

• Dry powder inhaler (DPI): 200 mcg/62.5 mcg /25 mcg

Trelegy Ellipta dosage for adults

Healthcare professionals prescribe Trelegy Ellipta as a maintenance treatment for asthma and COPD to reduce the incidence and severity of asthma attacks or COPD flare-ups. The inhaler is not intended as a rescue medication during an active flare-up of either condition. In those cases, the use of Trelegy Ellipta is contraindicated. That is, it is never to be used for airway closure (bronchospasm) or airway swelling. Those cases require a rescue inhaler such as albuterol. Other contraindications (reasons this medication should not be used) include any hypersensitivity to any of the three active ingredients in Trelegy or milk proteins. People who are lactose intolerant should ask the prescriber for medical advice before taking Trelegy.

Trelegy Ellipta dosage for asthma

Trelegy Ellipta combines three medications that help prevent asthma attacks and improve lung function. Fluticasone furoate is an inhaled corticosteroid (ICS) that reduces swelling in the airways. Umeclidinium (yoo-mi-cli-di-nee-um) bromide is a long-acting muscarinic antagonist (LAMA) that prevents muscles in the lungs from constricting. The dose of umeclidinium in Trelegy is always 62.5 mcg per puff. Vilanterol trifenatate is a long-acting beta2-agonist or LABA. It relaxes the muscles in the airways, promoting bronchodilation. In Trelegy, the vilanterol dose is always 25 mcg. Because all three drugs are long-acting, only one oral inhalation of Trelegy Ellipta is needed each day. 

• Standard Trelegy Ellipta dosage for asthma: 1 actuation (100 mcg/62.5 mcg/25 mcg or 200 mcg/62.5 mcg/25 mcg dose) daily

• Maximum Trelegy Ellipta dosage for asthma: 1 actuation (200 mcg/62.5 mcg/25 mcg dose) daily

Trelegy Ellipta dosage for COPD

Chronic obstructive pulmonary disease (COPD) is the blanket term for two closely related medical conditions: chronic bronchitis and emphysema. Like asthma, COPD causes episodic exacerbations caused by an inflammatory response in the lung’s tissues. During the flare-ups, swelling and muscle constriction narrow the airways, causing breathing problems. The three active ingredients in Trelegy Ellipta help prevent or minimize COPD exacerbations by blocking inflammation (fluticasone) of airway passages and preventing tightening of the airway muscles (umeclidinium and vilanterol). As with asthma, doses are taken once per day.

• Standard Trelegy Ellipta dosage for COPD: 1 actuation (100 mcg/62.5 mcg/25 mcg dose) once daily. This is the only strength that is FDA-approved for COPD.

Trelegy Ellipta dosage for children

Trelegy Ellipta is not FDA-approved for use in children or adolescents. 

Trelegy Ellipta dosage restrictions

No dosage adjustments are required for people with liver disease or renal (kidney) impairment. However, healthcare professionals are cautious about prescribing fluticasone to people with moderate to severe hepatic (liver) impairment.

Trelegy Ellipta dosage for pets 

Veterinarians do not normally prescribe Trelegy for dogs or cats. Animals needing inflammatory airway disease maintenance treatment can be prescribed fluticasone HFA (inhaled corticosteroid) and salmeterol HFA, a long-acting beta-adrenergic receptor agonist. Powder inhalers are not used with animals because they are breath-activated. Pet owners may need to administer each inhalant separately.

How to take Trelegy Ellipta

Taking a dose with the Trelegy Ellipta inhaler is more complex than using a metered inhaler. Powdered inhalers require you to breathe in the medicine with enough force to aerosolize it. You also have to prepare each dose. 

A healthcare professional should demonstrate the proper use of the inhaler. If you need a refresher, the American Lung Association has a step-by-step video tutorial on using an Ellipta dry powder inhaler.

General tips

• Your healthcare provider will tell you how much medicine to use. Do not use more than directed. 

• Use this medicine once a day, at about the same time each day.

• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.

• Each inhaler comes with only 30 doses. The package or other materials may say that there are 60 blisters or two rows of 30 blisters each. That’s because two blisters—one on each row—make up one dose. When you open the inhaler, each of the two blisters is opened.

• On the inhaler, write down the day the tray was opened in the “Tray opened” field. In the “Discard date” field, write the date six weeks from the open date. 

• When the counter has nine doses left, the left half of the counter will turn red. That means it’s time to refill the prescription.

• Do not use the inhaler after the discard date.

• Throw away the inhaler in the household trash.

Inhalation of Trelegy Ellipta

• Do not use the inhaler if the dose count is “0.”

• Do not open the cover until you are ready to take a dose. If the cover is closed without being taken, that dose will be lost.

• Open the cover of the inhaler all the way. It will click when completely opened and a dose has been prepared. The inhaler is ready to use. Do not close the cover until after you have taken a dose. 

• Exhale fully to get as much air out of the lungs as possible. Do not breathe directly toward the inhaler or into the mouthpiece.

• Put the mouthpiece between your lips and close your lips firmly around it.

• Do not cover the air vents with your fingers or hands. 

• Take one long, steady, deep breath through your mouth. 

• Remove the inhaler from your mouth, hold your breath for about 3 to 4 seconds, then exhale slowly.

• Close the inhaler. If needed, you may clean the mouthpiece using a dry tissue before closing the cover.

• When you have finished, rinse your mouth and spit out the water. Do not swallow the water. Rinsing your mouth helps prevent thrush (fungal infection of the mouth and throat).

Storing Trelegy Ellipta

• Store the inhaler at room temperature in a dry place protected from heat and light.

• Store the Trelegy Ellipta package unopened at room temperature, protected from moisture, heat, and light. Open it only when ready for use.

• Keep this medicine out of the reach of children.

Trelegy Ellipta dosage FAQs

How long does Trelegy Ellipta stay in your system?

Trelegy Ellipta is meant to work for 24 hours to prevent COPD and asthma symptoms such as wheezing, coughing, and shortness of breath. When taken once daily, a steady level of medication is maintained in the body to help prevent symptoms. 

However, you may wonder how long Trelegy stays in your system if you stop taking it. Each active ingredient of Trelegy Ellipta is cleared from the body at different rates. With half-lives of 11 hours, vilanterol and umeclidinium should be completely removed from the body in less than three days after your last dose. Fluticasone has a half-life of 24 hours, so it will take about five days for the body to eliminate the fluticasone component after your last dose.

What happens if I miss a dose of Trelegy Ellipta?

A missed dose of Trelegy Ellipta can be taken when remembered on the day it is supposed to be taken. Take the next dose as scheduled. Do not take more than one dose per day. 

How long can you take Trelegy Ellipta?

Trelegy Ellipta is intended for long-term use. It can be taken as long as it’s effective and the side effects are tolerable. Trelegy Ellipta may need to be discontinued if serious adverse reactions are experienced, such as:

• Sudden and life-threatening airway closure (paradoxical bronchospasm)

• Serious asthma-related events, including hospitalizations and death

• Worsening of asthma

• Chest pain

• Heart rhythm or heart rate abnormalities

• High blood pressure

• Low potassium

• Cataracts

• Glaucoma

• Worsening of narrow-angle glaucoma

• Blurred vision

• Worsening of urinary retention

• Pneumonia

• Loss of bone mineral density (osteoporosis)

• Serious infections because of a weakened immune system

• Serious allergic reactions

What is the maximum dosage for Trelegy Ellipta?

For COPD, the recommended dosage of 100 mcg/62.5 mcg/25 mcg per day is the same as the maximum dosage. Higher doses are not FDA-approved for COPD.

For asthma, the maximum dose is 200 mcg/62.5 mcg/25 mcg per day. Healthcare providers are urged to try alternative treatment options if that dose is ineffective. Never take more than one dose per day.

What interacts with Trelegy Ellipta?

Because Trelegy Ellipta contains three drugs that have different effects, several drug interactions are possible.

• Certain drugs increase Trelegy levels in the body. Examples include the antifungal drug ketoconazole and the antiviral drug ritonavir (an ingredient of the COVID-19 treatment Paxlovid). This could cause more serious Trelegy side effects.

• The antipsychotic drugs pimozide and thioridazine should never be used with Trelegy. Either of these drugs combined with Trelegy can cause dangerous heart rhythm problems. This can also occur with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and other drugs that affect heart rhythm. 

• Certain types of diuretics like hydrochlorothiazide or Lasix (furosemide) can also interact with vilanterol, causing low potassium levels and/or heart rhythm problems. 

• Beta blockers, normally used to treat high blood pressure, will block the effects of vilanterol. Because beta blockers also can worsen asthma or COPD, people with those conditions are usually not prescribed these drugs unless no other alternatives are available.

Umeclidinium is an anticholinergic drug. These drugs have commonly experienced and sometimes serious side effects that worsen if more than one type of anticholinergic drug is taken.

Is it safe to take Trelegy Ellipta during pregnancy?

Trelegy Ellipta may be prescribed to pregnant women if the healthcare provider determines that the benefits outweigh the risks. Animal data does not indicate any risk of congenital disabilities, but no clinical studies exist. Vilanterol may affect delivery by changing uterine contractions. Consult your healthcare provider for medical advice if you are pregnant or planning to become pregnant.

Is it safe to take Trelegy Ellipta while breastfeeding?

Healthcare professionals don’t know if Trelegy Ellipta is safe to use while breastfeeding, if it is present in human breast milk, or if it affects a nursing infant. Consult your healthcare provider for medical advice if you are breastfeeding.

What are the most common side effects of Trelegy Ellipta?

The most common adverse effects of Trelegy Ellipta are symptoms typical of an upper respiratory tract infection, such as nasal congestion, sore throat (pharyngitis), and sinus infection (sinusitis). Other common complaints include headache, back pain, urinary tract infection, constipation, and oral thrush (candidiasis).

Sources

• Trelegy, GlaxoSmithKline (GSK)

• Trelegy Ellipta prescribing information, DailyMed, National Library of Medicine