BLACK BOX WARNING
- LABAs increase risk of asthma-related death; use only as add-on therapy with inhaled corticosteroids in asthma — never as monotherapy
vilanterol
Brand: Breo Ellipta (with fluticasone furoate), Anoro Ellipta (with umeclidinium)
⚠ BBW Prototype: salmeterol
Drug Class: beta-2 adrenergic agonist (LABA)
Drug Family: bronchodilator
Subclass: ultra-long-acting beta-2 agonist
Organ Systems: respiratory
Mechanism of Action
Ultra-long-acting selective beta-2 adrenergic agonist with intrinsic efficacy; high receptor selectivity and dissociation kinetics confer a 24-hour duration of action enabling once-daily dosing; always used in combination products for asthma or COPD.
beta-2 adrenergic receptors (bronchial smooth muscle)
Indications
- COPD maintenance therapy (with umeclidinium as Anoro Ellipta)
- asthma maintenance therapy (with fluticasone furoate as Breo Ellipta)
- COPD with comorbid asthma
Contraindications
- monotherapy for asthma (without ICS) — black box warning
- hypersensitivity to vilanterol or milk proteins (dry powder inhaler contains lactose)
Adverse Effects
Common
- headache
- oropharyngeal pain
- nasopharyngitis
- upper respiratory infection
- tachycardia
Serious
- asthma-related death (as monotherapy in asthma — class effect)
- paradoxical bronchospasm
- cardiovascular effects (prolonged QT, arrhythmia)
Pharmacokinetics (ADME)
| Absorption | inhaled; Cmax reached within 10 minutes; absolute systemic bioavailability approximately 27% |
| Distribution | Vd approximately 165 L; 93-94% protein bound |
| Metabolism | extensive hepatic CYP3A4 metabolism to inactive metabolites |
| Excretion | fecal (~70%) and renal (~30%) |
| Half-life | approximately 21 hours |
| Onset | within 15 minutes |
| Peak | 1 hour |
| Duration | 24 hours |
| Protein Binding | 93-94% |
| Vd | approximately 165 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| non-selective beta-blockers | antagonize vilanterol bronchodilatory effects; may cause severe bronchospasm in asthma | major |
| strong CYP3A4 inhibitors (ketoconazole, ritonavir) | increase vilanterol systemic exposure; increased cardiovascular risk | moderate |
| MAOIs and tricyclic antidepressants | potentiate sympathomimetic cardiovascular effects | moderate |
Nursing Considerations
- Vilanterol is only available in fixed-dose combination inhaler products; ensure patients understand they should not use additional LABA-containing products concurrently.
- Instruct proper Ellipta inhaler technique: slide cover open, exhale fully away from device, inhale deeply through mouthpiece, hold breath for 3-4 seconds, close cover; rinse mouth with water after inhalation to minimize oropharyngeal absorption.
- Do not use vilanterol-containing inhalers for rescue bronchospasm relief; prescribe a separate SABA rescue inhaler for acute symptoms and ensure patients can differentiate between maintenance and rescue inhalers.
- Monitor for tachycardia, palpitations, and worsening asthma control; if patients require increased rescue inhaler use, reassess asthma management — this signals inadequate control, not a reason to increase LABA dose.
Clinical Pearls
- Vilanterol's 24-hour duration enables once-daily dosing, improving adherence compared with twice-daily LABAs (salmeterol, formoterol); this makes Breo Ellipta and Anoro Ellipta pharmacologically distinct from twice-daily combination products.
- The combination of vilanterol with umeclidinium (LAMA) in Anoro Ellipta provides dual bronchodilation via complementary mechanisms — beta-2 agonism and muscarinic antagonism — representing a cornerstone triple COPD therapy option when ICS is added.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.