Glycopyrronium and indacaterol

Easy-to-read medicine information about glycopyrronium + indacaterol - what is it, how to take glycopyrronium + indacaterol safely and possible side effects. Glycopyrronium + indacaterol is also called Ultibro Breezhaler®

Type of medicine Also called
  • Bronchodilator
  • Combination inhaler of 2 different long-acting bronchodilators
  • Ultibro Breezhaler®

What is glycopyrronium + indacaterol?

Glycopyrronium + indacaterol is used to improve breathing problems caused by COPD and to prevent them from recurring. It prevents symptoms such as  such wheezing, coughing, and shortness of breath and reduces your symptoms over the long term. Glycopyrronium + indacaterol is long-acting, which means that it works throughout the day. It must be used every day. 

In New Zealand glycopyrronium + indacaterol is available as inhalation capsules to be used with the breezhaler inhaler device called Ultibro breezhaler.

Ultibro contains glycopyrronium + indacaterol powder in a capsule form, which is for inhalation only. The powder from the capsule is breathed into the lungs using the breezhaler device provided. Do not swallow the capsules — they must be used by inhaling the contents of the capsule with the breezhaler. Using an inhaler device enables the medicine to go straight into your airways when you breathe in. This means that your airways and lungs are treated, but very little of the medicine gets into the rest of your body.

Glycopyrronium + indacaterol does not give immediate relief from wheezing, tight chest and shortness of breath
If you need quick relief from these symptoms, use your ‘reliever’ medicine such as salbutamol or terbutaline.


  • The dose of glycopyrronium + indacaterol is 1 capsule inhaled once a day.
  • Inhale the powder in the capsule using the breezhaler device. Do not swallow the capsules.
  • Follow your doctor's instructions carefully. The pharmacy label on your medicine will tell you how much to use, how often to use it and any special instructions.


  • Keep using your breezhaler every day. Do not stop using it, even if you feel better. Since COPD is a long-term condition, prevention with glycopyrronium + indacaterol is ongoing and it will need to be used every day for months or years.
  • Try to use your inhaler at the same time each day, to help you to remember to use it regularly.
  • If you miss a dose, you can take it as soon as you remember. But if it is nearly time for your next dose, just take your next dose at the right time.

How to use your breezhaler device

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist, or nurse to show you how to use your Breezhaler device. Here is some guidance:

 (Health Navigator NZ & Auckland District Health Board, 2018)

Using your breezhaler device

  • Remove the cap.
  • Hold the base of your inhaler device and tilt the mouthpiece. This opens the inhaler.
  • Take a capsule from the blister packaging and put it into the capsule chamber of the inhaler. Close the inhaler – you will hear it click.
  • Hold the inhaler upright and press both side buttons at the same time. You should hear a click as the capsule is pierced. Then release the side buttons.
  • Breathe out away from the inhaler and then put the mouthpiece in your mouth and close your lips firmly around it.
  • Breathe in and hold your breath for around 5 to10 seconds. Then breathe out away from the inhaler.
  • Remove the empty capsule, close the inhaler and then replace the cap.

Precautions – before using glycopyrronium + indacaterol

  • Do you have heart disease?
  • Do you have an overactive thyroid (hyperthyroid)?
  • Do you have high blood pressure (hypertension)?
  • Do you have an irregular heartbeat or rhythm, including a very fast pulse?
  • Do you have diabetes?
  • Do you have problems with your prostate, or have had difficulty passing urine?
  • Do you have glaucoma?
  • Do you have lactose intolerance?
  • Are you pregnant or breastfeeding?

If so, it’s important that you tell your doctor or pharmacist before you start using glycopyrronium + indacaterol. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines glycopyrronium + indacaterol can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.

Side effects What should I do?
  • A different taste in your mouth
  • Dry mouth
  • Nausea (feeling sick)
  • Headache
  • Cough
  • These are quite common when you first start using glycopyrronium + indacaterol, and usually go away with time
  • Tell your doctor if troublesome
  • Fast heart rate
  • Feeling nervous, restless, agitated
  • Trembling or shakiness
  • Problems sleeping
  • Tell your doctor if troublesome
  • Difficulty urinating (peeing)
  • Tell your doctor immediately or ring Healthline on 0800 611 116
  • Difficulty breathing or worsening of your breathing problem.
  • Tell your doctor immediately or ring Healthline on 0800 611 116

Learn more

Ultibro Breezhaler® Medsafe Consumer Information Sheets

Credits: Sandra Ponen, Pharmacist.