Glycopyrronium and indacaterol

Sounds like 'GLYE-koe-PIR-oh-nee-um' and 'IN-da-KA-ter-ol'

Easy-to-read medicine information about glycopyrronium + indacaterol – what it is, how to take it 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 such as wheezing, coughing and shortness of breath. It 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 which is for inhalation with your Breezhaler only. The powder from the capsule is breathed into your 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.

Dose

  • 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.

Tips

  • 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.
  • 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 & Auckland District Health Board, NZ, 2018

Using your Breezhaler device

  • Open: Remove the cover to expose the mouthpiece. Pull back the mouthpiece to reveal the capsule chamber.
  • Insert the capsule: The capsules come packaged in a foil wrapping. Pull back the foil edges to release one capsule. Do not remove the capsule by pushing it through the foil – this will damage the capsule. Place the capsule into the capsule chamber. Close the mouthpiece until you hear a click.
  • Pierce the capsule: 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.
  • Inhale your dose: Put the mouthpiece into your mouth and seal your lips firmly around it. Breathe in rapidly and deeply until your lungs are full and hold your breath for 10 seconds. You will hear the sound of the capsule vibrating in the chamber.
  • Take two breaths from one capsule: To get your full daily dose, you must use your inhaler twice from the same capsule.
  • Discard the used capsule: After inhaling your dose, open the mouthpiece and throw away the used capsule. Close the mouthpiece and the lid of the inhaler.

Cleaning and storing your Breezhaler: You can clean your device by wiping the mouthpiece with a clean dry tissue. Do not wash the mouthpiece or allow it to get wet when cleaning. You will get a new Breezhaler with your repeat prescription every month. Close the device when not in use. Store it in a cool dry place, away from heat and moisture.

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 you had difficulty passing urine?
  • Do you have glaucoma?
  • Do you have problems with your liver or kidneys?
  • 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
  • Sore throat, blocked nose 
  • Nausea (feeling sick)
  • Headache
  • Cough
  • These are quite common when you first start using glycopyrronium + indacaterol, and usually go away with time.
  • If you have trouble with a dry mouth, cough or different taste in your mouth, rinse your mouth out after use.
  • Tell your doctor if troublesome.
  • Fast heart rate
  • Feeling nervous, restless, agitated
  • Trembling or shakiness
  • Problems sleeping
  • Constipation (difficulty passing poos) or diarrhoea (runny poos)
  • Tell your doctor if troublesome.
  • Dizziness
  • Blurred vision
  • Tell your doctor.
  • Do not drive or use machinery.
  • Do not drink alcohol.
  • Difficulty urinating (peeing)
  • Tell your doctor immediately or phone Healthline on 0800 611 116.
  • Difficulty breathing or worsening of your breathing problem
  • Tell your doctor immediately or phone Healthline on 0800 611 116.

Learn more

Ultibro Breezhaler® Medsafe Consumer Information Sheets

References

  1. Indacaterol + glycopyrronium New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 23 Jun 2019