ICS + LABA + LAMA triple inhaler Pregnancy: No or limited data in pregnant women; animal studies have shown reproductive toxicity. Glucocorticoids are known to cause effects in the early gestation phase and beta2-sympathomimetics such as formoterol have tocolytic effects, so as a precautionary measure it is preferable to avoid use during pregnancy and during labour; use only if the expected benefit to the patient outweighs the potential risk to the foetus. Infants and neonates born to mothers receiving substantial doses should be observed for adrenal suppression. Breast-feeding: no relevant clinical data in humans; glucocorticoids are excreted in human milk and anticholinergics such as glycopyrronium could suppress lactation — decide whether to discontinue breast-feeding or the medicine.

Beclometasone with formoterol and glycopyrronium

Brand names: Trimbow

Used in: Asthma

This is a single-inhaler triple combination of beclometasone (inhaled corticosteroid), formoterol (long-acting beta-2 agonist) and glycopyrronium (long-acting muscarinic antagonist), used as maintenance therapy in COPD and, in some products, severe asthma not controlled on dual therapy.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Two inhalations twice daily

Route: Inhalation (breath-operated dry powder inhaler) — source product: Trimbow NEXThaler (DPI) 88 micrograms/5 micrograms/9 micrograms per actuation inhalation powder

Frequency: Twice daily

Max: Two inhalations twice daily (stated maximum dose)

Source: UK SPC (eMC) §4.2 for Trimbow NEXThaler (DPI) 88/5/9 micrograms per actuation inhalation powder (https://www.medicines.org.uk/emc/product/12829/smpc). Verbatim: 'The recommended dose is two inhalations twice daily. The maximum dose is two inhalations twice daily.' NOTE: the fetched SPC is for the NEXThaler dry-powder strength only — other Trimbow presentations (e.g. the pressurised inhalation solution/pMDI strengths) have their own posology and were NOT retrieved; verify the strength on the product being prescribed. ELDERLY: no dose adjustment is required in elderly patients (65 years of age and older). HEPATIC IMPAIRMENT: no relevant data in severe hepatic impairment (Child-Pugh class C); use with caution in these patients. PAEDIATRIC: 'There is no relevant use of Trimbow in the paediatric population (under 18 years of age) for the indication of COPD' — no paediatric dose is stated, so paedDose is null; verify any under-18 use against a children's formulary. ADMINISTRATION: for inhalation use; the patient should be shown correct inhaler technique by a physician or other healthcare professional, who should also regularly check the adequacy of inhalation technique. After each inhalation the patient should rinse the mouth or gargle with water without swallowing it, or brush the teeth. Breathe out slowly and deeply first, breathe in forcefully and deeply through the mouth, then hold the breath 5-10 seconds. Check the dose counter has gone down by one after use. §4.4: not indicated for the treatment of acute episodes of bronchospasm or acute exacerbation (i.e. not a rescue therapy); treatment should not be stopped abruptly; if anaesthesia with halogenated anaesthetics is planned, ensure Trimbow is not administered for at least 12 hours before the start of anaesthesia because of the risk of cardiac arrhythmias. §4.5 (interactions) was not retrieved in this bundle — the §4.4 text was truncated at the source-fetch limit; verify interactions against the full SPC.

Dose adjustments

Renal

Can be used at the recommended dose in mild (GFR >=50 to <80 mL/min/1.73 m2) to moderate (GFR >=30 to <50 mL/min/1.73 m2) renal impairment. In severe renal impairment (GFR <30 mL/min/1.73 m2) or end-stage renal disease requiring dialysis (GFR <15 mL/min/1.73 m2), especially if associated with significant body weight reduction, use should be considered only if the expected benefit outweighs the potential risk.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients

Side effects

Dysphonia (0.3% in COPD, 1.5% in asthma) and oral candidiasis (0.8% and 0.3%) — typical of inhaled corticosteroids
Muscle spasms (0.4% and 0.2%) — attributed to the long-acting beta2-agonist component
Dry mouth (0.4% and 0.5%; 0.6% with the inhalation powder) — typical anticholinergic effect
Pneumonia in COPD patients, pharyngitis, urinary tract infection, nasopharyngitis (common); headache (common)
Uncommon: hypokalaemia, hyperglycaemia, tremor, dizziness, atrial fibrillation, QT prolongation on ECG, tachycardia, palpitations

Clinical monograph

How it works

It pairs anti-inflammatory glucocorticoid action with two complementary bronchodilator mechanisms — beta-2 agonism and muscarinic antagonism — to maximise airflow and reduce exacerbations.

Prescribing in practice

Most important: reserve for patients inadequately controlled on dual therapy and counsel on the increased pneumonia risk associated with the inhaled corticosteroid component in COPD.
Apply antimuscarinic cautions: avoid or use carefully in narrow-angle glaucoma, prostatic hyperplasia and bladder-outflow obstruction.
Confirm the patient is not concurrently using a separate LABA or LAMA inhaler.

Monitoring

Monitor COPD or asthma control and exacerbations, watch for pneumonia and anticholinergic effects, and review cardiovascular tolerance.

Counselling the patient

Rinse the mouth after each dose to reduce oral thrush.
Report worsening breathlessness with fever, eye pain, or difficulty passing urine, and use it daily as prescribed.

Evidence & guidelines

Single-inhaler triple therapy reduces exacerbations versus dual therapy in COPD trials and is reflected in GOLD and NICE guidance.

Reference: NICE NG115; NICE NG80; GOLD; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways