Glycopyrronium with formoterol fumarate

How it works

Glycopyrronium blocks muscarinic receptors and formoterol stimulates beta2 adrenoceptors, producing complementary bronchodilation of airway smooth muscle through two mechanisms.

Prescribing in practice

• It is a regular maintenance treatment and must never be used to relieve acute breathlessness, for which a separate short-acting reliever is required.
• The antimuscarinic component warrants caution in closed-angle glaucoma, urinary retention and bladder outflow obstruction.
• Beta2 agonist effects include tremor, palpitations and hypokalaemia, and it should not be combined with other long-acting bronchodilators of the same classes.

Monitoring

Monitor COPD control and inhaler technique, with attention to antimuscarinic effects, heart rate and palpitations.

Counselling the patient

• Use regularly twice daily as maintenance, not for sudden symptoms.
• Report eye pain, blurred vision or difficulty passing urine.
• Mild tremor or a faster heartbeat can occur and usually settles.

Evidence & guidelines

A recognised long-acting muscarinic antagonist/long-acting beta2 agonist dual bronchodilator combination for COPD supported by trial data and consistent with NICE COPD guidance.