Glycopyrronium with indacaterol

How it works

Glycopyrronium blocks airway muscarinic receptors to reduce cholinergic bronchoconstriction, while indacaterol stimulates beta-2 receptors to relax bronchial smooth muscle, giving complementary sustained bronchodilation.

Prescribing in practice

• Maintenance only — it must not be used to relieve acute bronchospasm and patients must retain a separate short-acting reliever inhaler.
• Avoid in unstable cardiovascular disease; the beta-2 agonist component can cause tachycardia and the antimuscarinic warrants caution in narrow-angle glaucoma and significant bladder outflow obstruction.
• Confirm inhaler technique and that the patient can use the specific device before relying on it, as deposition determines efficacy.

Monitoring

Monitor symptom control, exacerbation frequency and inhaler technique, watching for antimuscarinic effects such as dry mouth or urinary retention and beta-agonist effects such as palpitations or tremor.

Counselling the patient

• This is a regular preventer, not a rescue inhaler — keep using your blue reliever for sudden symptoms.
• Report new palpitations, eye pain or difficulty passing urine.

Evidence & guidelines

NICE and GOLD support dual LABA/LAMA bronchodilation for COPD with persistent breathlessness or exacerbations despite single bronchodilator therapy.