Roflumilast

How it works

It inhibits phosphodiesterase-4, raising intracellular cyclic AMP in inflammatory cells and thereby reducing the airway inflammation characteristic of COPD.

Prescribing in practice

• Psychiatric effects including mood changes, anxiety, depression and suicidal ideation have been reported and warrant careful assessment of mental health before and during treatment.
• Weight loss, diarrhoea and nausea are common, particularly early in treatment, and weight should be monitored.
• It is not a bronchodilator and is contraindicated in moderate to severe hepatic impairment.

Monitoring

Monitor body weight, mental health and gastrointestinal tolerability during treatment.

Counselling the patient

• Report any low mood, anxiety or thoughts of self-harm to your healthcare team without delay.
• Some weight loss, nausea and diarrhoea are common at first and often settle.
• This tablet adds to your inhalers and is not a reliever for breathlessness.

Evidence & guidelines

The MHRA has highlighted the risk of psychiatric reactions with roflumilast, and NICE guidance positions it as add-on therapy in selected severe COPD.