Triple Therapy ICS/LAMA/LABA — COPD Pregnancy: There are limited data in pregnant women; animal studies have shown reproductive toxicity at exposures which are not clinically relevant. Administration to pregnant women should only be considered if the expected benefit to the mother justifies the potential risk to the foetus. Breast-feeding: excretion in human milk is unknown, but other corticosteroids, muscarinic antagonists and beta2-agonists are detected in human milk and a risk to newborns/infants cannot be excluded — decide whether to discontinue breast-feeding or the medicine.

Fluticasone Furoate / Umeclidinium / Vilanterol

Brand names: Trelegy Ellipta

Trelegy Ellipta is a single-inhaler triple combination of an inhaled corticosteroid (fluticasone furoate), a long-acting muscarinic antagonist (umeclidinium) and a long-acting beta2 agonist (vilanterol), delivered once daily by dry-powder inhaler for COPD and, in some products, severe asthma.

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: One inhalation once daily

Route: Inhalation (Ellipta dry powder inhaler) — for inhalation use only — source product: Trelegy Ellipta 92 micrograms/55 micrograms/22 micrograms inhalation powder, pre-dispensed

Frequency: Once daily, each day at the same time

Max: One inhalation once daily (the SPC states this is both the recommended and the maximum dose)

eMC SPC §4.2 (Trelegy Ellipta) — 'The recommended and maximum dose is one inhalation once daily, each day at the same time.' If a dose is missed the next dose should be inhaled at the usual time the next day. §4.2 does not state the inhaler strength — clinician to confirm (§4.8 refers only to the fluticasone furoate/vilanterol 100/25 comparator arm of other studies). Elderly (65 years and over): no dose adjustment. Renal impairment: no dose adjustment. Hepatic impairment: no dose adjustment in mild, moderate or severe impairment, but use with caution in moderate to severe impairment and monitor for systemic corticosteroid-related adverse reactions. Paediatric: there is no relevant use in the paediatric population (under 18 years) for the indication of COPD. Rinse the mouth with water without swallowing after use. §4.4: should not be used in patients with asthma, since it has not been studied in that population; there are no clinical data to support use for acute episodes of bronchospasm or to treat an acute COPD exacerbation (i.e. as rescue therapy); do not stop therapy without physician supervision. eMC §4.5 interactions was not retrieved in this bundle.

Dose adjustments

Renal

No dose adjustment is required in patients with renal impairment

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — 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

Nasopharyngitis (7%), headache (5%) and upper respiratory tract infection (2%) — the most frequently reported
Pneumonia, bronchitis, pharyngitis, rhinitis, sinusitis, influenza, candidiasis of mouth and throat, urinary tract infection (common)
Cough and oropharyngeal pain (common); dysphonia (uncommon)
Constipation (common); dry mouth (uncommon); arthralgia and back pain (common); fractures (uncommon); muscle spasms (rare)
Supraventricular tachyarrhythmia, tachycardia, atrial fibrillation (uncommon); palpitations (rare)
Blurred vision, glaucoma, eye pain (uncommon); raised intraocular pressure (rare); urinary retention and dysuria (rare); hypersensitivity reactions including anaphylaxis, angioedema, urticaria and rash (rare)

Clinical monograph

How it works

Fluticasone furoate provides anti-inflammatory corticosteroid activity, umeclidinium produces sustained bronchodilation by blocking muscarinic receptors, and vilanterol relaxes airway smooth muscle via beta2 adrenoceptor stimulation.

Prescribing in practice

It is a maintenance treatment only and must never be used to relieve acute breathlessness or an exacerbation, for which a separate short-acting reliever is needed.
Inhaled corticosteroid exposure raises the risk of pneumonia in COPD, and antimuscarinic effects warrant caution in glaucoma and bladder outflow obstruction.
It should not be combined with other long-acting bronchodilators or inhaled corticosteroids to avoid therapeutic duplication and additive effects.

Monitoring

Review inhaler technique and symptom control regularly, watching for pneumonia signs in COPD, oral candidiasis and antimuscarinic effects.

Counselling the patient

Use every day as a preventer, not for sudden symptoms.
Rinse the mouth after inhaling to reduce thrush and hoarseness.
Report worsening breathlessness, fever or new visual or urinary symptoms.

Evidence & guidelines

Once-daily single-inhaler triple therapy is supported by major COPD trials showing reduced exacerbations versus dual therapy and is recommended in NICE COPD guidance for appropriate patients.

Reference: IMPACT Trial (Lipson et al. NEJM 2018); NICE NG115 (COPD 2019); GOLD 2024; SPC Trelegy Ellipta; 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