LAMA/LABA combination bronchodilator (long-acting muscarinic antagonist / long-acting beta-2 agonist) Pregnancy: No data from use in pregnant women; animal studies showed reproductive toxicity with vilanterol at exposures that are not clinically relevant. Should be used during pregnancy only if the expected benefit to the mother justifies the potential risk to the foetus. Breast-feeding: excretion in human milk unknown, but other beta2-agonists are detected in human milk; a risk to newborns/infants cannot be excluded — decide whether to discontinue breast-feeding or the medicine.

Umeclidinium / Vilanterol (Anoro Ellipta)

Brand names: Anoro Ellipta (55 mcg umeclidinium / 22 mcg vilanterol per inhalation)

Umeclidinium/vilanterol (Anoro Ellipta) is a fixed-dose once-daily maintenance dry-powder inhaler combining a long-acting muscarinic antagonist (LAMA) with a long-acting beta-2 agonist (LABA) for COPD. It is a regular controller, not a reliever.

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: Anoro Ellipta 55 micrograms/22 micrograms inhalation powder, pre-dispensed

Frequency: Once daily

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

eMC SPC §4.2 — 'The recommended and maximum dose is one inhalation once daily.' ANORO ELLIPTA should be administered at the same time of day each day to maintain bronchodilation. 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; §4.8 refers to 'the recommended dose of 55/22 micrograms' (with 113/22 micrograms studied as a higher dose) — clinician to confirm the strength. Elderly: no dose adjustment in patients 65 years or older. Renal impairment: no dose adjustment. Hepatic impairment: no dose adjustment in mild or moderate; not studied in severe hepatic impairment, use with caution. Paediatric: there is no relevant use in the paediatric population (under 18 years) for the indication of COPD. §4.4 states this product should not be used in patients with asthma, as it has not been studied in that population, and is not indicated for acute episodes of bronchospasm. eMC §4.5 interactions was truncated in the fetched source before any interaction was listed, so no interaction list is recorded here.

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 (most frequently reported, 9%); also sinusitis, pharyngitis, upper respiratory tract infection, urinary tract infection (common)
Headache (common)
Cough, oropharyngeal pain (common); dysphonia (uncommon); paradoxical bronchospasm (rare)
Constipation, dry mouth (common)
Cardiac — atrial fibrillation, supraventricular tachycardia, tachycardia, supraventricular extrasystoles, palpitations (uncommon)
Urinary retention, dysuria, bladder outlet obstruction; blurred vision, glaucoma, raised intraocular pressure (rare)

Clinical monograph

How it works

Umeclidinium antagonises airway muscarinic receptors to reduce bronchoconstriction while vilanterol stimulates beta-2 adrenoceptors to relax smooth muscle, providing dual sustained bronchodilatation.

Prescribing in practice

Avoid the umeclidinium component in narrow-angle glaucoma and use cautiously with bladder-outflow obstruction or prostatic enlargement owing to antimuscarinic effects.
The vilanterol LABA needs caution in cardiovascular disease, arrhythmias and hyperthyroidism, with additive hypokalaemia risk alongside corticosteroids and diuretics.
Supply a separate short-acting bronchodilator, as the Ellipta device is for regular maintenance and not for acute symptom relief.

Monitoring

Monitor inhaler technique, breathlessness, exacerbation rate and antimuscarinic or cardiovascular tolerability at review.

Counselling the patient

Use one inhalation at the same time daily for prevention; it will not help a sudden attack.
Report eye pain, blurred vision or trouble passing urine.

Evidence & guidelines

Anoro Ellipta is supported by COPD trials and NICE guidance demonstrating greater lung-function and symptom benefit than single long-acting bronchodilators.

Reference: GOLD COPD Guidelines 2024; FLAME Trial (Wedzicha et al, NEJM 2016); NICE NG115 COPD; 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