Long-Acting Beta Agonist

Aka: Long-Acting Beta Agonist, Long-Acting Beta-2 Agonist, Long-Acting Inhaled Bronchodilator, LABA, Indacaterol, Arcapta, Breo Ellipta, Arformoterol, Brovana, Vilanterol, Trelegy Ellipta

advertisement

II. Indications

  1. Moderate Persistent Asthma
  2. Severe Persistent Asthma
  3. Chronic Obstructive Pulmonary Disease
  4. Exercise Induced Asthma

III. Mechanism

  1. Long acting beta Agonists (LABA) act primarily at beta-2 receptors to result in bronchodilation
    1. Adverse effects occur with beta-1 activity

IV. Precautions

  1. Adverse outcomes in Asthma with Long-Acting Beta Agonist (LABA)
    1. LABA use in Asthma was associated with increased Asthma deaths, increased intubations and hospitalizations
      1. McMahon (2011) Pediatrics 128(5): e1147-54 [PubMed]
    2. However FDA review of more recent studies found similar adverse outcomes with Inhaled Corticosteroids
      1. FDA removed LABA black box warning (see FDA communication link below)
  2. Risk of increased mortality and of more severe and life threatening Asthma Exacerbations
    1. Postulated to mask a patients awareness of severe Asthma Exacerbation
    2. FDA Black Box Warnings placed in 2003, but removed in 2017 (based on newer data as above)
      1. https://www.fda.gov/Drugs/DrugSafety/ucm589587.htm
  3. Not a substitute for Inhaled Corticosteroids
    1. Steroids are key management of persistent Asthma
    2. Long-Acting Beta Agonists are in addition to Inhaled Corticosteroids
    3. Lazarus (2001) JAMA 285:2583-93 [PubMed]
  4. Do NOT exceed dosing schedule (e.g. Serevent bid) except Formoterol in SMART Protocol
    1. Use a short acting Beta Agonist for rescue use
    2. Exception: See SMART Protocol below
  5. Tolerance over time to Protective effect
    1. Effect diminishes over one month of use
    2. Reference
      1. Simons (1997) Pediatrics 99:655-9 [PubMed]

V. Preparations: Long-Acting Beta Agonists (LABA)

  1. Salmeterol (Serevent) Dry Powder Diskus (50 ug/inhale)
    1. One inhalation every 12 hours
  2. Serevent Inhalation aerosol MDI (21 ug/puff)
    1. Adults: 2 puffs every 12 hours
    2. Child: 1-2 puffs every 12 hours
  3. Formoterol (Foradil)
    1. See Formoterol
    2. One inhalation every 12 hours
    3. Rapid onset within 5 minutes (contrast 15-30 minutes for other LABAs)
  4. Indacaterol (Arcapta Neohaler)
    1. Once daily dosing
    2. FDA approved for COPD (not proven to prevent COPD exacerbations)
    3. Same Cardiovascular Risks as other long acting beta Agonists
    4. Reference
      1. (2012) presc lett 19(1): 2
  5. Arformoterol (Brovana)
    1. Dose: 15 mcg twice daily

VI. Preparations: Combination of Long-Acting Beta Agonists with Corticosteroids

  1. Advair Diskus (Fluticasone/Salmeterol: 100/50, 250/50, 500/50)
    1. Dose: One puff twice daily
  2. Wixela Inhub (Fluticasone/Salmeterol)
    1. Released in 2019 at $150/Inhaler
  3. AirDuo (Fluticasone/Salmeterol: 55/14, 113/14, 232/14)
    1. Dose: One puff twice daily
    2. Generic available in 2017 for $90/month (compare with $475/month for Advair)
    3. (2017) Presc Lett 24(7)
  4. Symbicort (Budesonide/Formoterol: 80/4.5, 160/4.5)
    1. Dose: One puff twice daily
  5. Dulera (Mometasone/Formoterol: 50/5, 100/5, 200/5)
    1. Dose: Two puffs twice daily
  6. Breo Ellipta (Fluticasone/Vilanterol: 100/25)
    1. Only indicated for COPD (not Asthma)
    2. Dose: One puff once daily
  7. Trelegy Ellipta (Umeclidinium AND Fluticasone/Vilanterol)
    1. Indicated for severe COPD when an Inhaled Steroid and a LAMA and LABA are both indicated
    2. Indicated in Severe Asthma not controlled on medium to high dose Inhaled Corticosteroid and LABA
    3. Available in 2 strengths of fluticasone component (100 mcg for COPD or Asthma, 200 mcg for Asthma only)
    4. Dosing 1 puff daily of Dry Powder Inhaler
    5. (2020) Presc Lett, 27(11): 62

VII. Protocol: Single Maintenance and Reliever Therapy (SMART)

  1. See Single Maintenance and Reliever Therapy (SMART)

VIII. References

  1. (2022) Comparison of Asthma Medications, Presc Lett, #381217
  2. (2022) Inhaled Medications for COPD, Presc Lett, #381116
  3. (2020) Drugs for COPD, Med Lett Drug Ther 62: 137-44
  4. (2020) Drugs for Asthma, Med Lett Drug Ther 62: 193-200
  5. (2013) Presc Lett, 20(8): 43
  6. (2001) Med Clin North Am 43(1104):39-40 [PubMed]
  7. Wilson (2001) Chest 119:2021-6 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Long-Acting Beta Agonist." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Cost: Medications

breo ellipta (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BREO ELLIPTA 100-25 MCG INH Generic $3.75 each
BREO ELLIPTA 200-25 MCG INH Generic $3.70 each
arformoterol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ARFORMOTEROL 15 MCG/2 ML SOLN Generic $1.53 per ml
brovana (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BROVANA 15 MCG/2 ML SOLUTION Generic $1.20 per ml
trelegy ellipta (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TRELEGY ELLIPTA 100-62.5-25 $9.93 each
TRELEGY ELLIPTA 200-62.5-25 $9.95 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

advertisement