II. Mechanism

  1. Phosphodiesterase-4 Inhibitor increases lung, intracellular cAMP

III. Indications

  1. Severe, refractory COPD with frequent exacerbations

IV. Dosing

  1. Roflumilast 500 mcg orally daily ($250/month)

V. Adverse Effects

  1. Gastrointestinal (common, intolerable in 5%)
    1. Diarrhea
    2. Nausea
    3. Weight loss (may be >10%)
  2. Other common symptoms
    1. Headache
    2. Insomnia
  3. Psychiatric (3%)
    1. Suicidality
    2. Depression
    3. Anxiety

VI. Drug Interactions

  1. Cytochrome P450 3A4 Inhibitors
  2. Cytochrome P450 3A4 and Cytochrome P450 1A2 Inducers

VII. Efficacy

  1. NNT: 24 severe COPD patients to prevent 1 hospitalization per year
  2. Does not reduce mortality

VIII. References

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Cost: Medications

daliresp (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
DALIRESP 500 MCG TABLET $10.29 each