What is it used for?

• Chronic obstructive pulmonary disease (COPD) in adults aged 18 years and over.
• Anoro ellipta should not be used to relieve an attack of breathing difficulty. Instead, it should be used regularly each day to keep the airways open and help prevent breathing difficulties.

How does it work?

• Anoro ellipta inhaler contains two active ingredients, umeclidinium and vilanterol. These work in different ways to relax and open the airways and make it easier to breathe. In chronic obstructive lung diseases (COPD), such as chronic bronchitis or emphysema, the airways are narrowed and this makes breathing difficult.
• Umeclidinium is a type of medicine known as an antimuscarinic or anticholinergic bronchodilator. It works in the lungs, where it blocks receptors called muscarinic receptors that are found on the muscle surrounding the airways. A natural body chemical called acetylcholine normally acts on these receptors, causing the muscle in the airways to contract and the airways to narrow.
• Umeclidinium blocks the muscarinic receptors in the lungs and therefore stops the action of acetylcholine on them. This allows the muscle around the airways to relax and the airways to open. This makes it easier for people with COPD to breathe.
• Vilanterol is a type of medicine called a long-acting beta 2 agonist or bronchodilator. It works by acting on receptors in the lungs called beta 2 receptors. When vilanterol stimulates these receptors it causes the muscles in the airways to relax, which allows the airways to open.
• Inhaling these medicines allows them to act directly in the lungs where they are needed most. It also reduces the potential for side effects in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if they were taken by mouth.

How do I use it?

• Make sure you read the information leaflet provided with your inhaler, as this will give detailed instructions on how to use and look after your inhaler.
• One dose should be inhaled from Anoro ellipta inhaler once a day, every day, even when you don't have symptoms. You can use the inhaler either in the morning or evening, but you should always use it at the same time each day. The effect of each inhalation lasts for 24 hours.
• A dose counter on the inhaler indicates how many doses are left in the inhaler.
• Do not shake the inhaler before using it.
• To use the inhaler you first need to prepare a dose for inhalation. To do this, simply open the cover of the inhaler and slide it down until you hear a click; this shows that there is one dose ready to be inhaled. If you do not hear a click or the counter does not count down one dose, this means that there is no dose ready for inhalation. You should ask your pharmacist for advice.
• Before you inhale the prepared dose you should breath out as much as is comfortably possible first. You should not breathe out into the inhaler. Then put the inhaler mouthpiece between your lips and close your lips firmly around it, ensuring that the air vents are not blocked by your fingers. Take one long deep breath in and hold your breath for as long as possible (at least three to four seconds). Then remove the inhaler from your mouth and breathe out slowly and gently.
• The inhaler mouthpiece should be cleaned with a dry tissue if necessary and the cover replaced.
• If the cover is closed without inhaling the medicine, then the prepared single dose of medicine is lost.
• If you forget to take a dose at your usual time don't worry, just take your next dose when it is due. Do not take a double dose to make up for a missed dose. You should use your reliever inhaler if you have any breathing problems before your next dose of Anoro ellipta is due.
• You should not suddenly stop using this inhaler, even if you don't currently have any symptoms, unless your doctor tells you otherwise. This is because stopping treatment is likely to make your symptoms come back.

Not to be used in

• People with asthma.
• People with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Anoro ellipta inhaler contains lactose).
• The safety and effectiveness of this medicine in children under 18 years of age has not been fully established. It is not currently recommended for this age group.
• This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Use with caution in

• People with heart disease or high blood pressure (hypertension).
• People with an irregular heartbeat (arrhythmia).
• People with severely decreased liver function.
• People with closed angle glaucoma.
• People who have difficulty passing urine, for example men with an enlarged prostate gland or people with an obstruction of the bladder.
• Epilepsy.
• Overactive thyroid gland (hyperthyroidism).
• Diabetes.
• People with low levels of potassium in their blood (hypokalaemia).

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• The safety of this inhaler for use during pregnancy has not been established by the manufacturer. As it contains new medicines they do not recommend it for use in pregnancy, unless it is considered essential by your doctor because there is no alternative that is established as safer. Tell your doctor straight away if you think you could be pregnant while using this medicine.
• In general, inhalers can be used as normal during breastfeeding, because the amount of medicine that passes into the breast milk after using an inhaler is negligible and unlikely to harm the baby. However, it is not known to what extent the medicines in this inhaler pass into breast milk. Since it contains new medicines the manufacturer states that it should be avoided in women who are breastfeeding. Ask your doctor for further advice.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common 

• Dry mouth. See warning above.
• Inflammation of the nose and throat, causing a blocked or runny nose and sore throat (nasopharyngitis).
• Inflammation of the sinuses (sinusitis).
• Inflammation of the throat (pharyngitis).
• Sore mouth and throat.
• Infection of the upper respiratory tract.
• Cough.
• Headache.
• Constipation.
• Urinary tract infections.

Uncommon 

• Irregular heartbeat.
• Faster than normal heartbeat (tachycardia).
• Rash.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to make sure that the combination is safe.

Beta-blockers such as atenolol, propranolol or timolol should not generally be taken with this medicine. This is because beta-blockers have an opposite action to vilanterol and can cause the airways to narrow, which can result in breathing difficulties for people with COPD. This problem has sometimes been seen with eye drops containing beta-blockers, eg used for glaucoma.

Medicines in the same class as vilanterol can potentially cause a serious decrease in the level of potassium in the blood (hypokalaemia), which may result in adverse effects. It is not yet known if vilanterol can have this effect as well. However, if it does this could be increased by the following medicines, which can also lower potassium in the blood:

• acetazolamide
• other beta 2 agonists, such as salbutamol
• corticosteroids, such as beclometasone and prednisolone
• diuretics, such as bendroflumethiazide and furosemide
• xanthine derivates, such as theophylline or aminophylline.

If you are taking several of these medicines, your doctor may recommend that you have your blood potassium levels monitored regularly.

The following medicines may increase the amount of vilanterol that is found in the bloodstream after inhaling this medicine:

• the azole antifungals ketoconazole, itraconazole or voriconazole
• macrolide antibiotics such as clarithromycin or telithromycin
• protease inhibitors for HIV infection such as ritonavir
• telaprevir.

These medicines may therefore increase your exposure to vilanterol and so could increase the risk of its side effects.

References:

http://www.netdoctor.co.uk/medicines/lungs/a8931/anoro-ellipta-umeclidinium-vilanterol/

http://www.medicines.ie/medicine/16007/SPC/ANORO+55+micrograms+22+micrograms+inhalation+powder,+pre-dispensed

https://www.anoro.com

https://www.drugs.com/anoro-ellipta.html

https://www.rxlist.com/anoro-ellipta-side-effects-drug-center.htm