Relvar Ellipta

Relvar Ellipta (fluticasone furoate/vilanterol) is a combination inhaler containing an inhaled corticosteroid (ICS) and a long-acting beta-2 agonist (LABA) for the maintenance treatment of asthma and chronic obstructive pulmonary disease (COPD). It is delivered via the Ellipta device, a pre-loaded dry powder inhaler that is simple to operate and requires only once-daily dosing, making it one of the most convenient ICS/LABA inhalers available in the UK.

Two Active Ingredients, Two Mechanisms

Relvar Ellipta works through two complementary mechanisms. Fluticasone furoate, the ICS component, reduces chronic airway inflammation that drives both asthma and COPD, suppressing the production of inflammatory cytokines and decreasing bronchial hyper-reactivity. Vilanterol, the LABA component, binds to beta-2 adrenergic receptors in the smooth muscle of the airways, causing sustained bronchodilation that lasts for 24 hours, supporting the once-daily dosing regimen.

The Ellipta Device

The Ellipta inhaler is designed to be straightforward. A sliding cover is opened to prepare the dose, the patient breathes in steadily and deeply through the mouthpiece, and the device is then closed. There is no need to shake the inhaler, and the foil-sealed blisters ensure the powder is protected from moisture until use. A dose counter indicates how many doses remain, and the cover cannot be inadvertently re-opened to double-dose. The simple mechanism makes it suitable for patients with poor dexterity, older adults, and those who find conventional pressurised inhalers difficult to coordinate.

Important Safety Principle for Asthma

In the management of asthma, LABAs must never be used without an ICS. Using a LABA alone in asthma (without an ICS preventer) is associated with an increased risk of life-threatening asthma attacks. Relvar Ellipta, as a combination product, addresses this concern by ensuring both components are delivered simultaneously.

How to Use Relvar Ellipta

Slide the cover down until you hear a click, this opens the mouthpiece and loads the dose. Do not shake the inhaler. Breathe out fully away from the mouthpiece, then place the mouthpiece in your mouth, seal your lips around it, and breathe in steadily and deeply. Hold your breath for three to four seconds, then breathe out slowly. Close the cover after use.

Daily Routine

One inhalation of Relvar Ellipta once daily at the same time each day provides 24-hour coverage. Always rinse your mouth with water and spit out after each use to reduce the risk of oral thrush. Keep a short-acting reliever inhaler (such as salbutamol) available for breakthrough symptoms. If you need your reliever more than twice a week, your asthma control should be reviewed.

Relvar Ellipta is taken as one inhalation once daily via the Ellipta device. For asthma, the standard starting dose is the 92mcg/22mcg strength. If asthma remains inadequately controlled, the 184mcg/22mcg strength may be used. For COPD, the 92mcg/22mcg strength is used. The Ellipta device contains 30 doses per inhaler (a one-month supply).

No dose adjustment is required for age, renal impairment, or mild to moderate hepatic impairment. Relvar Ellipta has not been studied in patients with severe hepatic impairment, and caution is advised. Store below 25 degrees Celsius and keep in the sealed foil tray until ready for use; discard six weeks after opening the foil tray or when the dose counter reads zero, whichever comes first.

Common Side Effects

• Oral thrush (candidiasis) in the mouth or throat: reduced by mouth rinsing after each dose
• Headache
• Nasopharyngitis (runny nose, sore throat)
• Upper respiratory tract infection
• Hoarseness or voice changes
• Muscle cramps or musculoskeletal pain (LABA effect)
• Palpitations
• Bruising of the skin at high ICS doses

Serious Side Effects

• Paradoxical bronchospasm: Worsening breathlessness immediately after inhalation; use a reliever inhaler and seek urgent medical attention
• Adrenal suppression: At high fluticasone furoate doses; symptoms of adrenal insufficiency include profound fatigue, dizziness, and weight loss
• Cardiovascular effects: Vilanterol can cause cardiac arrhythmias, tachycardia, or blood pressure changes, particularly in patients with underlying cardiac disease
• Hypokalaemia: High-dose LABA use combined with other potassium-lowering medicines (diuretics, corticosteroids) can reduce potassium levels significantly
• Severe allergic reactions: Angioedema, urticaria, or rash require discontinuation and urgent review

LABA Must Not Be Used Without ICS in Asthma

Vilanterol, the LABA component, must never be used without the ICS component in asthma. Using a LABA alone without an inhaled corticosteroid in asthma significantly increases the risk of severe and potentially fatal asthma attacks. Relvar Ellipta delivers both components together, so this risk is inherently managed, but patients should never use a standalone LABA alongside Relvar Ellipta.

Do Not Use as a Reliever Inhaler

Relvar Ellipta is a maintenance treatment and must not be used to relieve sudden breathlessness during an acute exacerbation. Patients should always carry a short-acting beta-2 agonist such as salbutamol for this purpose. Relvar does not act rapidly enough to treat acute symptoms.

Cardiovascular and Metabolic Monitoring

Patients with existing cardiovascular disease, hypertension, cardiac arrhythmias, or diabetes should be monitored during treatment, as vilanterol can cause increases in heart rate, blood pressure, and blood glucose. Hypokalaemia (low potassium) can occur particularly in patients taking high doses, diuretics, or both. Potassium levels and ECG monitoring may be appropriate in high-risk patients.

• Known hypersensitivity to fluticasone furoate, vilanterol, lactose, or magnesium stearate
• Use as a reliever inhaler in acute asthma or COPD exacerbations
• Use of standalone LABA (vilanterol) without ICS coverage in asthma patients
• Untreated or active pulmonary tuberculosis
• Untreated fungal, bacterial, or viral respiratory infections
• Severe hepatic impairment (insufficient data)
• Children under 12 years with asthma (limited data)