Indacaterol

Indacaterol is a long-acting inhaled beta-2 adrenergic agonist (LABA) used for the maintenance treatment of chronic obstructive pulmonary disease (COPD). Administered once daily by inhalation, it provides bronchodilation for about 24 hours.

Indacaterol is not indicated for relief of acute bronchospasm and is not approved for the treatment of asthma due to safety concerns associated with LABAs in asthma.

Administration and dosing: Delivered as a dry powder via the Breezhaler device. The usual dose is 75 micrograms once daily. Onset of bronchodilation is rapid, typically within minutes, with peak effect in the first couple of hours and sustained effect over 24 hours. It can be used as monotherapy or in fixed-dose combinations, such as indacaterol/glycopyrronium (Utibron Neohaler).

Pharmacology: It is a selective beta-2 adrenergic receptor agonist which relaxes airway smooth muscle, leading to bronchodilation. It has minimal activity at beta-1 receptors, which reduces cardiac stimulation relative to nonselective beta agonists.

Safety and adverse effects: Common adverse effects include cough, sore throat, and headache; tremor and tachycardia may occur. Less common but serious events include cardiovascular events and paradoxical bronchospasm. Indacaterol should be used with caution in patients with significant cardiovascular disease, arrhythmias, or other risk factors, and it should not be used in asthma.

Regulatory status: In the United States, indacaterol is marketed as Arcapta Neohaler; in the European Union as Onbrez Breezhaler. Combination products, such as indacaterol/glycopyrronium (Utibron Neohaler), are also available for COPD.