umeclidinium

Umeclidinium is a long-acting muscarinic antagonist (LAMA) approved for the maintenance treatment of chronic obstructive pulmonary disease (COPD). It is delivered as an inhaled dry powder and is marketed in the United States as Incruse Ellipta, as well as in fixed-dose combinations such as umeclidinium/vilanterol (Anoro Ellipta).

Mechanism of action for umeclidinium involves selective antagonism of M3 muscarinic receptors on airway smooth muscle. By blocking acetylcholine-induced bronchoconstriction, it promotes bronchodilation and helps preserve airflow. It is a quaternary ammonium compound, which limits systemic absorption and supports once-daily dosing with a favorable safety profile.

Umeclidinium is indicated for the maintenance treatment of COPD to reduce symptoms and the risk of exacerbations. It is not intended for relief of acute bronchospasm and should be used as part of a long-term management plan. In clinical practice, it is commonly used as monotherapy or in combination with a long-acting beta-agonist (as part of Anoro Ellipta) for broader symptom control.

Administration and dosing typically involve inhalation of 62.5 micrograms once daily via the Ellipta device. The inhaled formulation is designed to minimize systemic exposure, with most pharmacologic effects localized to the lungs.

Common adverse effects include dry mouth and upper respiratory tract infections, with other muscarinic-related effects occurring infrequently due to limited systemic absorption. Umeclidinium is approved for COPD in many countries and was first approved in 2014 in the United States. It is not approved for asthma.