olodaterol

A long-acting beta₂-adrenergic agonist (LABA) that stimulates adenyl cyclase, resulting in accumulation of cyclic adenosine monophosphate (cAMP) at beta₂-adrenergic receptors resulting in bronchodilation.

Therapeutic effects:

Bronchodilation with decreased airflow obstruction.

Pharmacokinetics ⬆ ⬇

Absorption: 30% absorbed following oral inhalation (from lung surface); swallowed drug is minimally absorbed.

Distribution: Extensively distributed to tissues.

Metabolism/Excretion: Extensively metabolized by the liver, some by the CYP3A4 isoenzyme; only one metabolite binds to beta₂ adrenergic receptors. 5–7% excreted unchanged in urine, remainder in feces as drug and metabolites (84%).

Half-Life: 45 hr.

Time/Action Profile ⬆ ⬇

(improvement in FEV₁)

ROUTE	ONSET	PEAK	DURATION
Inhaln	within 1 hr	1–5 hr	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Acutely deteriorating COPD or acute respiratory symptoms;
Asthma.

Use Cautiously in:

History of seizures;
Thyrotoxicosis;
History of cardiovascular disorders (coronary insufficiency, arrhythmias, hypertension);
Sensitivity to sympathomimetics (adrenergics);
Severe hepatic impairment;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk; may interfere with uterine contractility during labor;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children.

Exercise Extreme Caution in:

Concurrent use with MAO inhibitors, tricyclic antidepressants, or drugs that prolong the QTc interval (↑ risk of adverse cardiovascular reactions).

Adv. Reactions/Side Effects ⬆ ⬇

CV: ↑BP, ECG changes, tachycardia

EENT: nasopharyngitis

Endo: hyperglycemia

F and E: hypokalemia

GI: diarrhea

MS: arthralgia, back pain

Neuro: dizziness.

Resp: cough, PARADOXICAL BRONCHOSPASM

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with MAO inhibitors, tricyclic antidepressants, or QT interval prolonging medications↑ risk of adverse cardiovascular reactions; use with extreme caution.
Concurrent use of other adrenergics↑ risk of adrenergic adverse reactions (tachycardia, ↑ BP).
Concurrent use with corticosteroids, non-potassium sparing diuretics, or theophylline may ↑ risk of hypokalemia and adverse cardiovascular reactions; use cautiously.
Concurrent use with beta blockers may ↓ effectiveness and cause severe bronchospasm; use cautiously.
Should not be used concurrently with any other long-acting beta2-adrenergic blockers
Ketoconazole may ↑ levels and risk of toxicity.

Route/Dosage ⬆ ⬇

Inhaln (Adults ): 2 inhalations once daily.

Availability ⬆ ⬇

Inhalation spray: 2.7 mcg (delivers 2.5 mcg) per actuation in cartridges containing 14 doses/cartridge (one actuation lost in priming) for use with Respimat inhaler
In combination with: tiotropium (Stiolto Respimat). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult health care professional about alternative medication if severe bronchospasm is present; onset of action is too slow for patients in acute distress. If paradoxical bronchospasm (wheezing) occurs, withhold medication and notify health care professional immediately.
Monitor for signs and symptoms of allergic reactions (difficulties in breathing or swallowing, swelling of tongue, lips and face, urticaria, skin rash). Discontinue therapy if symptoms occur.

Lab Test Considerations:

May cause transient hypokalemia and hyperglycemia.

Implementation ⬆ ⬇

Inhaln: Prior to first use, prime the inhaler by actuating toward ground until aerosol cloud is visible, then repeat procedure 3 more times. If not used for 3 days, actuate inhaler once to prepare for use. Striverdi Respimat has a slow-moving mist to assist with inhalation. Use once (2 puffs), at the same time daily.
- A rescue inhaler of short-acting beta₂-agonists should always be available to treat sudden bronchospasm.

Patient/Family Teaching ⬆ ⬇

Instruct patient in the correct use of Striverdi Respimat. Take missed doses as soon as remembered. Do not take more than 1 dose (2 puffs) in 24 hr. Advise patient not to discontinue without consulting health care professional; symptoms may recur.
Inform patient that olodaterol is a long-acting bronchodilator and should not be used for treating sudden breathing problems of COPD or asthma.
Advise patient to notify health care professional if signs and symptoms of allergic reaction, worsening symptoms; decreasing effectiveness of inhaled, short-acting beta₂-agonists; need for more inhalations than usual of inhaled, short-acting beta₂-agonists; or significant decrease in lung function occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of Rx, OTC, and herbal products without consulting health care professional.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇