olodaterol

General

Pronunciation:
oh-loh-dat-er-ole


Trade Name(s)

  • Striverdi Respimat

Ther. Class.
bronchodilators

Pharm. Class.
beta-adrenergic agonists

Indications

Maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and emphysema.

Action

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 Effect(s):

Bronchodilation with decreased airflow obstruction.

Pharmacokinetics

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

Distribution: Extensive tissue distribution; probably enters breast milk.

Metabolism and Excretion: Extensively metabolized (some by CYP 3A4), only one metabolite binds to B2  adrenergic receptors. Following inhalation, 5–7% excreted unchanged in urine, remainder in feces as drug and metabolites (84%).

Half-life: 45 hr (following inhalation).

TIME/ACTION PROFILE (improvement in FEV1)

ROUTEONSETPEAKDURATION
inhalnwithin 1 hr1–5 hr24 hr

Contraindication/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 only if potential maternal benefit justifies potential fetal risk; may interfere with uterine contractility during labor;
  • Lactation: Use while breast feeding only if potential maternal benefit justifies potential risk to infant;
  • Pedi:  Safety and effectiveness not established.

Exercise Extreme Caution in:

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

Adverse Reactions/Side Effects

CNS: dizziness .

CV: ↑ BP, ECG changes, tachycardia

EENT: nasopharyngitis

Endo: hyperglycemia

F and E: hypokalemia

GI: diarrhea

MS: arthralgia, back pain

Resp: PARADOXICAL BRONCHOSPASM, cough

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

  • Concurrent use with MAOIs, tricyclic antidepressants, or  drugs that prolong QTc  ↑ risk of adverse cardiovascular reactions (use with extreme caution).
  • Concurrent use of other  adrenergics  ↑ risk of adverse adrenergic adverse reactions (tachycardia, ↑ BP).
  • Concurrent use with corticosteroids, non-potassium sparing diuretics, or  xanthine derivatives  (including  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  (LABAs)
  • Blood levels may be ↑ by ketoconazole.

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 combination drugs.

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.

Potential Diagnoses

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.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding.

Evaluation/Desired Outcomes

Bronchodilation with decreased airflow obstruction.

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