Olodaterol

Olodaterol is a long-acting beta-2 agonist given once daily for COPD, with onset in about 5 minutes and duration 24 hours.

Classification. Long-acting beta-2 agonist.

Mechanism. Selective beta-2 agonism with prolonged effect.

Pharmacokinetics. Mostly hepatic glucuronidation. Half-life of inhaled drug about 45 hours.

First-line, COPD. 5 micrograms (2 puffs of 2.5 micrograms) once daily by soft mist inhaler. Maximum 5 micrograms daily.

Fixed combination. With tiotropium, 2.5 micrograms of each drug in each puff, 2 puffs once daily.

Asthma. Not licensed.

Titration. None. No loading dose.

Contraindications. Hypersensitivity.

Serious adverse effects. Arrhythmia, hypokalaemia, hypertension, paradoxical bronchospasm.

Common adverse effects. Nasopharyngitis, dizziness, rash, arthralgia.

Interactions. Beta-blockers; hypokalaemic drugs; QT-prolonging drugs.

Common prescribing errors. Giving 1 puff only. Using in asthma.

Special groups.

• Pregnancy: avoid unless needed. Breastfeeding: no data.

• Older adults: no adjustment.

• Kidney impairment: no adjustment except careful monitoring in severe impairment. Liver impairment: no adjustment in mild to moderate.

Formulations. Soft mist inhaler cartridge.

Technique. Prime a new device. Hold the breath for 10 seconds.

Baseline. Spirometry, heart rate.

Monitoring. Symptoms, exacerbations, spirometry.

Stop and reduce rules. Stop for arrhythmia. Therapeutic drug monitoring is not used.

Referral and escalation. Escalate for persistent exacerbations.