How does this medication work? What will it do for me?

This combination product contains two medications glycopyrronium and indacaterol. Glycopyrronium belongs to the group of medications known as anticholinergics. Indacaterol belongs to the group of medications known as long-acting bronchodilators. These medications work in different ways to relax the muscles in the walls of the small air passages in the lungs, keeping the air passage open and making it easier to breathe. 

This medication is used for the maintenance treatment of chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis. Regular daily use is important for this medication to be effective. It will not relieve an episode of increased difficulty breathing.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

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What form(s) does this medication come in?

Each capsule with a transparent yellow cap and natural transparent body containing a white-to-practically white powder, with the product code "IGP110.50" printed in blue under two blue bars on the body and the company logo printed in black on the cap, contains 143 µg indacaterol maleate equivalent to 110 µg indacaterol and 54 µg glycopyrronium bromide equivalent to 50 µg glycopyrronium. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate; capsule shell: hypromellose, purified water, carrageenan, potassium chloride, and FD&C Yellow No. 5/Tartrazine.

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How should I use this medication?

Glycopyrronium – indacaterol is inhaled into the lungs through the mouth. Do not swallow this medication.

The recommended adult dose of glycopyrronium – indacaterol is to inhale the contents of one capsule once daily, using the Breezhaler™ inhaler device that comes in the pack with the medication. Your health care professional should show you how to use the device. If you not sure about how to use the device, contact your doctor or pharmacist for advice.

When used regularly, this medication helps to prevent episodes of severe difficulty breathing.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. This medication will not reverse an episode of troubled breathing. If you experience shortness of breath, use your short-acting bronchodilator.

If you find you need to use your short-acting ("rescue") inhaler more often or if your condition seems to worsen, call your doctor. Severe blood pressure and heart problems may occur if glycopyrronium – indacaterol is used more often than one inhalation once daily.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature in its original packaging. Remove the capsule from the blister packaging only when you are ready to inhale your dose. When you start a new package of medication, discard the old inhaler device and use the new one that is provided. Protect this medication from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use glycopyrronium – indacaterol if you:

  • are allergic to indacaterol, glycopyrronium or any ingredients of the medication
  • are severely allergic to lactose or milk proteins
  • have been prescribed this medication to treat asthma
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What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • cough
  • diarrhea
  • difficulty falling asleep
  • dizziness
  • dry mouth
  • headache
  • heartburn
  • nausea
  • shakiness
  • skin rash, itchiness
  • sore mouth
  • sore throat
  • upset stomach
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • feeling of pressure or pain in cheeks or forehead
  • fever
  • high blood pressure
  • irregular heartbeat
  • leg or arm pain
  • nervousness
  • pain in muscles, joints or bones
  • symptoms of decreased amount of potassium in the blood (e.g., irregular heartbeat, muscle weakness and spasms, general feeling of being unwell)
  • symptoms of glaucoma (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
  • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
  • symptoms of a urinary tract infection (e.g., pain when urinating, urinating more often than usual, low back or flank pain)
  • tingling or numbness

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • crushing chest pain (signs of not enough blood and oxygen getting to the heart)
  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • sudden worsening of shortness of breath after using inhaler

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

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Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Diabetes: This medication may cause an increase in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Glaucoma: Glycopyrronium may cause symptoms of glaucoma (increased pressure in the eye) to worsen. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart rhythm: Glycopyrronium – indacaterol can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), or taking other medications that can cause heart rhythm problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Potassium levels: Decreases in blood levels of potassium may occur with normal use of glycopyrronium – indacaterol. This rarely causes problems, but potassium levels should be monitored by your doctor. If you experience unexplained nausea, fatigue, muscle weakness or tingling sensations, contact your doctor.

Prevention only: Glycopyrronium – indacaterol is not useful for treating acute symptoms (as a "rescue" medication). It is meant for prevention purposes only. Short-acting medications such as salbutamol, terbutaline, or formoterol are required for relief of breathing symptoms as instructed by your doctor and should be available at all times.

Urinary tract problems: This medication can cause increased difficulty with urine flow and urinary retention. If you have an enlarged prostate gland or other condition that makes it difficult to pass urine, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you experience difficulty starting to urinate or have pain when you urinate, speak with your doctor as soon as possible.

Worsening symptoms: If you find you need to use your short-acting ("rescue") inhaler more often or if your condition seems to worsen, call your doctor. If you have not been given instructions beforehand, contact your doctors immediately about what to do if any of the following situations occur (they may be signs of seriously worsening COPD):

  • decreased effectiveness of short-acting, inhaled bronchodilators such as salbutamol, terbutaline, or fenoterol (less than 4 hours of relief)
  • need for more inhalations than usual of short-acting, inhaled bronchodilators

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if glycopyrronium – indacaterol passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between glycopyrronium – indacaterol and any of the following:

  • aclinidium
  • alfuzosin
  • amantadine
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • anagrelide
  • antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • atomoxetine
  • atropine
  • azelastine
  • "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
  • belladonna
  • benztropine
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • beta 2 agonists (e.g., salbutamol, formoterol, terbutaline)
  • betahistine
  • bortezomib
  • bosutinib
  • caffeine
  • chloral hydrate
  • chloroquine
  • cisapride
  • oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
  • crizotinib
  • cyclobenzaprine
  • dasatinib
  • dimenhydrinate
  • dipivefrin
  • disopyramide
  • domperidone
  • donepezil
  • dronedarone
  • epinephrine
  • famotidine
  • flecainide
  • fingolimod
  • flavoxate
  • furosemide
  • galantamine
  • glycopyrrolate
  • ipratropium
  • ketotifen
  • lapatinib
  • levodopa
  • lithium
  • lopinavir
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • maprotiline
  • mefloquine
  • methadone
  • mifepristone
  • medications that increase blood levels of potassium (e.g., potassium chloride, salt substitutes containing potassium)
  • metformin
  • methylphenidate
  • mirabegron
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • nabilone
  • nasal decongestants (e.g., oxymetazoline, xylometazoline)
  • nilotinib
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
  • octreotide
  • orphenadrine
  • oxybutynin
  • paliperidone
  • pazopanib
  • pentamidine
  • pimozide
  • procainamide
  • propafenone
  • pseudoephedrine
  • quinidine
  • quinine
  • quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
  • ritonavir
  • rivastigmine
  • romidepsin
  • saquinavir
  • scopolamine
  • secretin
  • selective serotonin reuptake inhibitors (SSRI's; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
  • serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
  • sotalol
  • sulfamethoxazole
  • sunitinib
  • tacrolimus
  • tamoxifen
  • tetrabenazine
  • thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
  • theophylline
  • tiotropium
  • tolterodine
  • topiramate
  • trazodone
  • trimethoprim
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
  • vandetanib
  • vardenafil
  • vemurafenib
  • venlafaxine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.