Umeclidinium - vilanterol is a combination of two medications. Together they are used to reduce the symptoms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Umeclidinium is a long-acting muscarinic antagonist (LAMA). Vilanterol is a long-acting beta2-agonist (LABA). These medications work in different ways to open the airways, making it easier to breathe.

Umeclidinium - vilanterol should not be used as a rescue medication to relieve sudden attacks of COPD symptoms such as wheezing or shortness of breath. Consult your doctor or pharmacist for advice about rescue medications that are appropriate for you.

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.

The recommended dose of umeclidinium - vilanterol is one inhalation taken once daily. Try to use the inhaler at the same time every day to get the most benefit from it and to help you remember to use it.

Have your doctor or pharmacist explain how to use the inhaler and read the instructions carefully before using the inhaler. If you have any questions about how to use the inhaler, check with your health care professional.

Open the inhaler only when you are going to use the medication immediately. Each time you open and close the cover, a dose is prepared for inhalation. If you do not use the dose, it will be wasted.

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 used exactly as prescribed by your doctor.

If you miss a 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, protect it from light and moisture, and keep it out of the reach of children.

Umeclidinium - vilanterol is available as a disposable grey and red plastic inhaler containing 2 double-foil strips. One strip contains 62.5 µg of umeclidinium per blister and the other strip contains 25 µg of vilanterol per blister. Nonmedicinal ingredients: magnesium stearate and lactose monohydrate.

Do not take umeclidinium - vilanterol if you:

• are allergic to umeclidinium, vilanterol or any ingredients of the medication
• are severely allergic to milk proteins
• are using this medication to treat asthma

This medication should not be used by people under the age of 18.

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.

• arm, back, neck, or leg pain
• changed sense of taste
• cold symptoms (e.g., runny nose, stuffy nose, sore throat)
• constipation
• cough
• diarrhea
• dizziness
• dry mouth
• headache
• hoarseness
• nausea
• nervousness or anxiety
• sore throat
• stomach pain
• tremor
• trouble sleeping
• unusual tiredness
• vomiting

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

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

• difficulty or pain when urinating
• fast, pounding, or irregular heartbeat
• general feeling of being unwell
• muscle spasms
• sinus pain
• swollen, painful joints
• symptoms of high or low blood pressure (e.g., headache, ringing in the ears, dizziness, fainting)
• 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 low levels of potassium in the body (e.g., weakness, fatigue, muscle cramps, irregular heartbeat)
• symptoms of a lower respiratory (lung) infection (e.g., shortness of breath, cough, chest pain)
• 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 a urinary tract infection (e.g. pain when urinating, urinating more often than usual, low back or flank pain)

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

• breathing problems that develop quickly (e.g., shortness of breath, troubled breathing, wheezing, or tightness in chest, fast or irregular breathing)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• chest pain

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.

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.

Allergy: In rare cases, immediate allergic reactions may occur after using umeclidinium - vilanterol, causing hives, swelling around the throat and tongue, rash, and worsening of breathing problems. If this occurs, get emergency medical help at once.

Asthma related death: The safety and effectiveness of using this medication to treat asthma symptoms have not been determined. Studies have shown an increase in deaths caused by severe asthma symptoms when LABA medications have been used without a corticosteroid. This medication should not be used by people with asthma.

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

Glaucoma: Umeclidinium may cause symptoms of glaucoma (increased pressure in the eyes), such as blurred vision or eye pain or pressure to become worse. 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 conditions: This medication can cause an increase in blood pressure or heart rate in addition to changes to the heart rhythm. If you have any heart conditions, 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: Beta-2 agonists, such as vilanterol, 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), 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.

Inhalation-induced bronchospasm: Inhaled forms of medications may cause spasms of the airways, which make breathing difficult. If you experience this problem when using umeclidinium - vilanterol stop using this medication immediately. Speak to your doctor if you experience any problems with breathing while taking this or other inhaled medication.

Seizures: There have been occasional reports of seizures occurring with umeclidinium - vilanterol. Seizures are more likely to occur when higher doses of this medication are taken. If you have a history of epilepsy or medical conditions that increase the risk of seizures, 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.

Smoking: If you smoke, discuss with your doctor or pharmacist the benefits of stopping smoking. Smoking contributes to the symptoms of COPD. People who stop smoking often see a significant improvement in their breathing symptoms.

Thyroid disease: This medication may increase the symptoms of an overactive thyroid gland. If you have a history of thyroid 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.

Urinary tract problems: This medication can cause the symptoms of some urinary tract problems to become worse. If you have an enlarged prostate or other condition that causes urination to be difficult, 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.

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. It is very important that you have your "rescue" medication with you at all times. If you have not been given instructions beforehand, contact your doctor 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 either umeclidinium or vilanterol pass into breast milk. If you are a breast-feeding mother and are using 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 or people under the age of 18.

There may be an interaction between umeclidinium - vilanterol and any of the following:

• aclidinium
• amantadine
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• antihistamines (e.g., bilastine, cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine, rupatadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• atomoxetine
• atropine
• azelastine
• benztropine
• beta 2 agonists (e.g., salbutamol, formoterol, terbutaline)
• beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
• betahistine
• botulinum toxin
• caffeine
• cannabis
• cobicistat
• cocaine
• cyclobenzaprine
• darifenacin
• decongestants (e.g., naphazoline, oxymetazoline, phenylephrine, pseudoephedrine)
• dexmethylphenidate
• dimenhydrinate
• dipivefrin
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• domperidone
• donepezil
• dronedarone
• epinephrine
• flecainide
• galantamine
• glucagon
• glycopyrrolate
• HIV protease inhibitors (e.g., atazanavir, lopinavir, ritonavir)
• ipratropium
• ketotifen
• linezolid
• long-acting beta-2 agonists (e.g., formoterol, indacaterol, salmeterol)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• methadone
• methylphenidate
• metoclopramide
• midodrine
• mifepristone
• mirabegron
• modafinil
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• nabilone
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone, tapentadol, tramadol)
• orphenadrine
• oxybutynin
• ozanimod
• pizotifen
• potassium supplements
• procainamide
• protein kinase inhibitors (e.g., bosutinib, dasatinib, imatinib, nilotinib)
• quinidine
• quinine
• rivastigmine
• saquinavir
• scopolamine
• serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
• solifenacin
• tetrabenazine
• theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
• tiotropium
• tolterodine
• topiramate
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine)
• voriconazole

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.