Indacaterol: A Novel Ultra-Long-Acting Beta-Agonist for COPD and Asthma

Indacaterol is a new inhaled medication that belongs to the class of drugs called beta-2 adrenergic agonists. These drugs work by relaxing the muscles around the airways, making it easier to breathe. Indacaterol is different from other beta-2 agonists because it has a very long duration of action, lasting up to 24 hours with a single dose. This means that patients with chronic obstructive pulmonary disease (COPD) or asthma can use it once a day to prevent and relieve symptoms such as wheezing, coughing, shortness of breath and chest tightness.

What is COPD and how does indacaterol help?

COPD is a common lung condition that affects millions of people worldwide. It is caused by long-term exposure to irritants such as tobacco smoke, air pollution or occupational dusts and chemicals. COPD damages the airways and the air sacs in the lungs, making them narrow and inflamed. This reduces the amount of air that can flow in and out of the lungs, leading to breathing difficulties and reduced oxygen levels in the blood.

Indacaterol helps to improve airflow in the lungs by opening up the airways and reducing inflammation. It also reduces the frequency and severity of COPD exacerbations, which are episodes of worsening symptoms that often require hospitalization. Indacaterol has been shown to be as effective as other long-acting beta-2 agonists such as salmeterol or formoterol, but with the convenience of once-daily dosing. Indacaterol can be used alone or in combination with other medications such as corticosteroids or anticholinergics for better control of COPD symptoms.

What is asthma and how does indacaterol help?

Asthma is a chronic inflammatory disease of the airways that affects people of all ages. It is characterized by recurrent episodes of wheezing, breathlessness, chest tightness and coughing, especially at night or early in the morning. Asthma is triggered by various factors such as allergens, infections, exercise, stress or cold air. Asthma can be mild, moderate or severe, depending on the frequency and intensity of symptoms.

Indacaterol is a potential treatment option for patients with moderate to severe asthma who are not well controlled with other medications such as short-acting beta-2 agonists or inhaled corticosteroids. Indacaterol provides sustained bronchodilation and reduces inflammation in the airways, improving lung function and quality of life. Indacaterol has been shown to be safe and effective in clinical trials involving patients with asthma, but more long-term data are needed before it can be approved for this indication.

How to use indacaterol?

Indacaterol is delivered as a dry powder through a device called a breezhaler. The breezhaler consists of a capsule containing indacaterol powder and an inhaler device that pierces the capsule and releases the powder into the mouthpiece. To use the breezhaler, follow these steps:

Remove one capsule from the blister pack and insert it into the breezhaler chamber.
Close the breezhaler until you hear a click.
Hold the breezhaler upright with the mouthpiece facing you.
Breathe out fully away from the breezhaler.
Place the mouthpiece between your lips and inhale deeply and steadily until your lungs are full.
Hold your breath for about 10 seconds or as long as comfortable.
Breathe out slowly away from the breezhaler.
Open the breezhaler and remove the empty capsule.
Rinse your mouth with water after using indacaterol to prevent oral thrush.

You should use indacaterol once a day at the same time every day. Do not use more than one capsule per day. Do not swallow or chew the capsule. Do not use indacaterol if you are allergic to it or any of its ingredients. Do not use indacaterol to treat sudden attacks of breathlessness. Use a rescue inhaler such as salbutamol for this purpose.

What are the side effects of indacaterol?

Indacaterol is generally well tolerated, but like any medication, it may cause some side effects. The most common side effects are:

Cough
Headache
Nasal congestion
Throat irritation
Muscle spasms

Some rare but serious side effects are:

Allergic reactions such as rash, hives, swelling or difficulty breathing
Irregular heartbeat or palpitations
Chest pain or angina
High blood pressure or low blood potassium
Tremor or nervousness
Anxiety or depression
Glaucoma or increased eye pressure
Urinary retention or difficulty urinating

If you experience any of these side effects, stop using indacaterol and seek medical attention immediately.

What are the precautions and interactions of indacaterol?

Before using indacaterol, tell your doctor if you have any medical conditions such as:

Heart disease or arrhythmia
High blood pressure or diabetes
Thyroid problems or pheochromocytoma
Liver or kidney disease
Seizures or epilepsy
Tuberculosis or fungal infections
Osteoporosis or low bone density
Prostate problems or glaucoma

Also tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding.

Indacaterol may interact with other medications, such as:

Beta-blockers such as atenolol, metoprolol or propranolol
Diuretics such as furosemide, hydrochlorothiazide or spironolactone
Steroids such as prednisone, dexamethasone or fluticasone
Theophylline or aminophylline
Antidepressants such as amitriptyline, fluoxetine or paroxetine
Antihistamines such as diphenhydramine, loratadine or cetirizine
Antifungals such as ketoconazole, itraconazole or fluconazole
HIV medications such as ritonavir, saquinavir or indinavir
Grapefruit juice or herbal supplements such as St. John’s wort or ginkgo biloba

A comparison of indacaterol prices in different countries (USD)

Country	Brand name	Price per capsule (150 mcg)	Source (as of September 2023)
USA	Arcapta Neohaler	$3.50	GoodRx.com
Canada	Onbrez Breezhaler	$1.90	PharmacyChecker.com
UK	Onbrez Breezhaler	$1.60	BNF Online
Australia	Onbrez Breezhaler	$0.90	<a href=”https://www.pbs.gov.au/medicine/item/10167T-10168W-10169X-10170Y-10171B-10172C-10173D-10174E-10175F-10176G-10177H-10178J-10179K-10180L-10181