Revefenacin
Indications
Revefenacin is used for:
Chronic Obstructive Pulmonary Disease
Adult Dose
Chronic Obstructive Pulmonary Disease
Indicated for maintenance treatment of chronic obstructive pulmonary disease (COPD)
175 mcg inhaled PO qDay via nebulizer using a mouthpiece
Administer at the same time every day
Not to exceed 175 mg once daily
Hepatic impairment
Mild-to-severe: Safety not evaluated; not recommended in patients with any degree of hepatic impairment
Child Dose
Renal Dose
Renal impairment
Any degree of impairment: No dosage adjustment is required
Monitor for systemic antimuscarinic adverse effects in COPD patients with severe renal impairment
Administration
Do not swallow or inject solution
Orally inhale using a standard jet nebulizer connected to air compressor; safety and efficacy not established for administration via noncompressor nebulizer systems
Immediately before use, remove unit-dose vial from the foil pouch and open; discard vial and any residual content after use
Contra Indications
Hypersensitivity
Precautions
Do not initiate during acutely deteriorating or life-threatening COPD episodes; intended as maintenance treatment and not for relief of acute symptoms
Inhalers can produce paradoxical bronchospasm that may be life-threatening; if this occurs, treat immediately with an inhaled, short-acting bronchodilator and discontinue revefenacin
Caution with narrow-angle glaucoma; instruct patients to contact physician if symptoms occur (eg, eye pain, blurred vision, visual halos, colored images, red eyes from congestion, corneal edema)
May worsen urinary retention, especially with history of prostatic hyperplasia or bladder-neck obstruction
Immediate hypersensitivity reported; discontinue drug immediately
Pregnancy-Lactation
Pregnancy
There are no available data regarding use in pregnant women
Advise women to contact their physician if they become pregnant while taking revefenacin
Lactation
Data are not available regarding presence of revefenacin in human milk, effects on breastfed infant, or effects on milk production
Present in milk of lactating rats following dosing during pregnancy and lactation
Consider the development and health benefits of breastfeeding along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed child or from the underlying maternal condition
Interactions
Avoid coadministration with other anticholinergic drugs, owing to additive effects
OATP1B1 and OATP1B3 inhibitors may increase systemic exposure of revefenacin’s active metabolite; coadministration not recommended
Side Effects
Side effects of Revefenacin :
1-10%
Cough (4%)
Nasopharyngitis (4%)
Headache (4%)
Upper respiratory tract infection (3%)
Back pain (2%)
Hypertension (1-2%)
Dizziness (1-2%)
Oropharyngeal pain (1-2%)
Bronchitis (1-2%)
Frequency Not Defined
Paradoxical bronchospasm
Worsening narrow-angle glaucoma
Worsening urinary retention
Immediate hypersensitivity reactions
Mode of Action
Long-acting muscarinic antagonist (LAMA), which is often referred to as an anticholinergic; blocks action of acetylcholine at muscarinic receptors (M1 to M5); in the bronchial airways, it elicits pharmacologic effect by inhibiting M3 at the smooth muscle, leading to bronchodilation