STEPS

New Drug Reviews

Glycopyrrolate (Lonhala Magnair) for Treatment of Chronic Obstructive Pulmonary Disease

 

Am Fam Physician. 2019 May 15;99(10):643-648.

Glycopyrrolate nebulizer solution (Lonhala Magnair) is labeled for long-term maintenance therapy of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It is available with a portable nebulizer for self-administration by patients.

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DrugDosageDose formCost*

Glycopyrrolate (Lonhala Magnair)

One inhalation (25 mcg) twice daily

1-mL vial

$1,170


*—Estimated retail price of 30 days of treatment (60 vials) based on information obtained at https://www.goodrx.com (accessed February 7, 2019).

DrugDosageDose formCost*

Glycopyrrolate (Lonhala Magnair)

One inhalation (25 mcg) twice daily

1-mL vial

$1,170


*—Estimated retail price of 30 days of treatment (60 vials) based on information obtained at https://www.goodrx.com (accessed February 7, 2019).

Safety

Glycopyrrolate is an anticholinergic, which could theoretically induce narrow-angle glaucoma and worsen symptoms of urinary retention. Glycopyrrolate should not be used with other medications that have anticholinergic activity.1 It should not be initiated in patients during an acute exacerbation of COPD. All patients started on glycopyrrolate should have a short-acting beta agonist for treatment of acute symptoms and paradoxical bronchospasm. Glycopyrrolate should be avoided in patients with unstable cardiac disease because studies have not evaluated safety. Glycopyrrolate is excreted in breast milk and should not be used in pregnant and lactating women unless the expected benefit outweighs the potential risk. It is not approved for use in children.

Tolerability

Glycopyrrolate is well tolerated. In clinical trials, the pooled dropout rate due to adverse effects was 5%, compared with 9% for patients treated with placebo. Two 12-week randomized, placebo-controlled trials involved a total of 431 patients with moderate to severe COPD (average forced expiratory volume in one second [FEVI] of 52% of predicted). More than 2% of participants

Address correspondence to Montgomery Douglas, MD, at mdouglas@uchc.edu. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

References

1. Daily Med. Drug label information. Lonhala Magnair–glycopyrrolate solution. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78166def-5e2f-42a6-a1f1-0253e5765632. Accessed January 7, 2019.

2. Kerwin E, Donohue JF, Goodin T, Tosiello R, Wheeler A, Ferguson GT. Efficacy and safety of glycopyrrolate/eFlow®CS (nebulized glycopyrrolate) in moderate-to-very-severe COPD: results from the Glycopyrrolate for Obstructive Lung Disease via Electronic Nebulizer (GOLDEN) 3 and 4 randomized controlled trials. Respir Med. 2017;132:238–250.

3. Ferguson GT, Goodin T, Tosiello R, Wheeler A, Kerwin E. Long-term safety of glycopyrrolate/eFlow® CS in moderate-to-very-severe COPD: results from the Glycopyrrolate for Obstructive Lung Disease via Electronic Nebulizer (GOLDEN) 5 randomized study. Respir Med. 2017;132:251–260.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, Assistant Medical Editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

 

 

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