2. Duration of Therapy
Inhalational anticholinergic agents are suitable for chronic administration as side effects are minimal and drug effectiveness is maintained over years of regular, continuous use. Since inhalation anticholinergics are indicated in the management of chronic, lifelong diseases, there is no basis for limiting the duration of therapy. However, days’ supply for each MDI anticholinergic canister is limited based on the number of inhalations per canister as well as the maximum recommended dose per day. Days’ supply for inhalational anticholinergic therapy is summarized in Tables 4 and 5, based on the maximum recommended dose and the number of actuations per canister or number of capsules per blister card listed in Tables 1-3. Excessive use may be identified based on refill frequency. Inappropriate supply of inhaled anticholinergic agents will be monitored by reviewing excessive refills.
| Drug | Number of Actuations Per Canister | Days’ Supply (based on maximum dose per day)+ |
|---|---|---|
| aclidinium 400 mcg/ actuation |
30 60 |
15 30 |
| ipratropium bromide HFA (12.9 g inhaler) | 200 | ~16-17 |
| tiotropium inhalation capsules (5 capsules, 30 capsules, 90 capsules) | 5 to 90 (based on capsule number prescribed) | 5 to 90 (based on number of capsules prescribed) |
| tiotropium inhalation spray 1.25 mg/actuation | 60 | 30 |
| tiotropium inhalation spray 2.5 mcg/actuation | 28 60 |
14 30 |
| umeclidinium inhalation powder box of 30 foil blister powder strips |
30 | 30 |
Legend:
- + calculated based on canister size/blister package size and maximum dose allowed per day
| Drug | Number of Actuations Per Canister | Days’ Supply (based on maximum dose per day)+ |
|---|---|---|
| aclidinium bromide/ formoterol fumarate inhalation 400 mcg/12 mcg/inhalation |
60 | 30 |
| budesonide/ glycopyrrolate/ formoterol fumarate 160 mcg/ 9 mcg/ 4.8 mcg/ actuation |
120 | 30 |
| fluticasone furoate/ umeclidinium/ vilanterol inhalation powder~ 100 mcg/62.5 mcg/25 mcg/actuation 28 blisters (one strip contains fluticasone, one strip contains umeclidinium and vilanterol) 60 blisters (one strip contains fluticasone, one strip contains umeclidinium and vilanterol) |
14 30 |
14 30 |
| fluticasone furoate/ umeclidinium/ vilanterol inhalation powder~ 200 mcg/62.5 mcg/25 mcg/actuation 28 blisters (one strip contains fluticasone, one strip contains umeclidinium and vilanterol) 60 blisters (one strip contains fluticasone, one strip contains umeclidinium and vilanterol) |
14 30 |
14 30 |
| glycopyrrolate/formoterol aerosol inhalation (10.7 g inhaler) |
28 120 |
7 30 |
| ipratropium/albuterol spray (4 g cartridge) | 120 | 20 |
| tiotropium/olodaterol spray (4 g cartridge) | 60 | 30 |
| umeclidinium/vilanterol inhalation powder~ 14 blisters (one strip contains umeclidinium, one strip contains vilanterol) 60 blisters (one strip contains umeclidinium, one strip contains vilanterol) |
70 30 |
70 30 |
Legend:
- + calculated based on canister size/blister package size and maximum dose allowed per day
- ~ not indicated for use in children