Indacaterol (Onbrez) for chronic obstructive pulmonary disease (COPD)
Published in Medicine Update
Date published: About this date
Medicine Update is for people with chronic obstructive pulmonary disease (COPD) who are taking, or thinking about taking, indacaterol.
Indacaterol (brand name Onbrez) is a medicine used to treat the symptoms of chronic obstructive pulmonary disease (COPD). It’s a type of long-acting bronchodilator, which means that it works by relaxing the airways in the lungs over a period of time (24 hours).
Indacaterol is inhaled once a day using its own inhaler device called the Onbrez Breezhaler. It helps reduce shortness of breath and coughing. It also helps cut down the number of flare-ups or exacerbations.
Indacaterol is a maintenance treatment to help control symptoms and will not change the progression of your COPD. It’s just as effective at treating the symptoms of COPD as other maintenance inhalers such as tiotropium (Spiriva) and salmeterol (Serevent).
Coughing briefly just after using the indacaterol inhaler is very common. Otherwise, the side effects are similar to other long-acting bronchodilators.
Indacaterol must not be used for treating asthma.
The active ingredient of this medicine is indacaterol (pronounced IN-da-CAT-er-ol).
It is also known by the brand name Onbrez. It’s used in conjunction with an inhaler device called a Breezhaler.
Indacaterol belongs to a group of medicines called bronchodilators.
Indacaterol treats the symptoms of chronic obstructive pulmonary disease (COPD) — a condition of the lungs where the airways and lungs have become damaged, making it hard to breathe.
COPD is an umbrella term incorporating illnesses such as emphysema (where the small air sacs in the lungs are damaged) and chronic bronchitis (where the air passages are inflamed, causing coughing and excess mucus).
COPD usually begins after the age of 40, and often affects people who smoke or have smoked. If you have COPD, then quitting smoking will slow down the rate at which your COPD gets worse and may help you live longer.
COPD is a chronic condition that cannot be cured. However, it can be managed. Treatment can help you feel less short of breath or tight in the chest and avoid acute flare-ups.
You can be prescribed indacaterol through the Pharmaceutical Benefits Scheme (PBS) if you have been diagnosed with COPD and need ongoing treatment to help you breathe more easily.
Talk to your doctor if you have a heart problem, as indacaterol may not be suitable for you. Your doctor will need to consider this before prescribing indacaterol.
Indacaterol must not be used to treat asthma
Indacaterol is not suitable if you have asthma as well as COPD (sometimes called mixed airways disease). Ask your doctor if you’re not sure.
Do not let other members of your family or friends use your indacaterol inhaler for an asthma attack.
Indacaterol comes as a capsule that needs to be inserted into an inhaler device.
You must not swallow the capsules.
Read the instructions on the packaging
Each prescription comes with a new inhaler device. The packaging includes a leaflet with detailed instructions and diagrams explaining how to use the inhaler.
Load a new capsule into the inhaler device every time you use it. Make sure you know how to do this correctly. Ask your doctor, pharmacist or nurse to show you if you’re not sure.
Coughing after using the inhaler is quite common
You may cough briefly after inhaling indacaterol. Don’t worry about whether you have inhaled enough of the medicine — if the capsule is empty you will have received the full dose.
Use indacaterol once a day
You should inhale the contents of one 150-microgram capsule — using the inhaler device — once a day.
In some cases, your doctor may prescribe a 300-microgram capsule. This is a stronger dose, but is still a single capsule inhaled once a day.
Take indacaterol at the same time each day. This will help control your symptoms most effectively. It will also help you remember to take it every day.
Do not take indacaterol more than once a day
Do not take an extra dose, even if you feel that your normal dose is not working as well as usual. An extra dose won’t provide any extra benefit and will put you at risk of side effects.
Talk to your health professional if you feel that your normal dose is not working as well as usual so that your COPD treatment can be reviewed.
What to do if you forget to take indacaterol
If you miss a dose, take it as soon as you remember and then go back to taking the next dose as you would normally. If it’s almost time for your next dose, just take the next dose when you’re meant to.
Do not take a double dose to make up for the one that you missed.
What does indacaterol do?
Indacaterol works by relaxing the airways in your lungs, making it easier for you to breathe.
The effect of using indacaterol should last for 24 hours. This type of medicine is known as a long-acting bronchodilator.
Long-acting bronchodilators are used for ongoing treatment of COPD and need to be taken every day. They are sometimes called maintenance inhalers. Unlike short-acting bronchodilators, they do not provide rapid relief from symptoms.
How well does it work?
Indacaterol was found to reduce shortness of breath in clinical trials.
It also reduced the number of flare-ups or exacerbations.
A flare-up is where breathlessness, coughing and mucus get worse quite quickly over a few days. With an acute flare-up you may need to go to hospital for treatment.
How long will I need to keep taking indacaterol?
You need to take indacaterol every day to help control the symptoms of your COPD. Even if you are feeling better, you should speak to your health professional before you stop taking it.
Ask your health professional about the possible side effects of this medicine before you take it. Always tell them about any changes to your condition if you're taking a new medicine.
To report possible side effects call the Adverse Medicine Events (AME) line on 1300 134 237 from anywhere in Australia (Monday–Friday, 9am–5pm AEST).
People with questions about their medicines or seeking general information about side effects can also call the NPS Medicines Line on 1300 633 424 (also Monday–Friday, 9am–5pm AEST).
All medicines can have side effects. Sometimes the side effects are serious, but most of the time they are not.
For a more complete list of possible side effects, see the consumer medicine information (CMI) leaflet for Onbrez Breezhaler (indacaterol) available on our Medicines search page.
It’s very common to cough briefly immediately after using the indacaterol inhaler. This cough should not last for long.
Other common side effects shown in clinical trials were headache, runny or blocked nose, sore throat, cough and cold, and muscle spasms.
Some people became more aware of their heart beating (palpitations), or felt their heart race when taking indacaterol.
Indacaterol is a new medicine. Information on the side effects from taking indacaterol for longer than 12 months is still limited.
If you’re taking indacaterol, you should talk to your health professional before taking any other medicine, including any bought without a prescription from a pharmacy, supermarket or health food store.
Make sure your health professional knows about your other medical conditions
In particular, tell your health professional if you are taking medicines for:
Use a medicines list to help keep track of the medicines you are taking. Take it with you each time you visit a health professional, or if you go into hospital.
- glaucoma (including eye drops, e.g. timolol)
- high blood pressure and heart problems
- depression and other mental health conditions
- hay fever, coughs, colds and runny nose
You should also tell them about all other medicines you are taking for your COPD.
Other medicines for COPD
Medicines for COPD are usually inhaled, so they go directly to the lungs where they are needed.
Indacaterol is a maintenance inhaler. This type of medicine is for regular, ongoing use. It needs to be taken every day to control symptoms and help prevent flare-ups.
Examples of other maintenance inhalers include:
- eformoterol (Foradile, Oxis)
- ipratropium (Atrovent)
- salmeterol (Serevent)
- tiotropium (Spiriva).
If you’re currently using any other inhalers, make sure you know which type they are. Talk to your doctor if you are not sure.
Reliever inhalers – used to provide quick relief from a sudden attack of breathlessness. These short-acting bronchodilators are sometimes called puffers.
Preventer inhalers – prescribed for long-term regular use in people with more severe COPD who have frequent flare-ups. They contain steroids to reduce inflammation.
Combination inhalers – contain both a maintenance bronchodilator and a steroid preventer.
You should not be using a combination inhaler at the same time as indacaterol as these already include a bronchodilator. Combination inhalers include:
- fluticasone and salmeterol (Seretide)
- budesonide and eformoterol (Symbicort).
Sometimes you may also need a rescue medicine
Rescue medicines include steroid tablets (prednisolone) and antibiotics. They are available for dealing with a COPD flare-up. Your doctor will usually prescribe them as a short course of 7–10 days.
Sometimes you may need to go to hospital for treatment if you have a flare-up.
Make sure you have a COPD Action Plan
It is important that you understand which medicines you should be taking and when. Your health professional can help you with a COPD Action Plan that sets out when to take your regular medicines, how to recognise changes in your symptoms that indicate a flare-up and what to do if you get a flare-up.
As COPD is a progressive condition, it is likely to get worse over time. Your doctor will regularly review how well you are going and may revise the medicines you need to take.
A COPD Action Plan is also available from The Australian Lung Foundation.
How to decide between indacaterol and other maintenance inhalers
Your medicines will need to be tailored to suit your individual situation as not everyone needs the same medicines. You may need to try various options before you work out with your doctor what is best for you.
Remember that benefits and side effects differ between medicines and from person to person.
Your doctor will help you weigh up the potential benefits and side effects of indacaterol compared with other maintenance inhalers.
Indacaterol works just as well as other maintenance inhalers
In clinical trials, indacaterol on its own was as effective at controlling symptoms of COPD as other long-acting bronchodilators.
Some of these other inhalers need to be taken twice a day. This may be a consideration for you if you find it more convenient to take a once daily dose. Alternatively, twice a day may fit better with the other medicines you take.
Coughing can be problem
Coughing immediately after taking indacaterol is much more likely than with other inhalers. This is because indacaterol capsules contain a dry powder, which can irritate the throat.
Other side effects are similar to other bronchodilators
Most side effects experienced with indacaterol are the same as for other bronchodilators. Cold-like symptoms or headache are slightly more likely to occur with indacaterol.
Indacaterol does not contain a steroid
Sometimes combination inhalers that include a preventer steroid and a long-acting bronchodilator may also be used for maintenance treatment of COPD. Common side effects of these steroids are thrush in the mouth and throat and a hoarse voice. Other less common side effects are easy bruising and thinning of the skin. These occur more often with higher doses.
Indacaterol is not suitable for relieving sudden attacks of wheezing or breathlessness
You will have a separate reliever inhaler such as salbutamol (e.g. Ventolin) or terbutaline (Bricanyl) for the times when this is needed.
You may also need to take a preventer inhaler. If you are taking indacaterol you should not use a combination inhaler.
Most medicines prescribed by your doctor are covered by the PBS. This means that the Australian Government pays part of the cost of your medicine. For more information see www.pbs.gov.au
Cost to the Government
The full cost of indacaterol to the Australian Government is:
- $73.44 for 150-microgram capsules (30 in pack) with inhaler device
- $73.44 for 300-microgram capsules (30 in pack) with inhaler device.
Each prescription is for a 30-day supply of indacaterol.
Cost to the individual
If you get indacaterol through the Pharmaceutical Benefits Scheme (PBS), the Australian Government pays most of the cost and you will pay only a part, called the co-payment.
At the time of publication, people who are entitled to get indacaterol through the PBS will pay:
- $34.20 without a concession card
- $5.60 with a concession card.
If you’re not eligible to get indacaterol through the PBS, you will need to pay the full price for a prescription.
Smoking is the major cause of COPD. Stopping smoking is the single most important thing you can do. It will improve your lung health, help to slow down the progression of your COPD and may help you live longer. If you continue smoking, your lungs are likely to get worse far more quickly than if you quit. The sooner you quit smoking the better.
Your health professional or the Quitline (137 848) can help you increase your chance of success and learn from any past quit attempts.
It’s also important for you to avoid second-hand smoke.
People with COPD who exercise regularly get less short of breath, have fewer COPD symptoms and maintain a better quality of life.
Ideally, the activity that you do should make you a little out of breath. Don’t avoid exercise because it makes you feel a bit puffed.
Aim for at least 30 minutes of exercise, five times a week. You do not have to do all 30 minutes at once. Check with your doctor whether this amount of activity is recommended for you.
Some people will benefit from a program of education and exercise classes designed specifically for people with COPD. Speak to your health professional to find out if a pulmonary (lung) rehabilitation program is available and might be suitable for you.
Keeping a healthy weight — not overweight but not underweight either — is good for your overall health. Eating a healthy diet will help you to stay strong and have more energy. Many people with COPD can find it hard to eat properly and may lose weight. If this is a problem, a dietician can provide advice and information on how to adapt your diet.
Adapted with permission from The Australian Lung Foundation.
Visit www.lungfoundation.com.au or call free phone 1800 654 301 for a wealth of resources and information about support services for people with COPD.
The consumer medicine information (CMI) leaflet for Onbrez Breezhaler (indacaterol) will tell you:
- who should not use the medicine
- which other medicines should be avoided
- how to take the medicine
- most of the possible side effects
- the ingredients.
You can get the CMI leaflet for Onbrez Breezhaler from:
- your doctor or pharmacist
- our Medicines search page
- Novartis Pharmaceuticals, the makers of Onbrez Breezhaler (indacaterol) on 1800 671 203.
Information over the phone
NPS works with healthdirect Australia to provide consumers with information on medicines.
To get information about indacaterol call Medicines Line on 1300 MEDICINE (1300 633 424). This service is available anywhere in Australia, Monday to Friday, 9am to 5pm AEST, except NSW public holidays.
To report a side effect with indacaterol
Call the NPS Adverse Medicine Events (AME) Line on 1300 134 237, Monday to Friday, 9am to 5pm AEST excluding public holidays.
The AME Line is a service where you can report possible side effects of your medicine and contribute to national medicine safety efforts. Information on medicine-related side effects is passed on to the Therapeutic Goods Administration (TGA) for assessment, but your personal details will remain confidential and your privacy maintained.