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Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

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Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules)

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Glycopyrronium bromide, Indacaterol maleate may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Glycopyrronium bromide, Indacaterol maleate
Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

for

What Ultibro Breezhaler is This medicine contains two active substances called indacaterol and glycopyrronium. These belong to a group of medicines called bronchodilators. What Ultibro Breezhaler is used for This medicine is used to make breathing easier for adult patients who have breathing difficulties due to a lung disease called chronic obstructive pulmonary disease (COPD). In COPD the muscles around the airways tighten. This makes breathing difficult. This medicine blocks the tightening of these muscles in the lungs, making it easier for air to get in and out of the lungs. If you use this medicine once a day, it will help to reduce the effects of COPD on your everyday life. 2.

What you need to know before you take it

e Ultibro Breezhaler

Do not use Ultibro Breezhaler if you are allergic to indacaterol or glycopyrronium or any of the other ingredients of this medicine (listed in section 6). Warnings and precautions Talk to your doctor, pharmacist or nurse before using Ultibro Breezhaler if any of the following applies to you: you have asthma – this medicine should not be used as a treatment for asthma. you have heart problems. you have seizure or fits. you have thyroid gland problems (thyrotoxicosis). you have diabetes. you are using any medicines for your lung disease which contain active substances similar (same class) to those in Ultibro Breezhaler (see section "Other medicines and Ultibro Breezhaler"). 1

you have kidney problems. you have severe liver problems. you have an eye problem called narrow-angle glaucoma. you have difficulty passing urine. If any of the above applies to you (or you are not sure), talk to your doctor, pharmacist or nurse before using this medicine. During treatment with Ultibro Breezhaler Stop using this medicine and seek medical help immediately if you experience any of the following: eye pain or discomfort, temporary blurring of vision, visual halos or coloured images in association with red eyes – these may be signs of an acute attack of narrow-angle glaucoma. difficulty breathing or swallowing, swelling of the tongue, lips or face, skin rash, itching and hives (signs of an allergic reaction). tightness of the chest, coughing, wheezing or breathlessness immediately after using this medicine – these may be signs of a condition called paradoxical bronchospasm. Tell your doctor immediately if your COPD symptoms such as breathlessness, wheezing or cough do not improve or get worse. Ultibro Breezhaler is used as an ongoing treatment for your COPD. Do not use this medicine to treat a sudden attack of breathlessness or wheezing. Children and adolescents Do not give this medicine to children or adolescents below the age of 18 years. This is because it has not been studied in this age group. Other medicines and Ultibro Breezhaler Tell your doctor or pharmacist if you are using, have recently used or might use any other medicines. In particular, please tell your doctor or pharmacist if you are using: any medicines that may be similar to Ultibro Breezhaler (contain similar active substances). medicines called beta blockers that may be used for high blood pressure or other heart problems (such as propranolol), or for an eye problem called glaucoma (such as timolol). medicines that lower the amount of potassium in your blood. These include: steroids (such as prednisolone), diuretics (water tablets) used for high blood pressure (such as hydrochlorothiazide), medicines for breathing problems (such as theophylline). Pregnancy and breast-feeding There are no data on the use of this medicine in pregnant women and it is not known whether the active substances of this medicine pass into human milk. Indacaterol, one of the active substances in Ultibro Breezhaler, may prevent labour due to its effect on the uterus. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before using this medicine. You should not use Ultibro Breezhaler unless your doctor tells you to do so. Driving and using machines It is unlikely that this medicine will affect your ability to drive and use machines. However, this medicine may cause dizziness (see section 4). If you feel dizzy while taking this medicine, do not drive or use machines. Ultibro Breezhaler contains lactose This medicine contains lactose (23.5 mg per capsule). If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before using this medicine. Ask your doctor or pharmacist for advice before using any medicine. 2

3.

How to take it

Ultibro Breezhaler

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. How much Ultibro Breezhaler to use The usual dose is to inhale the content of one capsule each day. You only need to inhale once a day because the effect of this medicine lasts for 24 hours. Do not use more than your doctor tells you to use. Elderly (age 75 years and over) You can use this medicine if you are aged 75 years and over at the same dose as for other adults. When to inhale Ultibro Breezhaler Use this medicine at the same time each day. This will also help you to remember to use it. You can inhale Ultibro Breezhaler any time before or after food or drink. How to inhale Ultibro Breezhaler Ultibro Breezhaler is for inhalation use. In this pack, you will find an inhaler and capsules (in blisters) that contain the medicine as inhalation powder. Only use the capsules with the inhaler provided in this pack (Ultibro Breezhaler inhaler). The capsules should remain in the blister until you need to use them. Peel the backing away from the blister to open it – do not push the capsule through the foil. When you start a new pack, use the new Ultibro Breezhaler inhaler that is supplied in the pack. Dispose of the inhaler in each pack after all capsules in that pack have been used. Do not swallow the capsules. Please read the instructions at the end of this leaflet for more information on how to use the inhaler. If you use more Ultibro Breezhaler than you should If you have inhaled too much of this medicine or if someone else accidentally uses your capsules, you must immediately either tell your doctor or go to the nearest emergency unit. Show the pack of Ultibro Breezhaler. Medical attention may be needed. You may notice that your heart is beating faster than usual, or you may have a headache, feel drowsy, feel nauseous or have to vomit, or you may notice visual disturbances, feel constipated or have difficulty when passing urine. If you forget to use Ultibro Breezhaler If you forget to inhale a dose at the usual time, inhale one as soon as possible that day. Then, inhale the next dose as usual the next day. Do not inhale more than one dose on the same day. How long to continue your treatment with Ultibro Breezhaler − Keep using Ultibro Breezhaler for as long as your doctor tells you. − COPD is a long-term disease and you should use Ultibro Breezhaler every day and not only when you have breathing problems or other symptoms of COPD. If you have questions about how long to continue your treatment with this medicine, talk to your doctor or pharmacist. If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse. 4.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

3

Some side effects may be serious: Common (may affect up to 1 in 10 people) • difficulty breathing or swallowing, swelling of tongue, lips or face, urticaria, skin rash – these may be signs of an allergic reaction. • feeling tired or very thirsty, having an increased appetite without gaining weight and passing more urine than usual – these may be signs of high level of sugar in the blood (hyperglycaemia). Uncommon (may affect up to 1 in 100 people) • crushing chest pain with increased sweating – this may be a serious heart problem (ischaemic heart disease). • swelling mainly of the tongue, lips, face or throat (possible signs of angioedema). • difficulty breathing with wheezing or coughing. • eye pain or discomfort, temporary blurring of vision, visual halos or coloured images in association with red eyes – these may be signs of glaucoma. • irregular heartbeat. If you get any of these serious side effects, seek medical help immediately. Other side effects may include: Very common (may affect more than 1 in 10 people) • blocked nose, sneezing, cough, headache with or without fever – these may be signs of an upper respiratory tract infection. Common • combination of sore throat and runny nose – these may be signs of nasopharyngitis. • painful and frequent urination – these may be signs of a urinary tract infection called cystitis. • feeling of pressure or pain in the cheeks and forehead – these may be signs of inflammation of the sinuses called sinusitis. • runny or stuffy nose. • dizziness. • headache. • cough. • sore throat. • upset stomach, indigestion. • dental caries. • difficulty and pain when passing urine – these may be signs of a bladder obstruction or urinary retention. • fever. • chest pain. Uncommon • difficulty sleeping. • fast heart beat. • palpitations – signs of abnormal heart beat. • voice alteration (hoarseness). • nose bleeds. • diarrhoea or stomach ache. • dry mouth. • itching or rash. • pain that affects the muscles, ligaments, tendons, joints and bones. • muscle spasm. • muscle pain, aches or tenderness. • pain in arms or legs. 4

• •

swollen hands, ankles and feet. tiredness.

Rare (may affect up to 1 in 1000 people) • tingling or numbness. Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine. 5.

How to store it

Ultibro Breezhaler

Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton and blister after "EXP". The expiry date refers to the last day of that month. Do not store above 25°C. Store the capsules in the original blister in order to protect from moisture and do not remove until immediately before use. The inhaler in each pack should be disposed of after all capsules in that pack have been used. Do not use this medicine if you notice that the pack is damaged or shows signs of tampering. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment. 6.

Contents of the pack and other information

What Ultibro Breezhaler contains The active substances are indacaterol (as maleate) and glycopyrronium bromide. Each capsule contains 143 micrograms of indacaterol maleate equivalent to 110 micrograms of indacaterol and 63 micrograms of glycopyrronium bromide equivalent to 50 micrograms of glycopyrronium. The delivered dose (the dose that leaves the mouthpiece of the inhaler) is equivalent to 85 micrograms of indacaterol (equivalent to 110 micrograms of indacaterol maleate) and 43 micrograms of glycopyrronium (equivalent to 54 micrograms of glycopyrronium bromide). The other ingredients of the inhalation powder are lactose monohydrate and magnesium stearate (see section 2 under "Ultibro Breezhaler contains lactose"). What Ultibro Breezhaler looks like and contents of the pack Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder, hard capsules are transparent and yellow and contain a white to almost white powder. They have the product code "IGP110.50" printed in blue under two blue bars on the body and the company logo ( ) printed in black on the cap. In this pack, you will find a device called an inhaler together with capsules in blister strips. Each blister contains either 6 or 10 hard capsules. The following pack sizes are available: Single pack containing 6×1, 10×1, 12×1, 30×1 or 90×1 hard capsules, together with 1 inhaler. 5

Multipacks containing 96 (4 packs of 24×1) hard capsules and 4 inhalers. Multipacks containing 150 (15 packs of 10×1) hard capsules and 15 inhalers. Multipacks containing 150 (25 packs of 6×1) hard capsules and 25 inhalers. Not all pack sizes may be available in your country. Marketing Authorisation Holder Novartis Pharmaceuticals UK Limited 2nd Floor, The WestWorks Building, White City Place 195 Wood Lane, London, W12 7FQ United Kingdom. Manufacturer Novartis Pharmaceuticals UK Limited 2nd Floor, The WestWorks Building, White City Place 195 Wood Lane London W12 7FQ United Kingdom For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder: United Kingdom Novartis Pharmaceuticals UK Ltd. Tel: +44 1276 698370 This leaflet was last revised in February 2026

6

Please read the full Instructions for Use before using the Ultibro Breezhaler.

Insert

Pierce and release

Inhale deeply

Check capsule is empty

1

2

3

Check

Step 1a: Pull off cap

Step 2a: Pierce capsule once Hold the inhaler upright. Pierce capsule by firmly pressing both side buttons at the same time. You should hear a noise as the capsule is pierced. Only pierce the capsule once.

Step 1b: Open inhaler

Step 3a: Breathe out fully Do not blow into the inhaler.

If there is powder left in the capsule:

  • Close the inhaler.
  • Repeat steps 3a to 3c.

Step 3b: Inhale medicine deeply Hold the inhaler as shown in the picture. Place the mouthpiece in your mouth and close your lips firmly around it. Do not press the side buttons.

Step 2b: Release side buttons

7

Check capsule is empty Open the inhaler to see if any powder is left in the capsule.

Powder remaining

Empty

Breathe in quickly and as deeply as you can. During inhalation you will hear a whirring noise. You may taste the medicine as you inhale.

Remove empty capsule Put the empty capsule in your household waste. Close the inhaler and replace the cap.

Step 1c: Remove capsule Separate one of the blisters from the blister card. Peel open the blister and remove the capsule. Do not push the capsule through the foil. Do not swallow the capsule.

Step 3c: Hold breath Hold your breath for up to 5 seconds. Important Information

  • Ultibro Breezhaler capsules must always be stored in the blister card and only removed immediately before use.
  • Do not push the capsule through the foil to remove it from the blister.
  • Do not swallow the capsule.
  • Do not use the Ultibro Breezhaler capsules with any other inhaler.
  • Do not use the Ultibro Breezhaler inhaler to take any other capsule medicine.
  • Never place the capsule into your mouth or the mouthpiece of the inhaler.
  • Do not press the side buttons more than once.
  • Do not blow into the mouthpiece.
  • Do not press the side buttons while inhaling through the mouthpiece.
  • Do not handle capsules with wet hands.
  • Never wash your inhaler with water.

Step 1d: Insert capsule Never place a capsule directly into the mouthpiece.

Step 1e: Close inhaler

8

Frequently Asked Questions

Your Ultibro Breezhaler Inhaler pack contains:

  • One Ultibro Breezhaler inhaler
  • One or more blister cards, each containing either 6 or 10 Ultibro Breezhaler capsules to be used in the inhaler Capsule chamber Cap

Why didn't the inhaler make a noise when I inhaled? The capsule may be stuck in the capsule chamber. If this happens, carefully loosen the capsule by tapping the base of the inhaler. Inhale the medicine again by repeating steps 3a to 3c.

Mouthpiece

Screen Side buttons Blister

Base Inhaler

Inhaler base

Blister card

What should I do if there is powder left inside the capsule? You have not received enough of your medicine. Close the inhaler and repeat steps 3a to 3c. I coughed after inhaling

  • does this matter? This may happen. As long as the capsule is empty you have received enough of your medicine. I felt small pieces of the capsule on my tongue – does this matter? This can happen. It is not harmful. The chances of the capsule breaking into small pieces will be increased if the capsule is pierced more than once.

9

Cleaning the inhaler Wipe the mouthpiece inside and outside with a clean, dry, lint-free cloth to remove any powder residue. Keep the inhaler dry. Never wash your inhaler with water.

Disposing of the inhaler after use Each inhaler should be disposed of after all capsules have been used. Ask your pharmacist how to dispose of medicines and inhalers that are no longer required.

Frequently asked questions about Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules)

How do I take Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules)?

Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules) comes as capsule containing 85mcg / 43mcg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules)?

The active substance in Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules) is glycopyrronium bromide, indacaterol maleate.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules), as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules) without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Glycopyrronium bromide (30 medicines), Glycopyrronium bromide, indacaterol maleate (1 medicine), Indacaterol maleate (3 medicines)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Ultibro Breezhaler is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD).

4.2. Posology and method of administration

Posology

The recommended dose is the inhalation of the content of one capsule once daily using the Ultibro Breezhaler inhaler.

Ultibro Breezhaler is recommended to be administered at the same time of the day each day. If a dose is missed, it should be taken as soon as possible on the same day. Patients should be instructed not to take more than one dose in a day.

Special populations

Elderly population

Ultibro Breezhaler can be used at the recommended dose in elderly patients (75 years of age and older).

Renal impairment

Ultibro Breezhaler can be used at the recommended dose in patients with mild to moderate renal impairment. In patients with severe renal impairment or end-stage renal disease requiring dialysis it should be used only if the expected benefit outweighs the potential risk (see sections 4.4 and 5.2).

Hepatic impairment

Ultibro Breezhaler can be used at the recommended dose in patients with mild and moderate hepatic impairment. There are no data available for the use of Ultibro Breezhaler in patients with severe hepatic impairment, therefore caution should be observed in these patients (see section 5.2).

Paediatric population

There is no relevant use of Ultibro Breezhaler in the paediatric population (under 18 years) in the indication COPD. The safety and efficacy of Ultibro Breezhaler in children have not been established. No data are available.

Method of administration

For inhalation use only. The capsules must not be swallowed.

The capsules must be administered only using the Ultibro Breezhaler inhaler (see section 6.6). The inhaler provided with each new prescription should be used.

Patients should be instructed on how to administer the medicinal product correctly. Patients who do not experience improvement in breathing should be asked if they are swallowing the medicinal product rather than inhaling it.

For instructions on use of the medicinal product before administration, see section 6.6.

4.3. Contraindications

Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.

4.4. Special warnings and precautions for use

Ultibro Breezhaler should not be administered concomitantly with medicinal products containing other long-acting beta-adrenergic agonists or long-acting muscarinic antagonists, the pharmacotherapeutic groups to which the components of Ultibro Breezhaler belong (see section 4.5).

Asthma

Ultibro Breezhaler should not be used for the treatment of asthma due to the absence of data in this indication.

Long-acting beta2-adrenergic agonists may increase the risk of asthma-related serious adverse events, including asthma-related deaths, when used for the treatment of asthma.

Not for acute use

Ultibro Breezhaler is not indicated for the treatment of acute episodes of bronchospasm.

Hypersensitivity

Immediate hypersensitivity reactions have been reported after administration of indacaterol or glycopyrronium, which are the active substances of Ultibro Breezhaler. If signs suggesting allergic reactions occur, in particular, angioedema (difficulties in breathing or swallowing, swelling of the tongue, lips and face) urticaria or skin rash, treatment should be discontinued immediately and alternative therapy instituted.

Paradoxical bronchospasm

Administration of Ultibro Breezhaler may result in paradoxical bronchospasm which can be life-threatening. If this occurs, treatment should be discontinued immediately and alternative therapy instituted.

Anticholinergic effects related to glycopyrronium

Narrow-angle glaucoma

No data are available in patients with narrow-angle glaucoma, therefore Ultibro Breezhaler should be used with caution in these patients.

Patients should be informed about the signs and symptoms of acute narrow-angle glaucoma and should be informed to stop using Ultibro Breezhaler should any of these signs or symptoms develop.

Urinary retention

No data are available in patients with urinary retention, therefore Ultibro Breezhaler should be used with caution in these patients.

Patients with severe renal impairment

A moderate mean increase in total system exposure (AUClast) to glycopyrronium of up to 1.4-fold was seen in subjects with mild and moderate renal impairment and up to 2.2-fold in subjects with severe renal impairment and end-stage renal disease. In patients with severe renal impairment (estimated glomerular filtration rate below 30 ml/min/1.73 m2), including those with end-stage renal disease requiring dialysis, Ultibro Breezhaler should be used only if the expected benefit outweighs the potential risk (see section 5.2). These patients should be monitored closely for potential adverse reactions.

Cardiovascular effects

Ultibro Breezhaler should be used with caution in patients with cardiovascular disorders (coronary artery disease, acute myocardial infarction, cardiac arrhythmias, hypertension).

Beta2-adrenergic agonists may produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, blood pressure, and/or symptoms. In case such effects occur with this medicinal product, treatment may need to be discontinued. In addition, beta-adrenergic agonists have been reported to produce electrocardiographic (ECG) changes, such as flattening of the T wave, prolongation of QT interval and ST segment depression, although the clinical significance of these observations is unknown. Therefore, long-acting beta2-adrenergic agonists (LABA) or LABA-containing combination products such as Ultibro Breezhaler should be used with caution in patients with known or suspected prolongation of the QT interval or treated with medicinal products affecting the QT interval.

Patients with unstable ischaemic heart disease, left ventricular failure, history of myocardial infarction, arrhythmia (excluding chronic stable atrial fibrillation), a history of long QT syndrome or whose QTc (Fridericia method) was prolonged (>450 ms) were excluded from the clinical trials, and therefore there is no experience in these patient groups. Ultibro Breezhaler should be used with caution in these patient groups.

Hypokalaemia

Beta2-adrenergic agonists may produce significant hypokalaemia in some patients, which has the potential to produce adverse cardiovascular effects. The decrease in serum potassium is usually transient, not requiring supplementation. In patients with severe COPD, hypokalaemia may be potentiated by hypoxia and concomitant treatment, which may increase the susceptibility to cardiac arrhythmias (see section 4.5).

Clinically relevant effects of hypokalaemia have not been observed in clinical studies of Ultibro Breezhaler at the recommended therapeutic dose (see section 5.1).

Hyperglycaemia

Inhalation of high doses of beta2-adrenergic agonists may produce increases in plasma glucose. Upon initiation of treatment with Ultibro Breezhaler plasma glucose should be monitored more closely in diabetic patients.

During long-term clinical studies, more patients on Ultibro Breezhaler experienced clinically notable changes in blood glucose (4.9%) at the recommended dose than on placebo (2.7%). Ultibro Breezhaler has not been investigated in patients for whom diabetes mellitus is not well controlled, therefore caution and appropriate monitoring are advised in such patients.

General disorders

Ultibro Breezhaler should be used with caution in patients with convulsive disorders or thyrotoxicosis, and in patients who are unusually responsive to beta2-adrenergic agonists.

Excipients

This medicinal product contains lactose. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicinal product.

4.5. Interaction with other medicinal products and other forms of interaction

Concomitant administration of orally inhaled indacaterol and glycopyrronium, under steady-state conditions of both active substances, did not affect the pharmacokinetics of either active substance.

No specific interaction studies were conducted with Ultibro Breezhaler. Information on the potential for interactions is based on the potential for each of its two active substances.

Concomitant use not recommended

Beta-adrenergic blockers

Beta-adrenergic blockers may weaken or antagonise the effect of beta2-adrenergic agonists. Therefore Ultibro Breezhaler should not be given together with beta-adrenergic blockers (including eye drops) unless there are compelling reasons for their use. Where required, cardioselective beta-adrenergic blockers should be preferred, although they should be administered with caution.

Anticholinergics

The co-administration of Ultibro Breezhaler with other anticholinergic-containing medicinal products has not been studied and is therefore not recommended (see section 4.4).

Sympathomimetics

Concomitant administration of other sympathomimetics (alone or as part of combination therapy) may potentiate the adverse events of indacaterol (see section 4.4).

Caution required with concomitant use

Hypokalaemic treatment

Concomitant hypokalaemic treatment with methylxanthine derivatives, steroids, or non-potassium-sparing diuretics may potentiate the possible hypokalaemic effect of beta2-adrenergic agonists, therefore use with caution (see section 4.4).

To be taken into account with concomitant use

Metabolic and transporter based interactions

Inhibition of the key contributors of indacaterol clearance, CYP3A4 and P-glycoprotein (P-gp), raises the systemic exposure of indacaterol up to two-fold. The magnitude of exposure increases due to interactions does not raise any safety concerns given the safety experience of treatment with indacaterol in clinical studies of up to one year at doses up to twice the maximum recommended indacaterol dose.

Cimetidine or other inhibitors of organic cation transport

In a clinical study in healthy volunteers, cimetidine, an inhibitor of organic cation transport which is thought to contribute to the renal excretion of glycopyrronium, increased total exposure (AUC) to glycopyrronium by 22% and decreased renal clearance by 23%. Based on the magnitude of these changes, no clinically relevant drug interaction is expected when glycopyrronium is co-administered with cimetidine or other inhibitors of the organic cation transport.

4.6. Fertility, pregnancy and lactation

Pregnancy

There are no data from the use of Ultibro Breezhaler in pregnant women available. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity at clinically relevant exposures (see section 5.3).

Indacaterol may inhibit labour due to a relaxant effect on uterine smooth muscle. Therefore, Ultibro Breezhaler should only be used during pregnancy if the expected benefit to the patient justifies the potential risk to the foetus.

Breast-feeding

It is not known whether indacaterol, glycopyrronium and their metabolites are excreted in human milk. Available pharmacokinetic/toxicological data have shown excretion of indacaterol, glycopyrronium and their metabolites in the milk of lactating rats. The use of Ultibro Breezhaler by breast-feeding women should only be considered if the expected benefit to the woman is greater than any possible risk to the infant (see section 5.3).

Fertility

Reproduction studies and other data in animals do not indicate a concern regarding fertility in either males or females.

4.7. Effects on ability to drive and use machines

This medicinal product has no or negligible influence on the ability to drive and use machines. However, the occurrence of dizziness may influence the ability to drive and use machines (see section 4.8).

4.8. Undesirable effects

The presentation of the safety profile is based on the experience with Ultibro Breezhaler and the individual active substances.

Summary of the safety profile

The safety experience with Ultibro Breezhaler was comprised of exposure of up to 15 months at the recommended therapeutic dose.

Ultibro Breezhaler showed similar adverse reactions to the individual components. As it contains indacaterol and glycopyrronium, the type and severity of adverse reactions associated with each of these components may be expected in the combination.

The safety profile is characterised by typical anticholinergic and beta-adrenergic symptoms related to the individual components of the combination. Other most common adverse reactions related to the medicinal product (at least 3% of patients for Ultibro Breezhaler and also greater than placebo) were cough, nasopharyngitis and headache.

Tabulated summary of adverse reactions

Adverse reactions detected during clinical trials and from post-marketing sources are listed by MedDRA system organ class (Table 1). Within each system organ class, the adverse reactions are ranked by frequency, with the most frequent reactions first. Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness. In addition, the corresponding frequency category for each adverse reaction is based on the following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000, <1/1,000); very rare (<1/10,000); not known (cannot be estimated from the available data).

Table 1 Adverse reactions

Adverse reactions

Frequency category

Infections and infestations

Upper respiratory tract infection

Very common

Nasopharyngitis

Common

Urinary tract infection

Common

Sinusitis

Common

Rhinitis

Common

Immune system disorders

Hypersensitivity

Common

Angioedema2

Uncommon

Metabolism and nutrition disorders

Hyperglycaemia and diabetes mellitus

Common

Psychiatric disorders

Insomnia

Uncommon

Nervous system disorders

Dizziness

Common

Headache

Common

Paraesthesia

Rare

Eye disorders

Glaucoma1

Uncommon

Cardiac disorders

Ischaemic heart disease

Uncommon

Atrial fibrillation

Uncommon

Tachycardia

Uncommon

Palpitations

Uncommon

Respiratory, thoracic and mediastinal disorders

Cough

Common

Oropharyngeal pain including throat irritation

Common

Paradoxical bronchospasm

Uncommon

Dysphonia2

Uncommon

Epistaxis

Uncommon

Gastrointestinal disorders

Dyspepsia

Common

Dental caries

Common

Gastroenteritis

Uncommon

Dry mouth

Uncommon

Skin and subcutaneous tissue disorders

Pruritus/rash

Uncommon

Musculoskeletal and connective tissue disorders

Musculoskeletal pain

Uncommon

Muscle spasm

Uncommon

Myalgia

Uncommon

Pain in extremity

Uncommon

Renal and urinary disorders

Bladder obstruction and urinary retention

Common

General disorders and administration site conditions

Pyrexia1

Common

Chest pain

Common

Oedema peripheral

Uncommon

Fatigue

Uncommon

1 Adverse reaction observed with Ultibro Breezhaler, but not with the individual components.

2 Reports received from post-marketing experience; frequencies calculated, however, on the basis of clinical trial data.

Description of selected adverse reactions

Cough was common, but usually of mild intensity.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9. Overdose

There is no information on clinically relevant overdosing with Ultibro Breezhaler.

An overdose could lead to exaggerated effects typical of beta2-adrenergic stimulants, i.e. tachycardia, tremor, palpitations, headache, nausea, vomiting, drowsiness, ventricular arrhythmias, metabolic acidosis, hypokalaemia and hyperglycaemia or could induce anticholinergic effects such as increased intraocular pressure (causing pain, vision disturbances or reddening of the eye), obstipation or difficulties in voiding. Supportive and symptomatic treatment is indicated. In serious cases, patients should be hospitalised. Use of cardioselective beta blockers may be considered for treating beta2-adrenergic effects, but only under the supervision of a physician and with extreme caution since the use of beta-adrenergic blockers may provoke bronchospasm.

🇷🇴 Known in Romania as

Medicines sold in Romania with the same active substance: Cunoscut în România ca

⚠ Not the same combination. This medicine contains Glycopyrronium bromide, Indacaterol maleate. The products below do not contain exactly the same set of active substances — they are not direct substitutes.

  • ONBREZ BREEZHALER 150 µg prescription partial — not the same combinationINDACATEROLUM · inhaler / nebuliser
  • ONBREZ BREEZHALER 300 µg prescription partial — not the same combinationINDACATEROLUM · inhaler / nebuliser

Some of these do not contain exactly the same active substances — check each one. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Romanian medicines in the UK →

🇵🇱 Known in Poland as

Medicines sold in Poland with the same active substance: W Polsce znany jako

  • Ultibro BreezhalerIndacaterolum + Glycopyrronii bromidum · inhaler / nebuliser
  • Xoterna BreezhalerIndacaterolum + Glycopyrronii bromidum · inhaler / nebuliser
  • Ulunar BreezhalerIndacaterolum + Glycopyrronii bromidum · inhaler / nebuliser
  • Amidil Combo AmiHalerIndacateroli maleas + Glycopyrronii bromidum · inhaler / nebuliser

Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Polish medicines in the UK →

💬 Ask about this leaflet

Ask anything about Ultibro Breezhaler 85 micrograms/43 micrograms inhalation powder (hard capsules). The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.

Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.

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