Relvar Ellipta Drug Interactions

Clinically significant drug interactions mediated by fluticasone furoate or vilanterol at clinical doses are considered unlikely due to the low plasma concentrations achieved after inhaled dosing.
Interaction with Beta-Blockers: Beta-adrenergic blockers may weaken or antagonise the effect of beta₂-adrenergic agonists. Concurrent use of both non-selective and selective beta-blockers should be avoided unless there are compelling reasons for their use.
Interaction with CYP3A4 Inhibitors: Fluticasone furoate and vilanterol are both rapidly cleared by extensive first-pass metabolism mediated by the liver enzyme CYP3A4.
Care is advised when co-administering with strong CYP 3A4 inhibitors (e.g. ketoconazole, ritonavir) as there is potential for an increased systemic exposure to both fluticasone furoate and vilanterol, which could lead to an increase in the potential for adverse reactions (see Pharmacology: Pharmacokinetics under Actions).
Interaction with P-Glycoprotein Inhibitors: Fluticasone furoate and vilanterol are both substrates of P-glycoprotein (P-gp). A clinical pharmacology study in healthy subjects with co-administered vilanterol and the potent Pgp and moderate CYP3A4 inhibitor verapamil did not show any significant effect on the pharmacokinetics of vilanterol. Clinical pharmacology studies with a specific P-gp inhibitor and fluticasone furoate have not been conducted.