Fluticasone Furoate/Vilanterol (Relvar Ellipta)
Is It Right for You?
A complete guide to Fluticasone Furoate/Vilanterol (Relvar Ellipta) — what it treats, how it works, dosages, side effects, and when a clinician may prescribe it following an online consultation.
What Is Relvar Ellipta?
Relvar Ellipta is a once-daily dry powder inhaler combining fluticasone furoate (FF) — a next-generation inhaled corticosteroid — and vilanterol (VI) — an ultra-long-acting beta-2 agonist (LABA) — in two strengths: 92/22 mcg (fluticasone furoate 92 mcg / vilanterol 22 mcg) and 184/22 mcg (fluticasone furoate 184 mcg / vilanterol 22 mcg). The Ellipta inhaler is a pre-loaded, multi-dose DPI device designed for once-daily inhalation.
Relvar Ellipta is distinguished from other ICS/LABA inhalers by two pharmacologically important features: fluticasone furoate's exceptionally high glucocorticoid receptor affinity (the highest of any ICS) and vilanterol's ultra-long duration of action (>24 hours), which together enable true once-daily bronchodilation and anti-inflammatory control — a significant adherence advantage over twice-daily ICS/LABA regimens.
Relvar Ellipta is a prescription-only medication in the UK.
What Conditions Is Relvar Ellipta Used For?
Relvar Ellipta is indicated for:
regular maintenance treatment of asthma when a combination ICS/LABA is appropriate; the 92/22 mcg strength is appropriate for medium-dose ICS therapy; 184/22 mcg for patients requiring high-dose ICS
maintenance treatment of COPD in adults not adequately controlled on bronchodilator monotherapy, to reduce exacerbation frequency; note that the 184/22 mcg strength is not licensed for COPD
for appropriate patients currently controlled on twice-daily ICS/LABA therapy who would benefit from a once-daily regimen to improve adherence
The once-daily dosing schedule of Relvar Ellipta is supported by vilanterol's ultra-long duration of action. Taking more than one inhalation per day provides no additional benefit and significantly increases the risk of cardiovascular side effects (tachycardia, hypokalaemia, QT prolongation) from vilanterol overexposure. If a dose is missed, take it as soon as possible on the same day — but never take two doses on the same day.
How Does Relvar Ellipta Work?
Fluticasone furoate (next-generation ICS): Fluticasone furoate has the highest published affinity for the glucocorticoid receptor (GR) of any inhaled corticosteroid — approximately 1.7 times that of fluticasone propionate and 2.9 times that of budesonide. It forms a uniquely stable complex with the GR that dissociates very slowly, providing prolonged receptor occupancy in the airways. Systemically, fluticasone furoate is rapidly metabolised by hepatic CYP3A4 with negligible systemic GR activity — achieving potent local anti-inflammatory effects in the airways with very low systemic corticosteroid exposure. This favourable therapeutic index differentiates fluticasone furoate from fluticasone propionate at comparable clinical doses.
Vilanterol (ultra-long-acting LABA): Vilanterol is a selective beta-2 adrenergic agonist with intrinsic activity comparable to other LABAs but with a duration of action exceeding 24 hours — a consequence of its high affinity for the beta-2 receptor and its accumulation in airway smooth muscle membranes. This ultra-long duration reliably maintains bronchodilation throughout a 24-hour dosing interval, supporting once-daily administration. The combination with fluticasone furoate produces the same ICS/LABA synergy described for other combinations — mutual potentiation of anti-inflammatory and bronchodilatory effects.
Dosages & Administration
The correct dose depends on the type and severity of infection, age, weight, and kidney function. Always follow your clinician's instructions. The table below is for general reference only.
Administration Tips
Open and prepare the Ellipta correctly. Open the cover until a click is heard — this loads the dose. Do not close and reopen the cover before inhaling, as this wastes the loaded dose.
Exhale fully away from the inhaler, place the mouthpiece in your mouth, seal your lips, and inhale steadily and deeply. Hold breath for 3–4 seconds, then exhale slowly away from the inhaler.
Do not exhale into the device and keep the inhaler dry.
Rinse mouth with water and spit after every inhalation — essential to prevent oral candidiasis and dysphonia from fluticasone furoate deposition in the oropharynx.
Take at the same time every day. Once-daily dosing can be at any consistent time of day; many patients prefer the morning. Consistency is essential for sustained bronchodilation and anti-inflammatory control throughout the 24-hour period.
Do not use more than one inhalation per day. Vilanterol's ultra-long duration means double-dosing carries a real risk of cardiovascular and metabolic adverse effects.
Side Effects of Relvar Ellipta
Most side effects are mild and resolve on their own. Serious side effects are rare but require immediate medical attention.
- Nasopharyngitis and upper respiratory tract infections --- the most commonly reported adverse effect in clinical trials; not a direct pharmacological effect but reflects the slightly increased susceptibility in ICS-treated airways
- Oral candidiasis and dysphonia --- as with all ICS inhalers; preventable with consistent mouth rinsing
- Headache
- Palpitations and tremor --- beta-2 agonist effects of vilanterol
- Back pain and musculoskeletal pain --- reported in clinical trials
- Paradoxical bronchospasm --- immediate worsening of airway obstruction after inhalation; stop and use a fast-acting bronchodilator
- Adrenal suppression --- with high-dose or prolonged ICS therapy; risk is greater with fluticasone than with budesonide at equivalent doses due to fluticasone's higher potency; relevant in patients on multiple ICS sources or those switching from oral corticosteroids
- Hypokalaemia --- with high-dose vilanterol; monitor potassium in patients on concurrent diuretics or theophylline
- Cardiovascular effects --- tachycardia, QT prolongation at high vilanterol doses
- Severe hypersensitivity reactions --- rare
Vilanterol's >24-hour duration of action means double-dosing causes significant drug accumulation, with clinically important risk of tachycardia, hypokalaemia, and QT prolongation. Relvar Ellipta must be used strictly once daily.
Drug Interactions
Most side effects are mild and resolve on their own. Serious side effects are rare but require immediate medical attention Relvar Ellipta
antagonise vilanterol's bronchodilatory effect; contraindicated in asthma.
increase systemic fluticasone furoate exposure; risk of adrenal suppression; avoid concurrent use where possible.
additive hypokalaemia and QT prolongation risk with vilanterol.
Important Warnings
The higher-strength Relvar Ellipta 184/22 mcg is licensed for asthma only. Prescribing the 184/22 mcg strength for COPD is off-label; only the 92/22 mcg strength carries a COPD licence.
Speak to a Clinician About Treatment
Getting advice no longer means sitting in a waiting room. Through The GP Service, you can consult with a licensed clinician in minutes — from home, on your lunch break, or wherever works for you. If treatment is clinically appropriate, your clinician can issue a prescription during the consultation. A consultation does not guarantee a prescription.
The treatment you need, when you need it.
Relvar Ellipta FAQs
Vilanterol has an exceptionally long duration of action — more than 24 hours — which is longer than salmeterol or formoterol (both approximately 12 hours). Combined with fluticasone furoate's prolonged glucocorticoid receptor occupancy in the airways, this allows true once-daily dosing with maintained bronchodilation and anti-inflammatory control throughout the 24-hour period. Once-daily dosing is a significant practical advantage for adherence.
You can take the missed dose on the same day as soon as you remember, but do not take two doses in the same 24-hour period. Due to vilanterol's ultra-long duration of action, double-dosing causes significant accumulation and increases the risk of cardiovascular side effects including heart palpitations and low potassium levels. If you miss a full day, just resume your normal once-daily schedule.
Only the 92/22 mcg strength of Relvar Ellipta is licensed for COPD. The higher 184/22 mcg strength is licensed for asthma only. Your clinician will have selected the appropriate strength for your diagnosis. For COPD, ICS/LABA combinations are appropriate in patients with a history of exacerbations; long-acting muscarinic antagonists (LAMAs) such as umeclidinium are also frequently added to provide triple therapy.
Although both are fluticasone-based ICS agents, fluticasone furoate and fluticasone propionate are chemically different molecules with distinct pharmacokinetic profiles. Fluticasone furoate has higher glucocorticoid receptor affinity, longer receptor occupancy, and lower systemic bioavailability than fluticasone propionate. These properties allow once-daily dosing and are associated with a more favourable systemic safety profile at clinically equivalent doses.
Yes — as with all ICS-containing inhalers, rinsing your mouth with water and spitting (not swallowing) after every inhalation of Relvar Ellipta is essential. Fluticasone furoate deposited in the oropharynx can cause oral candidiasis (thrush) and dysphonia (hoarse voice). This simple measure very effectively prevents these local side effects.