Tribrez

Indications

Tribrez Inhaler is prescribed for the ongoing management of chronic obstructive pulmonary disease (COPD). It is not suitable for treating acute bronchospasm or asthma.

Pharmacology

Tribrez Inhaler is a pressurized metered-dose inhaler combining micronized Budesonide (an inhaled corticosteroid), micronized Glycopyrrolate (an anticholinergic), and micronized Formoterol Fumarate (a long-acting beta2-adrenergic agonist) for oral inhalation. Budesonide reduces lung inflammation that can impair breathing. Glycopyrrolate and Formoterol Fumarate help keep airway muscles relaxed, reducing symptoms like wheezing, coughing, chest tightness, and shortness of breath.

Dosage & Administration

Administer two inhalations of Tribrez Inhaler twice daily, once in the morning and once in the evening. Do not exceed the recommended dosage. After inhalation, rinse your mouth with water and avoid swallowing.

Interactions

• Use with strong cytochrome P450 3A4 inhibitors (e.g., ritonavir) cautiously, as they may enhance systemic corticosteroid effects.
• Other adrenergic drugs might increase the effect of Tribrez; use with caution.
• Diuretics, xanthine derivatives, or steroids may intensify hypokalemia or ECG changes; use with caution.
• Monoamine oxidase inhibitors and tricyclic antidepressants: Use with extreme caution due to potential cardiovascular effects.
• Beta-blockers may counteract bronchodilatory effects, leading to severe bronchospasm; use with caution.
• Avoid combining with other anticholinergic drugs due to additive effects.

Contraindications

Do not use Tribrez Inhaler in individuals with known hypersensitivity to Budesonide, Glycopyrrolate, Formoterol, or any of its components.

Side Effects

Possible serious side effects include hospitalizations for asthma-related events, Candida infections, increased pneumonia risk, immunosuppression, paradoxical bronchospasm, and hypersensitivity reactions. Monitor for cardiovascular effects, bone density reduction, and worsening of glaucoma or cataracts.

Pregnancy & Lactation

There are no well-controlled studies on the use of Tribrez Inhaler during pregnancy or lactation. Budesonide is present in human milk, but data on Glycopyrrolate and Formoterol Fumarate in milk are not available. Consider the benefits of breastfeeding against potential risks.

Precautions & Warnings

Tribrez Inhaler is not suitable for asthma treatment and has not been tested in patients with acutely deteriorating COPD. It should not be used as a rescue inhaler for acute bronchospasm. Patients should stop regular use of short-acting beta2-agonists and use them only for acute symptoms. Avoid exceeding the recommended dose or combining with other LABA medications.

Be vigilant for potential infections, particularly with Candida albicans, and monitor for pneumonia in COPD patients. Patients transitioning from systemic corticosteroids to ICS should be aware of the risk of adrenal insufficiency. Exercise caution with co-administration of CYP3A4 inhibitors and monitor for systemic corticosteroid effects.

Use in Special Populations

• Hepatic Impairment: Monitor for increased drug exposure in severe hepatic impairment.
• Renal Impairment: Use only if the benefits outweigh risks in severe renal impairment.
• Pediatric Use: Not recommended for children; safety and effectiveness in pediatric patients have not been established.
• Geriatric Use: No dosage adjustment necessary for elderly patients, though sensitivity may vary.

Overdose Effects

Overdose risks include systemic corticosteroid effects with Budesonide, anticholinergic symptoms with Glycopyrrolate, and exaggerated beta2-agonist effects with Formoterol Fumarate. Treatment involves discontinuation of Tribrez Inhaler and symptomatic support. Cardiac monitoring may be required.

Therapeutic Class

Combined bronchodilators

Storage Conditions

Store Tribrez Inhaler at room temperature, away from direct sunlight and heat. Do not puncture or incinerate the canister. Clean regularly, and discard after three months of removing from the foil pouch. Keep out of children’s reach and away from eyes.