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glycopyrrolate + indacaterol (NVA237 + QAB149 / Xoterna Breezhaler / Ultibro Breezhaler)

✓ Approved

Cipla Inc · ADRB2 · Small Molecule

What is glycopyrrolate + indacaterol?

glycopyrrolate + indacaterol is a small molecule developed by Cipla Inc. It is approved for therapeutic indications via inhaled.

Drug Profile

Brand NamesNVA237 + QAB149, Xoterna Breezhaler, Ultibro Breezhaler
CompanyCipla Inc
Drug ClassSmall Molecule
Molecular TargetADRB2, CHRM1, CHRM3
RouteInhaled
StatusApproved
Sources: ClinicalTrials.gov, Cipla Inc

Mechanism of Action

Molecular Targets

glycopyrrolate + indacaterol acts on 3 molecular targets:

ADRB2adrenoceptor beta 2 (B2AR, ARB2)
CHRM1cholinergic receptor muscarinic 1 (M1, HM1)
CHRM3cholinergic receptor muscarinic 3 (HM3, PBS)
Want deeper analysis?Noah AI can explain complex mechanisms and compare to similar drugs.

Therapeutic Indications

glycopyrrolate + indacaterol is developed for 1 unique indication across 1 therapeutic area.

Therapeutic AreaConditionPhase
Respiratory, thoracic and mediastinal disordersChronic obstructive pulmonary disease✓ Approved

Related Research Articles

PubMedThe Journal of asthma : official journal of the Association for the Care of Asthma2026-10-18

A Prospective Observational Real-World Study to Assess the Effectiveness and Safety of Single-Inhaler Triple Therapy with Glycopyrrolate/Formoterol Fumarate/Budesonide in Patients with Uncontrolled Asthma.

Thekkinkattil Mohankumar M, Katiyar Subodh S, Gopal Bharat B, Saha Arnab A et al.

Individuals with asthma remain inadequately controlled despite treatment with inhaled corticosteroid and long-acting β2-agonist (ICS/LABA) therapy. Single-inhaler triple therapy (SITT) combining ICS, LABA, and long-acting muscarinic antagonist (LAMA) offers a practical treatment escalation option. This study aims to assess the real-world effectiveness, safety, and adherence of SITT with budesonide/glycopyrrolate/formoterol fumarate in adults with uncontrolled asthma. This multicentric, prospective, observational study was conducted across five centers in India. Adults with uncontrolled asthma on stable ICS/LABA therapy who were prescribed SITT as part of routine care were followed for 12 weeks. Changes in lung function, asthma control (ACT), and quality of life (Mini-AQLQ) were assessed. Medication adherence, adverse events, and asthma exacerbations were recorded. Of 258 enrolled patients, 231 were included in the final analysis. Spirometry measurements showed notable improvements before and after bronchodilator use (all p < 0.001). These included higher MMEF values, suggesting improved small-airway function. Mean ACT scores improved from 14.29 at baseline to 18.49 at follow-up. Mini-AQLQ scores also improved over 12 weeks, indicating better patient-reported quality of life. Medication adherence was high, and no asthma exacerbations, adverse events, or serious adverse events were reported during follow-up. In routine practice, SITT BGF was associated with short-term improvements in lung function, asthma control, and QoL in adults with uncontrolled asthma. The mean ACT improved to partially controlled range at 12 weeks. Results suggest short-term effectiveness and tolerability, but longer-term and comparative studies are needed.

PMID 42892309
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PubMedCureus2026-10-17

Comparison of Sugammadex and Neostigmine for Reversal of Vecuronium-Induced Neuromuscular Blockade in Pediatric Patients: A Prospective Randomized Study.

Tiwari Neha N, Agarwal Aarti A, Verma Shilpi S, Goyal Puneet P et al.

Background and objective Neuromuscular blocking agents (NMBAs) used during general anesthesia require effective reversal to prevent residual paralysis. Neostigmine, the conventional reversal agent, is associated with slower recovery and muscarinic side effects. Sugammadex selectively encapsulates amino-steroidal NMBAs, providing rapid and predictable reversal. This study compared the efficacy, safety, and recovery profile of sugammadex and neostigmine for reversal of vecuronium-induced neuromuscular blockade in children. Methods In this prospective, randomized, double-blind trial, 100 children aged two to 12 years (American Society of Anesthesiologists (ASA) I-III) undergoing elective surgery requiring general anesthesia were randomized to receive sugammadex (2 mg/kg) or neostigmine (50 mcg/kg) with glycopyrrolate (10 mcg/kg). Neuromuscular function was monitored using train-of-four (TOF) stimulation. The primary outcome was time to achieve TOF ratios of ≥0.9 and 1.0 after reversal. Secondary outcomes included residual neuromuscular blockade, functional respiratory recovery assessed by tidal volume, hemodynamic adverse events, and respiratory complications. Results Demographic and intraoperative characteristics were comparable between groups. The median time (±IQR) to achieve TOF ≥0.9 and 1.0 was significantly shorter with Sugammadex than with Neostigmine [70(65-108) vs 252(240-280) and 85.5(75-142) vs 272(255-304) seconds, respectively, p = 0.001]. Heart rate was significantly higher following reversal with neostigmine and glycopyrrolate than with sugammadex, with the difference peaking at five minutes and progressively narrowing thereafter, but remaining significant for up to 1.5 hours after arrival in the post-anesthesia care unit. Tidal volume increased more rapidly with sugammadex than neostigmine after reversal, although this exploratory secondary outcome does not establish a causal relationship. Conclusions Sugammadex provided significantly faster and more reliable reversal of vecuronium-induced neuromuscular blockade in children aged two to 12 years, compared to neostigmine (as shown by neuromuscular monitoring), with less tachycardia following reversal.

PMID 42889689
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PubMedThe journal of ECT2026-10-13

Percussion Pacing as a Rescue for Peri-Stimulus Asystole During Electroconvulsive Therapy.

Arora Vivek V, Kataria Sandeep S

Electroconvulsive therapy (ECT) can provoke a brief parasympathetic surge, commonly causing transient sinus bradycardia or a short sinus pause. Most events last only seconds and resolve without intervention. Rarely, however, bradyarrhythmia or asystole may persist long enough to threaten cerebral perfusion, requiring anesthesia teams to respond immediately. We report the case of a male patient with treatment-resistant major depressive disorder who underwent bilateral ECT under methohexital and succinylcholine. Baseline sinus bradycardia was present at 47 beats per minute. Immediately after the ECT stimulus, the monitor demonstrated high-grade atrioventricular block that progressed to ventricular asystole with a flat plethysmographic waveform. Within 10 to 15 seconds, while glycopyrrolate and epinephrine were being prepared, percussion pacing was delivered using the ulnar aspect of a closed fist over the left lower sternal edge at ∼ the fourth-to-fifth intercostal space. Each blow produced a QRS complex on electrocardiography and a pulsatile deflection on the plethysmogram. An organized intrinsic rhythm returned after 3 impulses. The patient recovered uneventfully, and subsequent ECT sessions were preceded by prophylactic intravenous glycopyrrolate without recurrence. This case describes percussion pacing as an immediately deployable, equipment-free bridge within the cardiovascular rescue strategy for ECT services, with a low threshold to escalate to chest compressions and advanced cardiac life support.

PMID 42864698
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PubMedAmerican journal of veterinary research2026-10-07

Cardiovascular effects of increasing doses of glycopyrrolate in anesthetized New Zealand white rabbits.

Marchiori Jocelyn J M JJM, Sanchez Andrea A, Beaufrère Hugues H, Hawker William W et al.

To characterize the cardiovascular effects of 3 increasing doses of glycopyrrolate in healthy rabbits anesthetized with isoflurane. 9 healthy 1-year-old female New Zealand white rabbits were anesthetized with isoflurane and received increasing doses of glycopyrrolate at low dose (LD; 0.025 mg/kg), medium dose (MD; 0.05 mg/kg), and high dose (HD; 0.1 mg/kg) IV. Heart rate was recorded at baseline and 3, 5, 10, 20, and 30 minutes after administration of each dose. An arterial blood sample was collected to measure plasma glycopyrrolate concentrations at baseline and 3 and 30 minutes after administration of each dose. Analysis of plasma glycopyrrolate concentrations was performed using LC-MS-MS. The HD led to a significantly higher heart rate δ value than LD and MD only at 3 minutes (all P < .003). The HD caused significantly higher systolic arterial pressure and mean arterial pressure δ values at 3, 5, 20, and 30 minutes (P < .05) and diastolic arterial pressure at 3, 20, and 30 minutes (P < .05) than LD. The MD caused a significantly higher diastolic arterial pressure δ value at 20 and 30 minutes (P < .05) and mean arterial pressure at 5, 20, and 30 minutes (P < .05) than LD. The mean plasma concentration that elicited a significant increase in heart rate was 62 ± 16.11 ng/mL. A brief increase (< 5 minutes) in HR in nonbradycardic rabbits was observed with 0.1 mg/kg of glycopyrrolate during isoflurane anesthesia. Even at HDs, clinical effects of glycopyrrolate in rabbits appear very short lived.

PMID 42843405
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PubMedJournal of multidisciplinary healthcare2026-09-27

Early Prediction of Postoperative Urinary Retention After General Anesthesia Using Explainable Machine Learning.

Chang Hsiao-Cheng HC, Chen Li-Yun LY, Lin Yu-Shiang YS

Postoperative urinary retention (POUR) is a common and clinically important perioperative complication associated with pharmacological effects and autonomic dysfunction, which may lead to increased patient discomfort and delayed recovery. Its multifactorial etiology makes early clinical identification challenging. This study investigated the feasibility of using machine learning to predict early POUR after general anesthesia using readily available, non-invasive perioperative data. Model interpretation techniques were further applied to improve transparency and identify key clinical features contributing to risk stratification. This retrospective single-center cohort study included 522 adult inpatients from Cathay General Hospital who underwent surgery under general anesthesia with endotracheal intubation and were subsequently admitted to the post-anesthesia care unit (PACU). Early POUR was defined as postoperative urinary retention occurring during the PACU stay, generally within approximately one hour after extubation. A total of 11 routinely available non-invasive clinical features were used to develop and evaluate multiple machine learning models for predicting early POUR. These machine learning models included conventional classifiers, neural network-based models, and ensemble learning algorithms, including LightGBM, a gradient boosting-based ensemble learning algorithm. SHapley Additive exPlanations (SHAP) analysis was performed to interpret model predictions and identify key clinical features associated with early POUR. Early POUR occurred in 58 of 522 patients (11.1%). Among the evaluated machine learning models, LightGBM demonstrated favorable overall classification performance in predicting early POUR, with an accuracy of 81.03% and an F1 score of 81.50%. Logistic Regression achieved the highest area under the receiver operating characteristic curve (AUC) among the evaluated models (AUC = 0.7099). SHAP analysis identified several key predictors, including glycopyrrolate use, age, ASA class, anesthesia duration, and postoperative pain. This study suggests that machine learning may be a feasible approach for early POUR risk prediction. Interpretable approaches may facilitate individualized anesthetic planning and support clinical decision-making in the PACU, particularly in guiding early bladder monitoring and catheterization decisions for patients at risk of POUR.

PMID 42801195
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PubMedThe Journal of adolescent health : official publication of the Society for Adolescent Medicine2026-09-23

Cannabis-Associated Aerodigestive Symptoms in an Adolescent: A Case Report of Globus Sensation, Dysphagia, and Hypersalivation.

Draper Isabel I, Randhawa Pawanpreet P, Guilford Kristen K, Onigu-Otitte Edore E

Cannabis use remains common among adolescents, and evolving product potency and routes of administration raise concern for underrecognized effects on oropharyngeal and esophageal function. A 16-year-old male presented with globus sensation, dysphagia, and hypersalivation after 2 years of daily cannabis use. Extensive evaluation, including flexible laryngoscopy and barium esophagram, was unremarkable. Empiric treatment with proton pump inhibitors, antibiotics, and allergy medications offered minimal benefit. Symptoms partially improved after cannabis cessation and with glycopyrrolate, with further resolution following sustained abstinence. This case highlights a temporal association between chronic cannabis use and unexplained aerodigestive symptoms, including dysphagia, globus sensation, and hypersalivation in an adolescent. Adult studies suggest cannabinoid-mediated alterations in esophageal motility, but adolescent-specific data are limited. Alternative etiologies, including eosinophilic esophagitis, which was not excluded due to the absence of endoscopy with biopsies, remain possible.

PMID 42776104
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