Sequadra Inhaler

Sequadra Inhaler is a fixed-dose combination inhaler containing indacaterol maleate (110 mcg), a once-daily long-acting β₂-adrenergic agonist (LABA), and glycopyrronium (50 mcg), a long-acting muscarinic antagonist (LAMA). This dual bronchodilator formulation is supplied as a metered-dose/dispenser inhaler kit intended for maintenance treatment of chronic obstructive pulmonary disease (COPD) in adults. The combination pairs complementary mechanisms to provide sustained bronchodilation and symptom relief for patients with airflow limitation.

Key Features

How Sequadra Works

Indacaterol is a long-acting β₂-adrenergic agonist that stimulates β₂ receptors on airway smooth muscle, causing relaxation and sustained bronchodilation that eases airflow and reduces breathlessness. Glycopyrronium (glycopyrrolate) is an anticholinergic (muscarinic antagonist) that blocks acetylcholine-mediated bronchoconstriction and reduces bronchial secretions. When combined in a single inhaler, the LABA provides smooth muscle relaxation while the LAMA reduces vagally mediated bronchospasm and mucus production — together producing greater bronchodilation than either agent alone and improving lung emptying, exercise tolerance, and symptom control.

Indications / Uses

• Maintenance treatment of COPD in adults: Sequadra is indicated for long-term symptomatic management of chronic obstructive pulmonary disease (including chronic bronchitis and emphysema) where maintenance bronchodilation is required to reduce symptoms and exacerbations. It is not for relief of acute bronchospasm or a rescue inhaler.

(Not indicated as monotherapy for asthma; use only under a clinician’s direction and according to local labeling for COPD management.)

Dosage & How to Use

Important: Follow the exact dosing instructions on the product labeling and those supplied by your healthcare provider.

• Typical adult dosing: The usual regimen is one inhalation once daily (one actuation delivering 110 mcg indacaterol / 50 mcg glycopyrronium per dose). Do not exceed the recommended dose.
• How to use the inhaler: Remove the mouthpiece cover, exhale fully away from the device, place the mouthpiece between your lips, inhale steadily and deeply while activating the device (as per device instructions), hold breath for ~5–10 seconds if possible, then exhale slowly. Replace the mouthpiece cover after use. Many devices require priming before first use. Check the leaflet.
• Rescue medication: Keep a short-acting bronchodilator (e.g., salbutamol) available for breakthrough symptoms; Sequadra is not a rescue inhaler. If rescue medication is needed frequently, consult your clinician — treatment may need review.

Expected Benefits

• Sustained bronchodilation: Once-daily dual bronchodilation reduces breathlessness and improves airflow throughout the day.
• Symptom control and quality of life: Many patients report fewer COPD symptoms (wheeze, cough, exertional dyspnea), better exercise tolerance, and improved daily functioning with regular use.
• Reduction in exacerbation risk: By improving airway patency and reducing exacerbating factors (bronchospasm, mucus retention), combination LABA/LAMA therapy can reduce the frequency and severity of COPD exacerbations versus monotherapy in appropriate patients.

Side Effects

Most adverse effects are predictable from the pharmacology of LABA and LAMA agents and from inhaled delivery.

Common / usually mild

• Dry mouth (anticholinergic effect).
• Headache, nasopharyngitis, cough, or throat irritation following inhalation.

Less common / important

• Palpitations, tremor, or headache (β₂ agonist effects) — these are usually mild but should be reported if persistent.
• Urinary retention or worsening of pre-existing prostatic hyperplasia (anticholinergic effect) — use caution in patients with urinary retention.
• Paradoxical bronchospasm (rare) — if wheezing increases immediately after inhalation, stop the drug and seek urgent care.

If you experience severe chest pain, marked increase in breathlessness, marked palpitations, or signs of allergic reaction (swelling, rash, breathing difficulty), stop use and seek immediate medical attention.

Interactions & Important Clinical Notes

• Other bronchodilators: Concomitant use with other long-acting bronchodilators should be prescribed only if clinically justified; combining multiple long-acting agents of the same class can increase side-effect risk.
• Beta-blockers: Non-selective beta-blockers (e.g., propranolol) can antagonize β₂-agonist effects and exacerbate bronchospasm; avoid if possible in patients with COPD or use cardioselective agents with caution after specialist review.
• Anticholinergic drugs and urinary retention: Additive anticholinergic effects can increase the risk of dry mouth, constipation, blurred vision, or urinary retention; review concomitant medications that have anticholinergic properties.
• Cardiovascular disease: Use caution in patients with significant cardiovascular disorders (arrhythmias, ischemic heart disease); monitor for tachycardia or palpitations.

Always show your clinician a full list of medications (prescription and OTC) before starting Sequadra.

Pharmacokinetics

Indacaterol and glycopyrronium are formulated for inhaled delivery to maximize local pulmonary effects and minimize systemic exposure. After inhalation, both molecules act on airway receptors; systemic absorption is limited compared with oral dosing but measurable in plasma. The long duration of action of each component supports once-daily administration. Detailed pharmacokinetic parameters (onset, Tmax, systemic exposure) are available in the product monograph.

Precautions & Who Should Be Careful

• Not for acute bronchospasm: Do not use Sequadra to treat sudden breathing difficulty — use a rapid-acting inhaler and seek urgent care.
• Cardiac conditions: Patients with significant arrhythmias, severe hypertension, or recent myocardial infarction should use with caution and under specialist supervision due to potential β₂ effects.
• Narrow-angle glaucoma and urinary retention: Anticholinergic activity can worsen narrow-angle glaucoma or precipitate urinary retention; avoid or monitor closely in susceptible individuals.
• Pregnancy & breastfeeding: Safety data are limited; use only when benefits clearly outweigh risks and after discussion with the treating physician.

Storage & Handling

• Store the inhaler at room temperature away from direct heat and sunlight, per the product leaflet. Do not puncture or incinerate the device. Keep the mouthpiece clean and dry; replace the mouthpiece cover after each use. Dispose of the inhaler following the label instructions when the dose counter indicates empty. Keep out of reach of children.

Practical Tips & Realistic Expectations

• Technique matters: Correct inhaler technique is essential — if you’re unsure, ask your clinician or pharmacist to demonstrate and observe your technique. Poor technique reduces drug delivery and effectiveness.
• Regular use: For maintenance benefit, use once daily as prescribed; skipping doses reduces symptom control and may increase the risk of exacerbations.
• Carry a rescue inhaler: Always keep a short-acting bronchodilator with you for sudden symptoms. If you need rescue inhalers more often than usual, contact your prescriber.
• Monitoring: Regular follow-up with your respiratory clinician helps adjust therapy, check inhaler technique, and review symptom control and exacerbation history.

Conclusion

Sequadra Inhaler (indacaterol 110 mcg / glycopyrronium 50 mcg) is a once-daily, dual bronchodilator inhaler designed for maintenance of COPD in adults. The LABA/LAMA combination offers sustained bronchodilation, improved symptom control, and potential reduction in exacerbation frequency when used as part of a comprehensive COPD management plan. It must be used with correct technique, not as a rescue inhaler, and under the supervision of a healthcare provider who will weigh benefits and risks, particularly in patients with cardiovascular disease, narrow-angle glaucoma, or urinary retention.

References

https://pubmed.ncbi.nlm.nih.gov/20642373/

https://pubmed.ncbi.nlm.nih.gov/33612668/

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