Roflumilast

Roflumilast (Daliresp)

• phosphodiesterase inhibitor --> increase levels of intracellular cAMP in lung cells --> decreased neutrophil and eosinophil cell counts
• decrease inflammation, promote airway smooth muscle relaxation
• used for COPD associated with chronic bronchitis
• demonstrated significant improvement in FEV1 and reduction of rate of COPD exacerbations in comparison to placebo
• failed to show benefit in patients with emphysema
• has not been compared to other phosphodiesterase inhibitors
• has been studied as add-on therapy to long-acting beta agonist and long-acting anti-muscarinic
• uncertain in asthma
• 500 mcg orally once daily
• no renal dose adjustments, use caution in mild hepatic impairment, contraindicated in mod-severe hepatic impairment
• metabolized by liver, cyp 3A4 and 1A2
• take with or without food
• avoid use with strong cyp450 inducers
• may increase risk of depression/suicidal thoughts
• may cause diarrhea, nausea, headache, back pain
• can cause weight LOSS/decreased appetite
• initial response takes approx. 4 weeks
• NOT for ACUTE bronchospasm -- this is not a bronchodilator
• roflumilast PREVENTS exacerbations
• should be reserved for refractory disease
• data is less convincing than the effects of standard of care LABA and LAMA
• can be used as add-on to standard of care prevention
• cost 30 day supply = $354.17

References:

Product Information: DALIRESP(TM) oral tablets, roflumilast oral tablets. Forest Laboratories, Inc., St. Louis, MO, 2011.

Stoller J. Management of exacerbations of chronic obstructive pulmonary disease. UpToDate. Barnes P (Ed). Accessed on: 17 November 2016. 

Ferguson G. Management of stable chronic obstructive pulmonary disease. UpToDate. Stoller J (Ed). Accessed on: 17 November 2016.