Generic Name

Revefenacin

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Classification

FDA Approved Indications

• Chronic obstructive pulmonary disease (COPD)

Mechanism of Action

Revefenacin is a long-acting muscarinic antagonist that blocks M3 muscarinic receptors in airway smooth muscle, leading to bronchodilation.

Dosage and Administration

Adult: 1 vial (175 mcg) inhaled once daily via nebulizer.

Pediatric: Not indicated for pediatric use.

Geriatric: No specific dosage adjustment required, but caution in elderly due to potential for increased sensitivity.

Renal Impairment: No specific adjustment required; use with caution.

Hepatic Impairment: Limited data; use with caution.

Pharmacokinetics

Absorption: Absorbed via inhalation, systemic absorption is minimal.

Distribution: Extensive distribution in lung tissue; plasma protein binding approximately 40%.

Metabolism: Extensively metabolized by CYP2D6 and CYP3A4 enzymes.

Excretion: Primarily excreted in feces, minimal urinary excretion.

Half Life: Approximately 52 hours.

Contraindications

• Hypersensitivity to revefenacin or any component of the formulation.

Precautions

• Use with caution in patients with narrow-angle glaucoma, urinary retention, or bladder neck obstruction.

Adverse Reactions - Common

• Dry mouth (Common)
• Cough (Common)

Adverse Reactions - Serious

• Urinary retention (Rare)
• Allergic reactions including rash, urticaria (Rare)

Drug-Drug Interactions

• Other anticholinergic agents may increase anticholinergic side effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Use inhaler daily as prescribed.
• Report any signs of dry mouth, urinary problems, or allergic reactions.
• Do not stop medication abruptly.
• Maintain regular follow-up appointments.

Special Considerations

Black Box Warnings:

• None specific for revefenacin.

Genetic Factors: CYP2D6 poor metabolizers may have altered drug levels.

Lab Test Interference: No known interference.

Overdose Management

Signs/Symptoms: Severe anticholinergic effects such as hallucinations, agitation, urinary retention, tachycardia.

Treatment: Supportive care, activated charcoal if recent ingestion, and symptomatic treatment. No specific antidote.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F); avoid moisture and direct sunlight.

Stability: Stable until the expiration date printed on the packaging.