Anticholinergic Inhalers
Mild
Database
Complementary (intended)
Standard combination
Source: Kimi deep-research + Cla
Drug reference
ensifentrine
Inhaled PDE3/PDE4 dual inhibitor (bronchodilator + anti-inflammatory) · Bronchodilator
START
3 mg via jet nebuliser twice daily
TYPICAL MAX
6 mg/day
STOP IF
Paradoxical bronchospasm or hypersensitivity
WATCH
Inhaler technique (jet nebuliser only — not mesh); not for acute use
CDSCO approvedATC R03BX01
KDIGO 2024 + manufacturer label
- ONSET
- 15min · absorption
- PEAK
- 1h · Tmax
- t½
- 7h · t½
- DURATION
- 12h · BID
EXCRETION
Mainly faecal; minor renal
route + CYP
INTERACTIONS
—
none in our sources
PREGNANCY
Limited data; use only if benefit outweighs risk.
FDA category + note
Mechanism
Selective dual inhibitor of phosphodiesterase 3 (smooth-muscle bronchodilation) and phosphodiesterase 4 (anti-inflammatory) delivered by nebuliser — combines mechanism of both LABAs and anti-inflammatory inhalers in a single molecule.
Indications
Maintenance treatment of COPD
Dosing
- Adult
- 3 mg via standard jet nebuliser twice daily (12 h apart).
- Pediatric
- Not established.
- Renal adjustment
- No adjustment (inhaled, low systemic exposure).
- Hepatic adjustment
- No adjustment.
- Geriatric
- No specific adjustment.
- Max dose
- 6 mg/day (3 mg twice daily)
Pharmacokinetics
Onset
Bronchodilation within minutes; steady benefit over weeks
Peak effect
~1 h (after nebulisation)
Duration
~12 h (twice-daily)
Half-life
~7 h
Bioavailability
Low systemic; lung deposition delivers active drug
Protein binding
~95%
Metabolism
Hepatic (minimal CYP3A4)
Excretion
Mainly faecal; minor renal
Contraindications
- Hypersensitivity
- Acute bronchospasm (not for rescue use)
Side effects
Common
CoughNasopharyngitisHeadacheDiarrhoeaBack pain
Serious
- Paradoxical bronchospasm (rare)
- Severe hypersensitivity
Pregnancy & lactation
Pregnancy
Limited data; use only if benefit outweighs risk.
Lactation
Limited data; weigh benefit/risk.
Drug interactions
Beta Agonists
Mild
Database
Complementary effects (intended)
Standard combination COPD therapy
Source: Kimi deep-research + Cla
Other Pde Inhibitors
Mild
Database
Mechanism overlap
Monitor tolerability
Source: Kimi deep-research + Cla
Strong Cyp3a4 Inhibitors
Mild
Database
Limited metabolism implications
Routine monitoring
Source: Kimi deep-research + Cla
Theophylline
Mild
Database
Both PDE-acting; minimal additive at inhaled doses
Routine monitoring
Source: Kimi deep-research + Cla
Related guidelines
Inflammatory bowel disease
OTHER · Gastroenterology · 2015
Preventive care in inflammatory bowel disease
ACG · Gastroenterology · 2025
Heart failure in diabetes
RSSDI · Cardiology · 2023
Dialysis — initiation and maintenance
ISN_INDIA · Nephrology · 2023
Chronic obstructive pulmonary disease
GOLD · Pulmonology · 2025
Ask House about ensifentrine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20