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Phosphodiesterase-4 Inhibitor

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Phosphodiesterase-4 Inhibitor, Roflumilast, Daliresp

  • See Also
  1. COPD Management
  • Mechanism
  1. Phosphodiesterase-4 Inhibitor increases lung, intracellular cAMP
  • Indications
  1. Severe, refractory COPD with frequent exacerbations
  • Dosing
  1. Roflumilast 500 mcg orally daily ($250/month)
  • Adverse Effects
  1. Gastrointestinal (common, intolerable in 5%)
    1. Diarrhea
    2. Nausea
    3. Weight loss (may be >10%)
  2. Other common symptoms
    1. Headache
    2. Insomnia
  3. Psychiatric (3%)
    1. Suicidality
    2. Depression
    3. Anxiety
  • Drug Interactions
  1. Cytochrome P450 3A4 Inhibitors
  2. Cytochrome P450 3A4 and Cytochrome P450 1A2 Inducers
  • Efficacy
  1. NNT: 24 severe COPD patients to prevent 1 hospitalization per year
  2. Does not reduce mortality
  • References
  1. (2015) Presc Lett 22(5): 27
  2. Field (2011) Circ Respir Pulm Med 5: 57–70 [PubMed]