Yupelri Drug Interactions: What to Avoid and What to Tell Your Doctor

Before starting Yupelri (revefenacin), it's important to tell your doctor and pharmacist about every medication you take — including prescriptions, over-the-counter drugs, vitamins, and herbal supplements. Yupelri has two main categories of drug interactions that require attention. Here's what you need to know.

The Two Main Drug Interaction Categories With Yupelri

Yupelri's drug interaction profile focuses on two key areas:

Other anticholinergic medications: Combining Yupelri with any other anticholinergic drug can cause additive anticholinergic side effects — potentially worsening urinary retention, constipation, dry mouth, confusion, and glaucoma.

OATP1B1/1B3 transport inhibitors: Certain medications block the hepatic transport proteins (OATP1B1 and OATP1B3) that help clear Yupelri's active metabolite from the bloodstream. Blocking these transporters can significantly increase exposure to the metabolite, raising the risk of side effects.

Medications to Avoid: Other Anticholinergics

Do not use Yupelri together with other anticholinergic medications. This includes other LAMA bronchodilators for COPD, as well as anticholinergics used for other conditions. Examples to discuss with your doctor:

Other LAMA COPD Inhalers (Avoid Combination)

Tiotropium (Spiriva HandiHaler, Spiriva Respimat): The most commonly co-prescribed LAMA. Do not use tiotropium and Yupelri together.

Umeclidinium (Incruse Ellipta, component of Anoro Ellipta): Another LAMA — avoid combining with Yupelri.

Aclidinium (Tudorza Pressair): Avoid combination.

Glycopyrrolate (component of Bevespi Aerosphere, Utibron Neohaler): Avoid combination.

Ipratropium (Atrovent): A short-acting anticholinergic. Avoid using with Yupelri.

Non-COPD Anticholinergics to Report to Your Doctor

Many medications used for non-respiratory conditions are also anticholinergic. Tell your doctor if you take any of the following:

Overactive bladder medications: Oxybutynin (Ditropan), tolterodine (Detrol), darifenacin (Enablex), solifenacin (VESIcare), trospium (Sanctura)

Parkinson's medications: Benztropine (Cogentin), trihexyphenidyl

Antihistamines with anticholinergic activity: Diphenhydramine (Benadryl), promethazine (Phenergan)

Tricyclic antidepressants: Amitriptyline, nortriptyline, imipramine (all have anticholinergic properties)

Certain antipsychotics: Clozapine, olanzapine (may have anticholinergic properties)

GI antispasmodics: Dicyclomine (Bentyl), hyoscyamine (Levsin), atropine

Medications to Avoid: OATP1B1/1B3 Inhibitors

Yupelri is eliminated partly through hepatic transport proteins OATP1B1 and OATP1B3. Medications that block these transporters can significantly increase the blood levels of Yupelri's active metabolite, raising the risk of systemic anticholinergic side effects. These combinations are not recommended:

Cyclosporine (immunosuppressant used in organ transplant and autoimmune conditions)

Rifampicin/rifampin (antibiotic used for tuberculosis and other serious infections)

Ceftobiprole (antibiotic — OATP1B1/1B3 inhibitor)

Enasidenib (cancer medication — IDH2 inhibitor; avoid coadministration)

Drugs That May Reduce Yupelri's Effectiveness

Acetylcholinesterase inhibitors — medications that increase acetylcholine activity in the body — may reduce Yupelri's effectiveness. These include dementia medications such as:

Donepezil (Aricept) — for Alzheimer's disease

Rivastigmine (Exelon) — for Alzheimer's and Parkinson's dementia

Galantamine (Razadyne) — for Alzheimer's disease

If you take one of these medications, tell your doctor. The combination may require monitoring for reduced Yupelri efficacy.

What to Tell Your Doctor and Pharmacist

Before starting Yupelri, give your doctor and pharmacist a complete list of all:

Prescription medications (especially other COPD inhalers, bladder medications, Parkinson's drugs, antidepressants)

Over-the-counter medications (including antihistamines like Benadryl, which are strongly anticholinergic)

Herbal supplements and vitamins

Any immunosuppressant medications (especially cyclosporine)

For more information on Yupelri's safety profile, see: Yupelri Side Effects: What to Expect and When to Call Your Doctor. Once your prescription is ready, medfinder.com can help you find a pharmacy near you that has Yupelri in stock.