Trelegy Ellipta is a once-daily inhaler combining three active ingredients: an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting beta agonist. It’s prescribed for COPD and asthma, and like all triple-therapy inhalers, it carries a range of potential side effects from mild to serious. Most people tolerate it well, but knowing what to watch for helps you catch problems early.
Common Side Effects
In clinical trials involving over 4,000 patients, the most frequently reported side effects were relatively mild. Headache occurred in about 4% of patients during 12-week trials. Upper respiratory tract infections and sore throat each affected at least 1% of patients in a longer 52-week study. These are the kinds of side effects most users experience: annoying but not dangerous, and they often ease up as your body adjusts to the medication.
Respiratory Side Effects
Because Trelegy contains an inhaled corticosteroid, it can increase your risk of pneumonia, particularly if you have COPD. This is a well-established class effect of inhaled steroids rather than something unique to Trelegy. Symptoms like increased mucus production, fever, and worsening breathing should prompt a call to your doctor, since pneumonia in people with COPD can escalate quickly.
In rare cases, Trelegy can cause paradoxical bronchospasm, a sudden tightening of the airways immediately after you inhale a dose. This is the opposite of what the medication is supposed to do, and the FDA labels it as potentially life-threatening. If your breathing suddenly gets worse right after using the inhaler, stop using Trelegy, use a rescue inhaler, and get medical help immediately.
Heart-Related Effects
The long-acting beta agonist component in Trelegy can stimulate the cardiovascular system. In clinical studies of this ingredient, irregular heartbeats (extrasystoles) were among the most commonly reported heart-related effects, occurring in up to 18% of patients at higher doses compared to 10% in a control group. Some patients also experienced brief episodes of rapid heart rate. Blood pressure, however, did not show clinically significant changes in these trials.
If you notice your heart racing, pounding, or skipping beats after starting Trelegy, it’s worth mentioning to your doctor. People with existing heart conditions should be monitored more closely.
Urinary Retention
Trelegy’s anticholinergic component can, in some people, make it harder to fully empty the bladder. This side effect is uncommon enough that it didn’t reach the 1% threshold in clinical trials, but it has been reported after the drug reached the market. Men with an enlarged prostate or anyone with bladder-neck obstruction are at higher risk. Signs include difficulty starting urination, a weak stream, or painful urination.
Effects on Blood Sugar
If you have diabetes, Trelegy’s inhaled corticosteroid component may nudge your blood sugar levels higher. Research from the VA health system found that in people without diabetes, inhaled corticosteroids had no measurable effect on blood glucose. But in people with diabetes, every increase in corticosteroid dose was associated with higher glucose levels. The effect is dose-dependent, so it’s worth keeping a closer eye on your blood sugar readings after starting Trelegy and discussing any changes with your care team.
Bone and Eye Health Over Time
Long-term use of inhaled corticosteroids, including the one in Trelegy, carries risks that develop gradually rather than appearing in the first few weeks. Bone thinning (osteoporosis) is one concern, particularly for older adults or anyone already at risk for fractures. This happens because corticosteroids can interfere with the body’s ability to maintain bone density over months and years of use.
Eye problems are another long-term consideration. Trelegy’s labeling warns about glaucoma, increased eye pressure, and cataracts. Narrow-angle glaucoma is the most urgent of these, as it can cause permanent vision loss if untreated. Regular eye exams are recommended for anyone using Trelegy long term, even if you’ve never had eye problems before. Blurred vision or eye pain after starting the medication warrants a prompt check.
Thrush and Voice Changes
The inhaled corticosteroid in Trelegy can promote yeast overgrowth in the mouth and throat, leading to oral thrush, a condition marked by white patches, soreness, or a cottony feeling in your mouth. Hoarseness or voice changes (dysphonia) can also occur. Rinsing your mouth with water after each dose and spitting it out, rather than swallowing, significantly reduces the risk of both problems.
Allergic Reactions
Serious allergic reactions to Trelegy are rare but possible. Signs include skin rash, hives, swelling of the face or throat, and breathing difficulty beyond what your underlying condition causes. Any of these symptoms appearing shortly after a dose require emergency attention.