Zimbus Breezhaler

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ANNEX I 
 

SUMMARY OF PRODUCT CHARACTERISTICS 



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1. NAME OF THE MEDICINAL PRODUCT 
 

Zimbus Breezhaler 114 micrograms/46 micrograms/136 micrograms inhalation powder, hard capsules 

 

 

2. QUALITATIVE AND QUANTITATIVE COMPOSITION 
 

Each capsule contains 150 mcg of indacaterol (as acetate), 63 mcg of glycopyrronium bromide 

equivalent to 50 mcg of glycopyrronium and 160 mcg of mometasone furoate. 

 

Each delivered dose (the dose that leaves the mouthpiece of the inhaler) contains 114 mcg of 

indacaterol (as acetate), 58 mcg of glycopyrronium bromide equivalent to 46 mcg of glycopyrronium 

and 136 mcg of mometasone furoate. 

 

Excipient(s) with known effect 

 

Each capsule contains 25 mg of lactose monohydrate. 

 

For the full list of excipients, see section 6.1. 

 

 

3. PHARMACEUTICAL FORM 
 

Inhalation powder, hard capsule (inhalation powder). 

 

Capsules with green transparent cap and uncoloured transparent body containing a white powder, with 

the product code “IGM150-50-160” printed in black above two black bars on the body and with the 

product logo printed in black and surrounded by a black bar on the cap. 

 

 

4. CLINICAL PARTICULARS 
 

4.1 Therapeutic indications 
 

Zimbus Breezhaler is indicated as a maintenance treatment of asthma in adult patients not adequately 

controlled with a maintenance combination of a long-acting beta2-agonist and a high dose of an 

inhaled corticosteroid who experienced one or more asthma exacerbations in the previous year. 

 

4.2 Posology and method of administration 
 

Posology 

 

The recommended dose is one capsule to be inhaled once daily. 

 

The maximum recommended dose is 114 mcg/46 mcg/136 mcg once daily. 

 

Treatment should be administered at the same time of the day each day. It can be administered 

irrespective of the time of the day. If a dose is missed, it should be taken as soon as possible. Patients 

should be instructed not to take more than one dose in a day. 

 

  



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Special populations 

Elderly population 

No dose adjustment is required in elderly patients (65 years of age or older) (see section 5.2). 

 

Renal impairment 

No dose adjustment is required in patients with mild to moderate renal impairment. Caution should be 

observed in patients with severe renal impairment or end-stage renal disease requiring dialysis (see 

sections 4.4 and 5.2). 

 

Hepatic impairment 

No dose adjustment is required in patients with mild or moderate hepatic impairment. No data are 

available for the use of the medicinal product in patients with severe hepatic impairment, therefore it 

should be used in these patients only if the expected benefit outweighs the potential risk (see 

section 5.2). 

 

Paediatric population 

The safety and efficacy of Zimbus Breezhaler in paediatric patients below 18 years of age have not 

been established. No data are available. 

 

Method of administration 

 

For inhalation use only. The capsules must not be swallowed. 

 

The capsules must be administered only using the inhaler provided (see section 6.6) with each new 

prescription. 

 

Patients should be instructed on how to administer the medicinal product correctly. Patients who do 

not experience improvement in breathing should be asked if they are swallowing the medicinal 

product rather than inhaling it. 

 

The capsules must only be removed from the blister immediately before use. 

 

After inhalation, patients should rinse their mouth with water without swallowing (see sections 4.4 and 

6.6). 

 

For instructions on use of the medicinal product before administration, see section 6.6. 

 

Information for patients using a sensor for Zimbus Breezhaler 

The pack may contain an electronic sensor to be attached to the base of the inhaler. 

 

The sensor and App are not required for administration of the medicinal product to the patient. The 

sensor and App do not control or interfere with delivery of the medicinal product using the inhaler. 

 

The prescribing physician may discuss with the patient whether the use of the sensor and App is 

appropriate. 

 

For detailed instructions on how to use the sensor and the App, see the Instructions for Use provided 

in the sensor pack and the App. 

 

4.3 Contraindications 
 

Hypersensitivity to the active substances or to any of the excipients listed in section 6.1. 

 



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4.4 Special warnings and precautions for use 
 

Deterioration of disease 

 

This medicinal product should not be used to treat acute asthma symptoms, including acute episodes 

of bronchospasm, for which a short-acting bronchodilator is required. Increasing use of short-acting 

bronchodilators to relieve symptoms indicates deterioration of control and patients should be reviewed 

by a physician. 

 

Patients should not stop treatment without physician supervision since symptoms may recur after 

discontinuation. 

 

It is recommended that treatment with this medicinal product should not be stopped abruptly. If 

patients find the treatment ineffective, they should continue treatment but must seek medical attention. 

Increasing use of reliever bronchodilators indicates a worsening of the underlying condition and 

warrants a reassessment of the therapy. Sudden and progressive deterioration in the symptoms of 

asthma is potentially life-threatening and the patient should undergo urgent medical assessment. 

 

Hypersensitivity 

 

Immediate hypersensitivity reactions have been observed after administration of this medicinal 

product. If signs suggesting allergic reactions occur, in particular angioedema (including difficulties in 

breathing or swallowing, swelling of the tongue, lips and face), urticaria or skin rash, treatment should 

be discontinued immediately and alternative therapy instituted. 

 

Paradoxical bronchospasm 

 

As with other inhalation therapy, administration of this medicinal product may result in paradoxical 

bronchospasm, which can be life-threatening. If this occurs, treatment should be discontinued 

immediately and alternative therapy instituted. 

 

Cardiovascular effects 

 

Like other medicinal products containing beta2-adrenergic agonists, this medicinal product may 

produce a clinically significant cardiovascular effect in some patients as measured by increases in 

pulse rate, blood pressure, and/or symptoms. If such effects occur, treatment may need to be 

discontinued. 

 

This medicinal product should be used with caution in patients with cardiovascular disorders 

(coronary artery disease, acute myocardial infarction, cardiac arrhythmias, hypertension), convulsive 

disorders or thyrotoxicosis, and in patients who are unusually responsive to beta2-adrenergic agonists. 

 

Patients with unstable ischaemic heart disease, a history of myocardial infarction in last 12 months, 

New York Heart Association (NYHA) class III/IV left ventricular failure, arrhythmia, uncontrolled 

hypertension, cerebrovascular disease, history of long QT syndrome and patients being treated with 

medicinal products known to prolong QTc were excluded from studies in the 

indacaterol/glycopyrronium/mometasone furoate clinical development programme. Thus safety 

outcomes in these populations are considered unknown. 

 

While beta2-adrenergic agonists have been reported to produce electrocardiographic (ECG) changes, 

such as flattening of the T wave, prolongation of QT interval and ST segment depression, the clinical 

significance of these findings is unknown. 

 

Long-acting beta2-adrenergic agonists (LABA) or LABA-containing combination products such as 

Zimbus Breezhaler should therefore be used with caution in patients with known or suspected 

prolongation of the QT interval or who are being treated with medicinal products affecting the QT 

interval. 



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Hypokalaemia with beta agonists 

 

Beta2-adrenergic agonists may produce significant hypokalaemia in some patients, which has the 

potential to produce adverse cardiovascular effects. The decrease in serum potassium is usually 

transient, not requiring supplementation. In patients with severe asthma, hypokalaemia may be 

potentiated by hypoxia and concomitant treatment, which may increase the susceptibility to cardiac 

arrhythmias (see section 4.5). 

 

Clinically relevant hypokalaemia has not been observed in clinical studies of 

indacaterol/glycopyrronium/mometasone furoate at the recommended therapeutic dose. 

 

Hyperglycaemia 

 

Inhalation of high doses of beta2-adrenergic agonists and corticosteroids may produce increases in 

plasma glucose. Upon initiation of treatment, plasma glucose should be monitored more closely in 

diabetic patients. 

 

This medicinal product has not been investigated in patients with Type I diabetes mellitus or 

uncontrolled Type II diabetes mellitus. 

 

Anticholinergic effect related to glycopyrronium 

 

Like other anticholinergic medicinal products, this medicinal product should be used with caution in 

patients with narrow-angle glaucoma or urinary retention. 

 

Patients should be advised about signs and symptoms of acute narrow-angle glaucoma and should be 

instructed to stop treatment and to contact their doctor immediately should any of these signs or 

symptoms develop. 

 

Patients with severe renal impairment 

 

For patients with severe renal impairment (estimated glomerular filtration rate below 

30 ml/min/1.73 m2), including those with end-stage renal disease requiring dialysis, caution should be 

observed (see sections 4.2 and 5.2). 

 

Prevention of oropharyngeal infections 

 

In order to reduce the risk of oropharyngeal candida infection, patients should be advised to rinse their 

mouth or gargle with water without swallowing it or brush their teeth after inhaling the prescribed 

dose. 

 

Systemic effects of corticosteroids 

 

Systemic effects of inhaled corticosteroids may occur, particularly at high doses prescribed for 

prolonged periods. These effects are much less likely to occur than with oral corticosteroids and may 

vary in individual patients and between different corticosteroid preparations. 

 

Possible systemic effects may include Cushing’s syndrome, Cushingoid features, adrenal suppression, 

growth retardation in children and adolescents, decrease in bone mineral density, cataracts, glaucoma, 

and, more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, 

sleep disorders, anxiety, depression or aggression (particularly in children). It is therefore important 

that the dose of inhaled corticosteroid is titrated to the lowest dose at which effective control of asthma 

is maintained. 

 



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Visual disturbance may be reported with systemic and topical (including intranasal, inhaled and 

intraocular) corticosteroid use. Patients presenting with symptoms such as blurred vision or other 

visual disturbances should be considered for referral to an ophthalmologist for evaluation of possible 

causes of visual disturbances, which may include cataract, glaucoma or rare diseases such as central 

serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical 

corticosteroids. 

 

This medicinal product should be administered with caution in patients with pulmonary tuberculosis or 

in patients with chronic or untreated infections. 

 

Excipients 

 

This medicinal product contains lactose. Patients with rare hereditary problems of galactose 

intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicinal 

product. 

 

4.5 Interaction with other medicinal products and other forms of interaction 
 

No specific interaction studies were conducted with indacaterol/glycopyrronium/mometasone furoate. 

Information on the potential for interactions is based on the potential for each of the monotherapy 

components. 

 

Medicinal products known to prolong the QTc interval 

 

Like other medicinal products containing a beta2-adrenergic agonist, this medicinal product should be 

administered with caution to patients being treated with monoamine oxidase inhibitors, tricyclic 

antidepressants, or medicinal products known to prolong the QT interval, as any effect of these on the 

QT interval may be potentiated. Medicinal products known to prolong the QT interval may increase 

the risk of ventricular arrhythmia (see sections 4.4 and 5.1). 

 

Hypokalaemic treatment 

 

Concomitant hypokalaemic treatment with methylxanthine derivatives, steroids, or 

non-potassium-sparing diuretics may potentiate the possible hypokalaemic effect of beta2-adrenergic 

agonists (see section 4.4). 

 

Beta-adrenergic blockers 

 

Beta-adrenergic blockers may weaken or antagonise the effect of beta2-adrenergic agonists. Therefore, 

this medicinal product should not be given together with beta-adrenergic blockers unless there are 

compelling reasons for their use. Where required, cardioselective beta-adrenergic blockers should be 

preferred, although they should be administered with caution. 

 

Interaction with CYP3A4 and P-glycoprotein inhibitors 

 

Inhibition of CYP3A4 and P-glycoprotein (P-gp) has no impact on the safety of therapeutic doses of 

Zimbus Breezhaler. 

 

Inhibition of the key contributors of indacaterol clearance (CYP3A4 and P-gp) or mometasone furoate 

clearance (CYP3A4) raises the systemic exposure of indacaterol or mometasone furoate up to 

two-fold. 

 

Due to the very low plasma concentration achieved after inhaled dosing, clinically significant 

interactions with mometasone furoate are unlikely. However, there may be a potential for increased 

systemic exposure to mometasone furoate when strong CYP3A4 inhibitors (e.g. ketoconazole, 

itraconazole, nelfinavir, ritonavir, cobicistat) are co-administered. 

 



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Cimetidine or other inhibitors of organic cation transport 

 

In a clinical study in healthy volunteers, cimetidine, an inhibitor of organic cation transport which is 

thought to contribute to the renal excretion of glycopyrronium, increased total exposure (AUC) to 

glycopyrronium by 22% and decreased renal clearance by 23%. Based on the magnitude of these 

changes, no clinically relevant drug interaction is expected when glycopyrronium is co-administered 

with cimetidine or other inhibitors of the organic cation transport. 

 

Other long-acting antimuscarinics and long-acting beta2-adrenergic agonists 

 

The co-administration of this medicinal product with other medicinal products containing long-acting 

muscarinic antagonists or long-acting beta2-adrenergic agonists has not been studied and is not 

recommended as it may potentiate adverse reactions (see sections 4.8 and 4.9). 

 

4.6 Fertility, pregnancy and lactation 
 

Pregnancy 

 

There are insufficient data from the use of Zimbus Breezhaler or its individual components 

(indacaterol, glycopyrronium and mometasone furoate) in pregnant women to determine whether there 

is a risk. 

 

Indacaterol and glycopyrronium were not teratogenic in rats and rabbits following subcutaneous or 

inhalation administration, respectively (see section 5.3). In animal reproduction studies with pregnant 

mice, rats and rabbits, mometasone furoate caused increased foetal malformations and decreased foetal 

survival and growth. 

 

Like other medicinal products containing beta2-adrenergic agonists, indacaterol may inhibit labour due 

to a relaxant effect on uterine smooth muscle. 

 

This medicinal product should only be used during pregnancy if the expected benefit to the patient 

justifies the potential risk to the foetus. 

 

Breast-feeding 

 

There is no information available on the presence of indacaterol, glycopyrronium or mometasone 

furoate in human milk, on the effects on a breast-fed infant, or on the effects on milk production. 

Other inhaled corticosteroids similar to mometasone furoate are transferred into human milk. 

Indacaterol, glycopyrronium and mometasone furoate have been detected in the milk of lactating rats. 

Glycopyrronium reached up to 10-fold higher concentrations in the milk of lactating rats than in the 

blood of the dam after intravenous administration. 

 

A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from therapy, 

taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman. 

 

Fertility 

 

Reproduction studies and other data in animals did not indicate a concern regarding fertility in either 

males or females. 

 

4.7 Effects on ability to drive and use machines 
 

This medicinal product has no or negligible influence on the ability to drive and use machines. 

 



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4.8 Undesirable effects 
 

Summary of the safety profile 

 

The most common adverse reactions over 52 weeks were asthma (exacerbation) (41.8%), 

nasopharyngitis (10.9%), upper respiratory tract infection (5.6%) and headache (4.2%). 

 

Tabulated list of adverse reactions 

 

Adverse drug reactions (ADRs) are listed by MedDRA system organ class (Table 1). The frequency of 

the ADRs is based on the IRIDIUM study. Within each system organ class, the adverse drug reactions 

are ranked by frequency, with the most frequent reactions first. Within each frequency grouping, 

adverse drug reactions are presented in order of decreasing seriousness. In addition, the corresponding 

frequency category for each adverse drug reaction is based on the following convention (CIOMS III): 

very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 

to <1/1,000); very rare (<1/10,000). 

 

Table 1 Adverse reactions 

 

System organ class Adverse reactions Frequency 

category 

Infections and infestations 

Nasopharyngitis Very common 

Upper respiratory tract 

infection 

Common 

Candidiasis*1 Common 

Urinary tract infection*2 Common 

Immune system disorders Hypersensitivity*3 Common 

Metabolism and nutrition disorders Hyperglycaemia*4 Uncommon 

Nervous system disorders Headache*5 Common 

Eye disorders Cataract Uncommon 

Cardiac disorders Tachycardia*6 Common 

Respiratory, thoracic and mediastinal disorders 

Asthma (exacerbation) Very common 

Oropharyngeal pain*7 Common 

Cough Common 

Dysphonia Common 

Gastrointestinal disorders 
Gastroenteritis*8 Common 

Dry mouth*9 Uncommon 

Skin and subcutaneous tissue disorders 
Rash*10 Uncommon 

Pruritus*11 Uncommon 

Musculoskeletal and connective tissue disorders 
Musculoskeletal pain*12 Common 

Muscle spasms Common 

Renal and urinary disorders Dysuria Uncommon 

General disorders and administration site 

conditions 

Pyrexia Common 

* Indicates grouping of preferred terms (PTs): 

1 Oral candidiasis, oropharyngeal candidiasis. 

2 Asymptomatic bacteriuria, bacteriuria, cystitis, urethritis, urinary tract infection, urinary tract infection viral. 

3 Drug eruption, drug hypersensitivity, hypersensitivity, rash, rash pruritic, urticaria. 

4 Blood glucose increased, hyperglycaemia. 

5 Headache, tension headache. 

6 Sinus tachycardia, supraventricular tachycardia, tachycardia. 

7 Odynophagia, oropharyngeal discomfort, oropharyngeal pain, throat irritation. 

8 Chronic gastritis, enteritis, gastritis, gastroenteritis, gastrointestinal inflammation. 

9 Dry mouth, dry throat. 

10 Drug eruption, rash, rash papular, rash pruritic. 

11 Eye pruritus, pruritus, pruritus genital. 

12 Back pain, musculoskeletal chest pain, musculoskeletal pain, myalgia, neck pain. 



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Reporting of suspected adverse reactions 

 

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 

allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 

professionals are asked to report any suspected adverse reactions via the national reporting system 

listed in Appendix V. 

 

4.9 Overdose 
 

General supportive measures and symptomatic treatment should be initiated in cases of suspected 

overdose. 

 

An overdose will likely produce signs, symptoms or adverse effects associated with the 

pharmacological actions of the individual components (e.g. tachycardia, tremor, palpitations, 

headache, nausea, vomiting, drowsiness, ventricular arrhythmias, metabolic acidosis, hypokalaemia, 

hyperglycaemia, increased intraocular pressure [causing pain, vision disturbances or reddening of the 

eye], constipation or difficulties in voiding, suppression of hypothalamic pituitary adrenal axis 

function). 

 

Use of cardioselective beta blockers may be considered for treating beta2-adrenergic effects, but only 

under the supervision of a physician and with extreme caution, since the use of beta2-adrenergic 

blockers may provoke bronchospasm. In serious cases, patients should be hospitalised. 

 

 

5. PHARMACOLOGICAL PROPERTIES 
 

5.1 Pharmacodynamic properties 
 

Pharmacotherapeutic group: Drugs for obstructive airway diseases, adrenergics in combination with 

anticholinergics incl. triple combinations with corticosteroids. ATC code: R03AL12 

 

Mechanism of action 

 

This medicinal product is a combination of indacaterol, a long-acting beta2-adrenergic agonist 

(LABA), glycopyrronium, a long-acting muscarinic receptor antagonist (LAMA) and mometasone 

furoate, an inhaled synthetic corticosteroid (ICS). 

 

Indacaterol 

The pharmacological effects of beta2-adrenoceptor agonists, including indacaterol, are at least in part 

attributable to increased cyclic-3’, 5’-adenosine monophosphate (cyclic AMP) levels, which cause 

relaxation of bronchial smooth muscle. 

 

When inhaled, indacaterol acts locally in the lung as a bronchodilator. Indacaterol is a partial agonist 

at the human beta2-adrenergic receptor with nanomolar potency. In isolated human bronchus, 

indacaterol has a rapid onset of action and a long duration of action. 

 

Although beta2-adrenergic receptors are the predominant adrenergic receptors in bronchial smooth 

muscle and beta1-receptors are the predominant receptors in the human heart, there are also 

beta2-adrenergic receptors in the human heart comprising 10% to 50% of the total adrenergic 

receptors. 

 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


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Glycopyrronium 

Glycopyrronium works by blocking the bronchoconstrictor action of acetylcholine on airway smooth 

muscle cells, thereby dilating the airways. Glycopyrronium bromide is a high-affinity muscarinic 

receptor antagonist. It demonstrated 4- to 5-fold selectivity for the human M3 and M1 receptors over 

the human M2 receptor in competition binding studies. It has a rapid onset of action, as evidenced by 

observed receptor association/dissociation kinetic parameters and by the onset of action after 

inhalation in clinical studies. The long duration of action can be partly attributed to sustained drug 

concentrations in the lungs, as reflected by the prolonged terminal elimination half-life of 

glycopyrronium after inhalation via the inhaler in contrast to the half-life after intravenous 

administration (see section 5.2). 

 

Mometasone furoate 

Mometasone furoate is a synthetic corticosteroid with high affinity for glucocorticoid receptors and 

local anti-inflammatory properties. In vitro, mometasone furoate inhibits the release of leukotrienes 

from leukocytes of allergic patients. In cell culture, mometasone furoate demonstrated high potency in 

inhibition of synthesis and release of IL-1, IL-5, IL-6 and TNF-alpha. It is also a potent inhibitor of 

leukotriene production and of the production of the Th2 cytokines IL-4 and IL-5 from human CD4+ 

T-cells. 

 

Pharmacodynamic effects 

 

The pharmacodynamic response profile of this medicinal product is characterised by rapid onset of 

action within 5 minutes after dosing and sustained effect over the whole 24-hour dosing interval. 

 

The pharmacodynamic response profile is further characterised by increased mean peak forced 

expiratory volume in the first second (FEV1) of 172 ml following 

indacaterol/glycopyrronium/mometasone furoate 114 mcg/46 mcg/136 mcg once daily compared to 

salmeterol/fluticasone 50 mcg/500 mcg twice daily. 

 

No tachyphylaxis to the lung function benefits of Zimbus Breezhaler was observed over time. 

 

QTc interval 

The effect of this medicinal product on the QTc interval has not been evaluated in a thorough QT 

(TQT) study. For mometasone furoate, no QTc prolonging properties are known. 

 

  



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Clinical efficacy and safety 

 

The safety and efficacy of Zimbus Breezhaler in adult patients with persistent asthma was evaluated in 

the phase III randomised, double-blind study (IRIDIUM). The IRIDIUM study was a 52-week study 

evaluating Zimbus Breezhaler 114 mcg/46 mcg/68 mcg once daily (N=620) and 

114 mcg/46 mcg/136 mcg once daily (N=619) compared to indacaterol/mometasone furoate 

125 mcg/127.5 mcg once daily (N=617) and 125 mcg/260 mcg once daily (N=618), respectively. A 

third active control arm included subjects treated with salmeterol/fluticasone propionate 

50 mcg/500 mcg twice daily (N=618). All subjects were required to have symptomatic asthma 

(ACQ-7 score ≥1.5) and were on asthma maintenance therapy using a medium or high dose inhaled 

synthetic corticosteroid (ICS) and LABA combination therapy for at least 3 months prior to study 

entry. The mean age was 52.2 years. At screening, 99.9% of patients reported a history of exacerbation 

in the past year. At study entry, the most common asthma medications reported were medium dose of 

ICS in combination with a LABA (62.6%) and high dose of ICS in combination with a LABA 

(36.7%). 

 

The primary objective of the study was to demonstrate superiority of either Zimbus Breezhaler 

114 mcg/46 mcg/68 mcg once daily over indacaterol/mometasone furoate 125 mcg/127.5 mcg once 

daily or Zimbus Breezhaler 114 mcg/46 mcg/136 mcg once daily over indacaterol/mometasone furoate 

125 mcg/260 mcg once daily in terms of trough FEV1 at week 26. 

 

Zimbus Breezhaler 114 mcg/46 mcg/136 mcg once daily demonstrated statistically significant 

improvements in trough FEV1 at week 26 compared to indacaterol/mometasone furoate at 

corresponding dose. Clinically meaningful improvements in lung function (change from baseline 

trough FEV1 at week 26, morning and evening peak expiratory flow) were also observed compared to 

salmeterol/fluticasone propionate 50 mcg/500 mcg twice daily. Findings at week 52 were consistent 

with week 26 (see Table 2). 

 

All treatment groups showed clinically relevant improvements from baseline in ACQ-7 at week 26, 

however no statistically significant differences between groups were observed. The mean change from 

baseline in ACQ-7 at week 26 (key secondary endpoint) and week 52 was around -1 for all treatment 

groups. The ACQ-7 responder rates (defined as a change decrease in score of ≥0.5) at different time 

points are described in Table 2. 

 

Exacerbations were a secondary endpoint (not part of confirmatory testing strategy). Zimbus 

Breezhaler 114 mcg/46 mcg/136 mcg once daily demonstrated a reduction in the annual rate of 

exacerbations compared to salmeterol/fluticasone propionate 50 mcg/500 mcg twice daily and 

indacaterol/mometasone furoate 125 mcg/260 mcg once daily (see Table 2). 

 

Results for the most clinically relevant endpoints are described in Table 2. 

 

  



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Table 2 Results of primary and secondary endpoints in IRIDIUM study at weeks 26 and 52 

 
Endpoint Time point/ 

Duration 

Zimbus Breezhaler1 vs IND/MF2 Zimbus Breezhaler1 vs SAL/FP3 

Lung function 

Trough FEV14 

Treatment 

difference 

P value 

(95% CI) 

Week 26 

(Primary 

endpoint) 

65 ml 

<0.001 

(31, 99) 

119 ml 

<0.001 

(85, 154) 

Week 52 

86 ml 

<0.001 

(51, 120) 

145 ml 

<0.001 

(111, 180) 

Mean morning peak expiratory flow (PEF) 

Treatment 

difference 

(95% CI) 

Week 52* 
18.7 l/min 

(13.4, 24.1) 

34.8 l/min 

(29.5, 40.1) 

Mean evening peak expiratory flow (PEF) 

Treatment 

difference 

(95% CI) 

Week 52* 
17.5 l/min 

(12.3, 22.8) 

29.5 l/min 

(24.2, 34.7) 

Symptoms 

ACQ responders (percentage of patients achieving minimal clinical important difference (MCID) from 

baseline with ACQ ≥0.5) 

Percentage Week 4 66% vs 63% 66% vs 53% 

Odds ratio 

(95% CI) 

1.21 

(0.94, 1.54) 

1.72 

(1.35, 2.20) 

Percentage Week 12 68% vs 67% 68% vs 61% 

Odds ratio 

(95% CI) 

1.11 

(0.86, 1.42) 

1.35 

(1.05, 1.73) 

Percentage Week 26 71% vs 74% 71% vs 67% 

Odds ratio 

(95% CI) 

0.92 

(0.70, 1.20) 

1.21 

(0.93, 1.57) 

Percentage Week 52 79% vs 78% 79% vs 73% 

Odds ratio 

(95% CI) 

1.10 

(0.83, 1.47) 

1.41 

(1.06, 1.86) 

Annualised rate of asthma exacerbations 

Moderate or severe exacerbations 

AR Week 52 0.46 vs 0.54 0.46 vs 0.72 

RR** 

(95% CI) 

Week 52 0.85 

(0.68, 1.04) 

0.64 

(0.52, 0.78) 

Severe exacerbations 

AR Week 52 0.26 vs 0.33 0.26 vs 0.45 

RR** 

(95% CI) 

Week 52 0.78 

(0.61, 1.00) 

0.58 

(0.45, 0.73) 

* Mean value for the treatment duration. 

** RR <1.00 favours indacaterol/glycopyrronium/mometasone furoate. 
1 Zimbus Breezhaler 114 mcg/46 mcg/136 mcg od. 
2 IND/MF: indacaterol/mometasone furoate high dose: 125 mcg/260 mcg od. 

Mometasone furoate 136 mcg in Zimbus Breezhaler is comparable to mometasone furoate 260 mcg in 

indacaterol/mometasone furoate. 
3 SAL/FP: salmeterol/fluticasone propionate high dose: 50 mcg/500 mcg bid (content dose). 
4 Trough FEV1: the mean of the two FEV1 values measured at 23 hours 15 min and 23 hours 45 min 

after the evening dose. 

Primary endpoint (trough FEV1 at week 26) and key secondary endpoint (ACQ-7 score at week 26) were part 

of confirmatory testing strategy and thus controlled for multiplicity. All other endpoints were not part of 

confirmatory testing strategy. 

RR = rate ratio, AR = annualised rate 

od = once daily, bid = twice daily 

 



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Paediatric population 

 

The European Medicines Agency has deferred the obligation to submit the results of studies with 

indacaterol/glycopyrronium/mometasone furoate in one or more subsets of the paediatric population in 

asthma (see section 4.2 for information on paediatric use). 

 

5.2 Pharmacokinetic properties 
 

Absorption 

 

Following inhalation of Zimbus Breezhaler, the median time to reach peak plasma concentrations of 

indacaterol, glycopyrronium and mometasone furoate was approximately 15 minutes, 5 minutes and 

1 hour, respectively. 

 

Based on the in vitro performance data, the dose of each of the monotherapy components delivered to 

the lung is expected to be similar for the indacaterol/glycopyrronium/mometasone furoate combination 

and the monotherapy products. Steady-state plasma exposure to indacaterol, glycopyrronium and 

mometasone furoate after inhalation of the combination was similar to the systemic exposure after 

inhalation of indacaterol maleate, glycopyrronium or mometasone furoate as monotherapy products. 

 

Following inhalation of the combination, the absolute bioavailability was estimated to be about 45% 

for indacaterol, 40% for glycopyrronium and less than 10% for mometasone furoate. 

 

Indacaterol 

Indacaterol concentrations increased with repeated once-daily administration. Steady-state was 

achieved within 12 to 14 days. The mean accumulation ratio of indacaterol, i.e. AUC over the 24-h 

dosing interval on day 14 compared to day 1, was in the range of 2.9 to 3.8 for once-daily inhaled 

doses between 60 and 480 mcg (delivered dose). Systemic exposure results from a composite of 

pulmonary and gastrointestinal absorption; about 75% of systemic exposure was from pulmonary 

absorption and about 25% from gastrointestinal absorption. 

 

Glycopyrronium 

About 90% of systemic exposure following inhalation is due to lung absorption and 10% is due to 

gastrointestinal absorption. The absolute bioavailability of orally administered glycopyrronium was 

estimated to be about 5%. 

 

Mometasone furoate 

Mometasone furoate concentrations increased with repeated once-daily administration via the 

Breezhaler inhaler. Steady state was achieved after 12 days. The mean accumulation ratio of 

mometasone furoate, i.e. AUC over the 24-h dosing interval on day 14 compared to day 1, was in the 

range of 1.28 to 1.40 for once-daily inhaled doses between 68 and 136 mcg as part of the 

indacaterol/glycopyrronium/mometasone furoate combination. 

 

Following oral administration of mometasone furoate, the absolute oral systemic bioavailability of 

mometasone furoate was estimated to be very low (<2%). 

 

Distribution 

 

Indacaterol 

After intravenous infusion the volume of distribution (Vz) of indacaterol was 2361 to 2557 litres, 

indicating an extensive distribution. The in vitro human serum and plasma protein binding were 94.1 

to 95.3% and 95.1 to 96.2%, respectively. 

 



14 

Glycopyrronium 

After intravenous dosing, the steady-state volume of distribution (Vss) of glycopyrronium was 83 litres 

and the volume of distribution in the terminal phase (Vz) was 376 litres. The apparent volume of 

distribution in the terminal phase following inhalation (Vz/F) was 7,310 litres, which reflects the much 

slower elimination after inhalation. The in vitro human plasma protein binding of glycopyrronium was 

38% to 41% at concentrations of 1 to 10 ng/ml. These concentrations were at least 6-fold higher than 

the steady-state mean peak levels achieved in plasma for a 44 mcg once-daily dosing regimen. 

 

Mometasone furoate 

After intravenous bolus administration, the Vd is 332 litres. The in vitro protein binding for 

mometasone furoate is high, 98% to 99% in concentration range of 5 to 500 ng/ml. 

 

Biotransformation 

 

Indacaterol 

After oral administration of radiolabelled indacaterol in a human ADME (absorption, distribution, 

metabolism, excretion) study, unchanged indacaterol was the main component in serum, accounting 

for about one third of total drug-related AUC over 24 hours. A hydroxylated derivative was the most 

prominent metabolite in serum. Phenolic O-glucuronides of indacaterol and hydroxylated indacaterol 

were further prominent metabolites. A diastereomer of the hydroxylated derivative, an N-glucuronide 

of indacaterol, and C- and N-dealkylated products were further metabolites identified. 

 

In vitro investigations indicated that UGT1A1 was the only UGT isoform that metabolised indacaterol 

to the phenolic O-glucuronide. The oxidative metabolites were found in incubations with recombinant 

CYP1A1, CYP2D6 and CYP3A4. CYP3A4 is concluded to be the predominant isoenzyme responsible 

for hydroxylation of indacaterol. In vitro investigations further indicated that indacaterol is a 

low-affinity substrate for the efflux pump P-gp. 

 

In vitro the UGT1A1 isoform is a major contributor to the metabolic clearance of indacaterol. 

However, as shown in a clinical study in populations with different UGT1A1 genotypes, systemic 

exposure to indacaterol is not significantly affected by the UGT1A1-genotype. 

 

Glycopyrronium 

In vitro metabolism studies showed consistent metabolic pathways for glycopyrronium bromide 

between animals and humans. No human-specific metabolites were found. Hydroxylation resulting in 

a variety of mono- and bis-hydroxylated metabolites and direct hydrolysis resulting in the formation of 

a carboxylic acid derivative (M9) were seen. 

 

In vitro investigations showed that multiple CYP isoenzymes contribute to the oxidative 

biotransformation of glycopyrronium. The hydrolysis to M9 is likely to be catalysed by members of 

the cholinesterase family. 

 

After inhalation, systemic exposure to M9 was on average in the same order of magnitude as the 

exposure to the parent drug. Since in vitro studies did not show lung metabolism and M9 was of minor 

importance in the circulation (about 4% of parent drug Cmax and AUC) after intravenous 

administration, it is assumed that M9 is formed from the swallowed dose fraction of orally inhaled 

glycopyrronium bromide by pre-systemic hydrolysis and/or via first-pass metabolism. After inhalation 

as well as after intravenous administration, only minimal amounts of M9 were found in the urine (i.e. 

≤0.5% of dose). Glucuronide and/or sulfate conjugates of glycopyrronium were found in urine of 

humans after repeated inhalation, accounting for about 3% of the dose. 

 

In vitro inhibition studies demonstrated that glycopyrronium bromide has no relevant capacity to 

inhibit CYP1A2, CYP2A6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1 or CYP3A4/5, the 

efflux transporters MDR1, MRP2 or MXR, and the uptake transporters OATP1B1, OATP1B3, OAT1, 

OAT3, OCT1 or OCT2. In vitro enzyme induction studies did not indicate a clinically relevant 

induction by glycopyrronium bromide for any of the cytochrome P450 isoenzymes tested as well as 

for UGT1A1 and the transporters MDR1 and MRP2. 



15 

 

Mometasone furoate 

The portion of an inhaled mometasone furoate dose that is swallowed and absorbed in the 

gastrointestinal tract undergoes extensive metabolism to multiple metabolites. There are no major 

metabolites detectable in plasma. In human liver microsomes, mometasone furoate is metabolised by 

CYP3A4. 

 

Elimination 

 

Indacaterol 

In clinical studies which included urine collection, the amount of indacaterol excreted unchanged via 

urine was generally lower than 2% of the dose. Renal clearance of indacaterol was, on average, 

between 0.46 and 1.20 litres/hour. Compared with the serum clearance of indacaterol of 18.8 to 

23.3 litres/hour, it is evident that renal clearance plays a minor role (about 2 to 6% of systemic 

clearance) in the elimination of systemically available indacaterol. 

 

In a human ADME study in which indacaterol was given orally, the faecal route of excretion was 

dominant over the urinary route. Indacaterol was excreted into human faeces primarily as unchanged 

parent substance (54% of the dose) and, to a lesser extent, hydroxylated indacaterol metabolites (23% 

of the dose). Mass balance was complete, with ≥90% of the dose recovered in the excreta. 

 

Indacaterol serum concentrations declined in a multi-phasic manner with an average terminal half-life 

ranging from 45.5 to 126 hours. The effective half-life, calculated from the accumulation of 

indacaterol after repeated dosing, ranged from 40 to 52 hours, which is consistent with the observed 

time to steady state of approximately 12 to 14 days. 

 

Glycopyrronium 

After intravenous administration of [3H]-labelled glycopyrronium bromide to humans, the mean 

urinary excretion of radioactivity in 48 hours amounted to 85% of the dose. A further 5% of the dose 

was found in the bile. Thus, mass balance was almost complete. 

 

Renal elimination of parent drug accounts for about 60 to 70% of total clearance of systemically 

available glycopyrronium whereas non-renal clearance processes account for about 30 to 40%. Biliary 

clearance contributes to the non-renal clearance, but the majority of non-renal clearance is thought to 

be due to metabolism. 

 

Mean renal clearance of glycopyrronium was in the range of 17.4 and 24.4 litres/hour. Active tubular 

secretion contributes to the renal elimination of glycopyrronium. Up to 20% of the dose was found in 

urine as parent drug. 

 

Glycopyrronium plasma concentrations declined in a multi-phasic manner. The mean terminal 

elimination half-life was much longer after inhalation (33 to 57 hours) than after intravenous 

(6.2 hours) and oral (2.8 hours) administration. The elimination pattern suggests a sustained lung 

absorption and/or transfer of glycopyrronium into the systemic circulation at and beyond 24 h after 

inhalation. 

 

Mometasone furoate 

After intravenous bolus administration, mometasone furoate has a terminal elimination T½ of 

approximately 4.5 hours. A radiolabelled, orally inhaled dose is excreted mainly in the faeces (74%) 

and to a lesser extent in the urine (8%). 

 

Interactions 

 

Concomitant administration of orally inhaled indacaterol, glycopyrronium and mometasone furoate 

under steady-state conditions did not affect the pharmacokinetics of any of the active substances. 

 



16 

Special populations 

 

A population pharmacokinetic analysis in patients with asthma after inhalation of Zimbus Breezhaler 

indicated no significant effect of age, gender, body weight, smoking status, baseline estimated 

glomerular filtration rate (eGFR) and FEV1 at baseline on the systemic exposure to indacaterol, 

glycopyrronium or mometasone furoate. 

 

Patients with renal impairment 

The effect of renal impairment on the pharmacokinetics of indacaterol, glycopyrronium and 

mometasone furoate has not been evaluated in dedicated studies with Zimbus Breezhaler. In a 

population pharmacokinetic analysis, estimated glomerular filtration rate (eGFR) was not a 

statistically significant covariate for systemic exposure of indacaterol, glycopyrronium and 

mometasone furoate following administration of Zimbus Breezhaler in patients with asthma. 

 

Due to the very low contribution of the urinary pathway to the total body elimination of indacaterol 

and mometasone furoate, the effects of renal impairment on their systemic exposure have not been 

investigated (see sections 4.2 and 4.4). 

 

Renal impairment has an impact on the systemic exposure to glycopyrronium administered as a 

monotherapy. A moderate mean increase in total systemic exposure (AUClast) of up to 1.4-fold was 

seen in subjects with mild and moderate renal impairment and up to 2.2-fold in subjects with severe 

renal impairment and end-stage renal disease. Based on a population pharmacokinetic analysis of 

glycopyrronium in asthma patients following Zimbus Breezhaler administration, AUC0-24h increased 

by 27% or decreased by 19% for patients with an absolute GFR of 58 or 143 ml/min, respectively, 

compared to a patient with an absolute GFR of 93 ml/min. Based on a population pharmacokinetic 

analysis of glycopyrronium in chronic obstructive pulmonary disease patients with mild and moderate 

renal impairment (eGFR ≥30 ml/min/1.73 m2), glycopyrronium can be used at the recommended dose. 

 

Patients with hepatic impairment 

The effect of hepatic impairment on the pharmacokinetics of indacaterol, glycopyrronium and 

mometasone furoate has not been evaluated in subjects with hepatic impairment following 

administration of Zimbus Breezhaler. However, studies have been conducted with the monotherapy 

components indacaterol and mometasone furoate (see section 4.2). 

 

Indacaterol 

Patients with mild and moderate hepatic impairment showed no relevant changes in Cmax or AUC of 

indacaterol, nor did protein binding differ between mild and moderate hepatic impaired subjects and 

their healthy controls. Studies in subjects with severe hepatic impairment were not performed. 

 

Glycopyrronium 

Clinical studies in patients with hepatic impairment have not been conducted. Glycopyrronium is 

cleared predominantly from the systemic circulation by renal excretion. Impairment of the hepatic 

metabolism of glycopyrronium is not thought to result in a clinically relevant increase in systemic 

exposure. 

 

Mometasone furoate 

A study evaluating the administration of a single inhaled dose of 400 mcg mometasone furoate by dry 

powder inhaler to subjects with mild (n=4), moderate (n=4), and severe (n=4) hepatic impairment 

resulted in only 1 or 2 subjects in each group having detectable peak plasma concentrations of 

mometasone furoate (ranging from 50 to 105 pcg/ml). The observed peak plasma concentrations 

appear to increase with severity of hepatic impairment; however, the numbers of detectable levels 

(assay lower limit of quantification was 50 pcg/ml) were few. 

 



17 

Other special populations 

There were no major differences in total systemic exposure (AUC) for indacaterol, glycopyrronium or 

mometasone furoate between Japanese and Caucasian subjects. Insufficient pharmacokinetic data are 

available for other ethnicities or races. Total systemic exposure (AUC) for glycopyrronium may be up 

to 1.8-fold higher in asthma patients with low body weight (35 kg) and up to 2.5-fold higher in asthma 

patients with low body weight (35 kg) and low absolute GFR (45 ml/min). 

 

5.3 Preclinical safety data 
 

No animal studies were performed with the combination of indacaterol, glycopyrronium and 

mometasone furoate. The non-clinical assessments of each monotherapy and of 

indacaterol/mometasone and indacaterol/glycopyrronium combination products are presented below: 

 

Indacaterol 

 

Effects on the cardiovascular system attributable to the beta2-agonistic properties of indacaterol 

included tachycardia, arrhythmias and myocardial lesions in dogs. Mild irritation of the nasal cavity 

and larynx was seen in rodents. 

 

Genotoxicity studies did not reveal any mutagenic or clastogenic potential. 

 

Carcinogenicity was assessed in a two-year rat study and a six-month transgenic mouse study. 

Increased incidences of benign ovarian leiomyoma and focal hyperplasia of ovarian smooth muscle in 

rats were consistent with similar findings reported for other beta2-adrenergic agonists. No evidence of 

carcinogenicity was seen in mice. 

 

All these findings occurred at exposures sufficiently in excess of those anticipated in humans. 

 

Following subcutaneous administration in a rabbit study, adverse effects of indacaterol with respect to 

pregnancy and embryonal/foetal development could only be demonstrated at doses more than 500-fold 

those achieved following daily inhalation of 150 mcg in humans (based on AUC0-24 h). 

 

Although indacaterol did not affect general reproductive performance in a rat fertility study, a decrease 

in the number of pregnant F1 offspring was observed in the peri- and post-natal developmental rat 

study at an exposure 14-fold higher than in humans treated with indacaterol. Indacaterol was not 

embryotoxic or teratogenic in rats or rabbits. 

 

Glycopyrronium 

 

Effects attributable to the muscarinic receptor antagonist properties of glycopyrronium included mild 

to moderate increases in heart rate in dogs, lens opacities in rats and reversible changes associated 

with reduced glandular secretions in rats and dogs. Mild irritancy or adaptive changes in the 

respiratory tract were seen in rats. All these findings occurred at exposures sufficiently in excess of 

those anticipated in humans. 

 

Genotoxicity studies did not reveal any mutagenic or clastogenic potential for glycopyrronium. 

Carcinogenicity studies in transgenic mice using oral administration and in rats using inhalation 

administration revealed no evidence of carcinogenicity. 

 

Glycopyrronium was not teratogenic in rats or rabbits following inhalation administration. 

Glycopyrronium and its metabolites did not significantly cross the placental barrier of pregnant mice, 

rabbits and dogs. Published data for glycopyrronium in animals do not indicate any reproductive 

toxicity issues. Fertility and pre- and post-natal development were not affected in rats. 

 



18 

Mometasone furoate 

 

All observed effects are typical of the glucocorticoid class of compounds and are related to 

exaggerated pharmacological effects of glucocorticoids. 

 

Mometasone furoate showed no genotoxic activity in a standard battery of in vitro and in vivo tests. 

 

In carcinogenicity studies in mice and rats, inhaled mometasone furoate demonstrated no statistically 

significant increase in the incidence of tumours. 

 

Like other glucocorticoids, mometasone furoate is a teratogen in rodents and rabbits. Effects noted 

were umbilical hernia in rats, cleft palate in mice and gallbladder agenesis, umbilical hernia and flexed 

front paws in rabbits. There were also reductions in maternal body weight gains, effects on foetal 

growth (lower foetal body weight and/or delayed ossification) in rats, rabbits and mice, and reduced 

offspring survival in mice. In studies of reproductive function, subcutaneous mometasone furoate at 

15 mcg/kg prolonged gestation and difficult labour occurred, with a reduction in offspring survival 

and body weight. 

 

Indacaterol and glycopyrronium combination 

 

Findings during the nonclinical safety studies of indacaterol/glycopyrronium were consistent with the 

known pharmacological effects of the indacaterol or glycopyrronium monotherapy components. 

 

The effect on heart rate for indacaterol/glycopyrronium was increased in magnitude and duration 

compared with the changes observed for each monotherapy component alone. 

 

Shortening of electrocardiograph intervals and decreased systolic and diastolic blood pressure were 

also apparent. Indacaterol administered to dogs alone or in the indacaterol/glycopyrronium 

combination was associated with a similar incidence of myocardial lesions. 

 

Indacaterol and mometasone furoate combination 

 

The findings during the 13-week inhalation toxicity studies were predominantly attributable to the 

mometasone furoate and were typical pharmacological effects of glucocorticoids. Increased heart rates 

associated with indacaterol were apparent in dogs after administration of indacaterol/mometasone 

furoate or indacaterol alone. 

 

 

  



19 

6. PHARMACEUTICAL PARTICULARS 
 

6.1 List of excipients 
 

Capsule contents 

 

Lactose monohydrate 

Magnesium stearate 

 

Capsule shell 

 

Hypromellose 

Printing ink 

 

6.2 Incompatibilities 
 

Not applicable. 

 

6.3 Shelf life 
 

30 months. 

 

6.4 Special precautions for storage 
 

Store in the original package in order to protect from light and moisture. 

This medicinal product does not require any special temperature storage conditions. 

 

6.5 Nature and contents of container 
 

Inhaler body and cap are made from acrylonitrile butadiene styrene, push buttons are made from 

methyl metacrylate acrylonitrile butadiene styrene. Needles and springs are made from stainless steel. 

 

PA/Alu/PVC – Alu perforated unit-dose blister. Each blister contains 10 hard capsules. 

 

Single pack containing 10 x 1, 30 x 1 or 90 x 1 hard capsules, together with 1 inhaler. 

Pack containing 30 x 1 hard capsules, together with 1 inhaler and 1 sensor. 

Multipacks containing 150 (15 packs of 10 x 1) hard capsules and 15 inhalers. 

 

Not all pack sizes may be marketed. 

 

6.6 Special precautions for disposal and other handling 
 

The inhaler provided with each new prescription should be used. The inhaler in each pack should be 

disposed of after all capsules in that pack have been used. 

 

Any unused medicinal product or waste material should be disposed of in accordance with local 

requirements. 

 

  



20 

Instructions for handling and use 

 

Please read the full Instructions for Use before using the Zimbus Breezhaler. 

 

 

 

 

  
Insert Pierce and release Inhale deeply Check capsule is empty 

 
  

 

 
   

 
   

 

 

 

 

 

 

  
Step 1a: 

Pull off cap 

Step 2a: 

Pierce capsule once 

Hold the inhaler upright. 

Pierce capsule by firmly 

pressing both side 

buttons at the same time. 

Step 3a: 

Breathe out fully 

Do not blow into the 

inhaler. 

Check capsule is empty 

Open the inhaler to see if 

any powder is left in the 

capsule. 

   

You should hear a noise 

as the capsule is pierced. 

Only pierce the capsule 

once. 

 

If there is powder left in 

the capsule: 

 Close the inhaler. 

 Repeat steps 3a to 3d. 

Step 1b: 

Open inhaler 

 
Step 2b: 

Release side buttons 

Step 3b: 

Inhale medicine deeply 

Hold the inhaler as 

shown in the picture. 

Place the mouthpiece in 

your mouth and close 

your lips firmly around 

it. 

Do not press the side 

buttons. 

  
Powder Empty 

remaining 

1 
 

2 
 

3 
 

Check 
 



21 

 

 

 Breathe in quickly and as 

deeply as you can. 

During inhalation you 

will hear a whirring 

noise. 

You may taste the 

medicine as you inhale. 

 

Step 1c: 

Remove capsule 

Separate one of the 

blisters from the blister 

card. 

Peel open the blister and 

remove the capsule. 

Do not push the capsule 

through the foil. 

Do not swallow the 

capsule. 

 

 
Step 3c: 

Hold breath 

Hold your breath for up 

to 5 seconds. 

 

 

Step 3d: 

Rinse mouth 

Rinse your mouth with 

water after each dose and 

spit it out. 

Remove empty capsule 

Put the empty capsule in 

your household waste. 

 

Close the inhaler and 

replace the cap. 



22 

 
Step 1d: 

Insert capsule 

Never place a capsule 

directly into the 

mouthpiece. 

 

  Important Information 

 Zimbus Breezhaler 
capsules must always be 

stored in the blister card 

and only removed 

immediately before use. 

 Do not push the capsule 
through the foil to 

remove it from the 

blister. 

 Do not swallow the 
capsule. 

 Do not use the Zimbus 
Breezhaler capsules with 

any other inhaler. 

 Do not use the Zimbus 
Breezhaler inhaler to 

take any other capsule 

medicine. 

 Never place the capsule 
into your mouth or the 

mouthpiece of the 

inhaler. 

 Do not press the side 
buttons more than once. 

 Do not blow into the 
mouthpiece. 

 Do not press the side 
buttons while inhaling 

through the mouthpiece. 

 Do not handle capsules 
with wet hands. 

 Never wash your inhaler 
with water. 

 
Step 1e: 

Close inhaler 

 



23 

Your Zimbus Breezhaler Inhaler pack contains: 
 One Zimbus Breezhaler inhaler 
 One or more blister cards, each containing 

10 Zimbus Breezhaler capsules to be used in 
the inhaler 

 

 

Frequently Asked 

Questions 

 

Why didn’t the inhaler 

make a noise when I 

inhaled? 

The capsule may be stuck 

in the capsule chamber. If 

this happens, carefully 

loosen the capsule by 

tapping the base of the 

inhaler. Inhale the 

medicine again by 

repeating steps 3a to 3d. 

 

What should I do if there 

is powder left inside the 

capsule? 

You have not received 

enough of your medicine. 

Close the inhaler and 

repeat steps 3a to 3d. 

 

I coughed after inhaling 

– does this matter? 

This may happen. As long 

as the capsule is empty 

you have received enough 

of your medicine. 

 

I felt small pieces of the 

capsule on my tongue – 

does this matter? 

This can happen. It is not 

harmful. The chances of 

the capsule breaking into 

small pieces will be 

increased if the capsule is 

pierced more than once. 

Cleaning the inhaler 

Wipe the mouthpiece 

inside and outside with a 

clean, dry, lint-free cloth to 

remove any powder 

residue. Keep the inhaler 

dry. Never wash your 

inhaler with water. 

Disposing of the inhaler 

after use 

Each inhaler should be 

disposed of after all 

capsules have been used. 

Ask your pharmacist how 

to dispose of medicines 

and inhalers that are no 

longer required. 

 

For detailed instructions on use of the sensor and the App, see the Instructions for Use provided in the 

sensor pack and the App. 

 

 

  

Base 

Cap 

Side 

buttons 

Blister 

Screen 

Capsule 

chamber 

Inhaler Inhaler base Blister card 

Mouthpiece 



24 

7. MARKETING AUTHORISATION HOLDER 
 

Novartis Europharm Limited 

Vista Building 

Elm Park, Merrion Road 

Dublin 4 

Ireland 

 

 

8. MARKETING AUTHORISATION NUMBER(S) 
 

EU/1/20/1440/001-005 

 

 

9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 
 

 

10. DATE OF REVISION OF THE TEXT 
 

 

Detailed information on this medicinal product is available on the website of the European Medicines 

Agency http://www.ema.europa.eu. 

  

http://www.ema.europa.eu/


25 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANNEX II 
 

A. MANUFACTURERS RESPONSIBLE FOR BATCH 

RELEASE 

 

B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY 

AND USE 

 

C. OTHER CONDITIONS AND REQUIREMENTS OF THE 

MARKETING AUTHORISATION 

 

D. CONDITIONS OR RESTRICTIONS WITH REGARD TO 

THE SAFE AND EFFECTIVE USE OF THE MEDICINAL 

PRODUCT 

 



26 

A. MANUFACTURERS RESPONSIBLE FOR BATCH RELEASE 
 

Name and address of the manufacturers responsible for batch release 

 

Novartis Pharma GmbH 

Roonstraße 25 

D-90429 Nuremberg 

Germany 

 

Novartis Farmacéutica, S.A. 

Ronda de Santa Maria, 158 

08210 Barberà del Vallés (Barcelona) 

Spain 

 

The printed package leaflet of the medicinal product must state the name and address of the 

manufacturer responsible for the release of the concerned batch. 

 

 

B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE 

 

Medicinal product subject to medical prescription. 

 

 

C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 

AUTHORISATION 

 

 Periodic safety update reports (PSURs) 
 

The requirements for submission of PSURs for this medicinal product are set out in the list of 

Union reference dates (EURD list) provided for under Article 107c(7) of Directive 2001/83/EC 

and any subsequent updates published on the European medicines web-portal. 

 

The marketing authorisation holder (MAH) shall submit the first PSUR for this product within 

6 months following authorisation. 

 

 

D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND 

EFFECTIVE USE OF THE MEDICINAL PRODUCT 

 

 Risk management plan (RMP) 
 

The marketing authorisation holder (MAH) shall perform the required pharmacovigilance 

activities and interventions detailed in the agreed RMP presented in Module 1.8.2 of the 

marketing authorisation and any agreed subsequent updates of the RMP. 

 

An updated RMP should be submitted: 

 At the request of the European Medicines Agency; 

 Whenever the risk management system is modified, especially as the result of new information 
being received that may lead to a significant change to the benefit/risk profile or as the result of 

an important (pharmacovigilance or risk minimisation) milestone being reached. 

  



27 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANNEX III 

 

LABELLING AND PACKAGE LEAFLET 

  



28 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. LABELLING 
  



29 

 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 

 

OUTER CARTON OF UNIT PACK 

 

 

1. NAME OF THE MEDICINAL PRODUCT 

 

Zimbus Breezhaler 114 micrograms/46 micrograms/136 micrograms inhalation powder, hard capsules 

indacaterol/glycopyrronium/mometasone furoate 

 

 

2. STATEMENT OF ACTIVE SUBSTANCE(S) 

 

Each delivered dose contains 114 micrograms indacaterol (as acetate), 46 micrograms glycopyrronium 

(equivalent to 58 micrograms glycopyrronium bromide) and 136 micrograms mometasone furoate. 

 

 

3. LIST OF EXCIPIENTS 

 

Also contains lactose and magnesium stearate. See package leaflet for further information. 

 

 

4. PHARMACEUTICAL FORM AND CONTENTS 

 

Inhalation powder, hard capsule 

 

10 x 1 capsules + 1 inhaler 

30 x 1 capsules + 1 inhaler 

90 x 1 capsules + 1 inhaler 

 

 

5. METHOD AND ROUTE(S) OF ADMINISTRATION 

 

Read the package leaflet before use. 

For use only with the inhaler provided in the pack. 

Do not swallow capsules. 

Inhalation use 

Treatment for 90 days. 

 

 

6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 

 

Keep out of the sight and reach of children. 

 

 

7. OTHER SPECIAL WARNING(S), IF NECESSARY 

 

 

8. EXPIRY DATE 

 

EXP 

The inhaler in each pack should be disposed of after all capsules in that pack have been used. 

 



30 

 

9. SPECIAL STORAGE CONDITIONS 

 

Store in the original package in order to protect from light and moisture. 

 

 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 

APPROPRIATE 

 

 

11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 

 

Novartis Europharm Limited 

Vista Building 

Elm Park, Merrion Road 

Dublin 4 

Ireland 

 

 

12. MARKETING AUTHORISATION NUMBER(S) 

 

EU/1/20/1440/001 10 x 1 capsules + 1 inhaler 

EU/1/20/1440/002 30 x 1 capsules + 1 inhaler 

EU/1/20/1440/004 90 x 1 capsules + 1 inhaler 

 

 

13. BATCH NUMBER 

 

Lot 

 

 

14. GENERAL CLASSIFICATION FOR SUPPLY 

 

 

15. INSTRUCTIONS ON USE 

 

 

16. INFORMATION IN BRAILLE 

 

Zimbus Breezhaler 

 

 

17. UNIQUE IDENTIFIER – 2D BARCODE 

 

2D barcode carrying the unique identifier included. 

 

 

18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 

 

PC 

SN 

NN 
  



31 

 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 

 

OUTER CARTON OF UNIT PACK CONTAINING SENSOR 

 

 

1. NAME OF THE MEDICINAL PRODUCT 

 

Zimbus Breezhaler 114 micrograms/46 micrograms/136 micrograms inhalation powder, hard capsules 

indacaterol/glycopyrronium/mometasone furoate 

 

 

2. STATEMENT OF ACTIVE SUBSTANCE(S) 

 

Each delivered dose contains 114 micrograms indacaterol (as acetate), 46 micrograms glycopyrronium 

(equivalent to 58 micrograms glycopyrronium bromide) and 136 micrograms mometasone furoate. 

 

 

3. LIST OF EXCIPIENTS 

 

Also contains lactose and magnesium stearate. See package leaflet for further information. 

 

 

4. PHARMACEUTICAL FORM AND CONTENTS 

 

Inhalation powder, hard capsule 

 

30 x 1 capsules + 1 inhaler + 1 sensor 

 

 

5. METHOD AND ROUTE(S) OF ADMINISTRATION 

 

Read the package leaflet before use. 

For use only with the inhaler provided in the pack. 

Do not swallow capsules. 

Inhalation use 

 

 

6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 

 

Keep out of the sight and reach of children. 

 

 

7. OTHER SPECIAL WARNING(S), IF NECESSARY 

 

 

8. EXPIRY DATE 

 

EXP 

The inhaler in each pack should be disposed of after all capsules in that pack have been used. 

 

 



32 

9. SPECIAL STORAGE CONDITIONS 

 

Store in the original package in order to protect from light and moisture. 

 

 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 

APPROPRIATE 

 

 

11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 

 

Novartis Europharm Limited 

Vista Building 

Elm Park, Merrion Road 

Dublin 4 

Ireland 

 

 

12. MARKETING AUTHORISATION NUMBER(S) 

 

EU/1/20/1440/003 30 x 1 capsules + 1 inhaler + 1 sensor 

 

 

13. BATCH NUMBER 

 

Lot 

 

 

14. GENERAL CLASSIFICATION FOR SUPPLY 

 

 

15. INSTRUCTIONS ON USE 

 

 

16. INFORMATION IN BRAILLE 

 

Zimbus Breezhaler 

 

 

17. UNIQUE IDENTIFIER – 2D BARCODE 

 

2D barcode carrying the unique identifier included. 

 

 

18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 

 

PC 

SN 

NN 

  



33 

 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 

 

INTERMEDIATE CARTON OF UNIT PACK CONTAINING SENSOR 

 

 

1. NAME OF THE MEDICINAL PRODUCT 

 

Zimbus Breezhaler 114 micrograms/46 micrograms/136 micrograms inhalation powder, hard capsules 

indacaterol/glycopyrronium/mometasone furoate 

 

 

2. STATEMENT OF ACTIVE SUBSTANCE(S) 

 

Each delivered dose contains 114 micrograms indacaterol (as acetate), 46 micrograms glycopyrronium 

(equivalent to 58 micrograms glycopyrronium bromide) and 136 micrograms mometasone furoate. 

 

 

3. LIST OF EXCIPIENTS 

 

Also contains lactose and magnesium stearate. See package leaflet for further information. 

 

 

4. PHARMACEUTICAL FORM AND CONTENTS 

 

Inhalation powder, hard capsule 

 

30 x 1 capsules + 1 inhaler 

 

 

5. METHOD AND ROUTE(S) OF ADMINISTRATION 

 

Read the package leaflet before use. 

For use only with the inhaler provided in the pack. 

Do not swallow capsules. 

Inhalation use 

 

 

6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 

 

Keep out of the sight and reach of children. 

 

 

7. OTHER SPECIAL WARNING(S), IF NECESSARY 

 

 

8. EXPIRY DATE 

 

EXP 

The inhaler in each pack should be disposed of after all capsules in that pack have been used. 

 

 



34 

9. SPECIAL STORAGE CONDITIONS 

 

Store in the original package in order to protect from light and moisture. 

 

 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 

APPROPRIATE 

 

 

11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 

 

Novartis Europharm Limited 

Vista Building 

Elm Park, Merrion Road 

Dublin 4 

Ireland 

 

 

12. MARKETING AUTHORISATION NUMBER(S) 

 

EU/1/20/1440/003 30 x 1 capsules + 1 inhaler + 1 sensor 

 

 

13. BATCH NUMBER 

 

Lot 

 

 

14. GENERAL CLASSIFICATION FOR SUPPLY 

 

 

15. INSTRUCTIONS ON USE 

 

 

16. INFORMATION IN BRAILLE 

 

Zimbus Breezhaler 

 

 

17. UNIQUE IDENTIFIER – 2D BARCODE 

 

 

18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 

  



35 

 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 

 

OUTER CARTON OF MULTIPACK (INCLUDING BLUE BOX) 

 

 

1. NAME OF THE MEDICINAL PRODUCT 

 

Zimbus Breezhaler 114 micrograms/46 micrograms/136 micrograms inhalation powder, hard capsules 

indacaterol/glycopyrronium/mometasone furoate 

 

 

2. STATEMENT OF ACTIVE SUBSTANCE(S) 

 

Each delivered dose contains 114 micrograms indacaterol (as acetate), 46 micrograms glycopyrronium 

(equivalent to 58 micrograms glycopyrronium bromide) and 136 micrograms mometasone furoate. 

 

 

3. LIST OF EXCIPIENTS 

 

Also contains lactose and magnesium stearate. See package leaflet for further information. 

 

 

4. PHARMACEUTICAL FORM AND CONTENTS 

 

Inhalation powder, hard capsule 

 

Multipack: 150 (15 packs of 10 x 1) capsules + 15 inhalers 

 

 

5. METHOD AND ROUTE(S) OF ADMINISTRATION 

 

Read the package leaflet before use. 

For use only with the inhaler provided in the pack. 

Do not swallow capsules. 

Inhalation use 

 

 

6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 

 

Keep out of the sight and reach of children. 

 

 

7. OTHER SPECIAL WARNING(S), IF NECESSARY 

 

 

8. EXPIRY DATE 

 

EXP 

The inhaler in each pack should be disposed of after all capsules in that pack have been used. 

 

 



36 

9. SPECIAL STORAGE CONDITIONS 

 

Store in the original package in order to protect from light and moisture. 

 

 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 

APPROPRIATE 

 

 

11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 

 

Novartis Europharm Limited 

Vista Building 

Elm Park, Merrion Road 

Dublin 4 

Ireland 

 

 

12. MARKETING AUTHORISATION NUMBER(S) 

 

EU/1/20/1440/005 150 (15 packs of 10 x 1) capsules + 15 inhalers 

 

 

13. BATCH NUMBER 

 

Lot 

 

 

14. GENERAL CLASSIFICATION FOR SUPPLY 

 

 

15. INSTRUCTIONS ON USE 

 

 

16. INFORMATION IN BRAILLE 

 

Zimbus Breezhaler 

 

 

17. UNIQUE IDENTIFIER – 2D BARCODE 

 

2D barcode carrying the unique identifier included. 

 

 

18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 

 

PC 

SN 

NN 

  



37 

 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 

 

INTERMEDIATE CARTON OF MULTIPACK (WITHOUT BLUE BOX) 

 

 

1. NAME OF THE MEDICINAL PRODUCT 

 

Zimbus Breezhaler 114 micrograms/46 micrograms/136 micrograms inhalation powder, hard capsules 

indacaterol/glycopyrronium/mometasone furoate 

 

 

2. STATEMENT OF ACTIVE SUBSTANCE(S) 

 

Each delivered dose contains 114 micrograms indacaterol (as acetate), 46 micrograms glycopyrronium 

(equivalent to 58 micrograms glycopyrronium bromide) and 136 micrograms mometasone furoate. 

 

 

3. LIST OF EXCIPIENTS 

 

Also contains lactose and magnesium stearate. See package leaflet for further information. 

 

 

4. PHARMACEUTICAL FORM AND CONTENTS 

 

Inhalation powder, hard capsule 

 

10 x 1 capsules + 1 inhaler. Component of a multipack. Not to be sold separately. 

 

 

5. METHOD AND ROUTE(S) OF ADMINISTRATION 

 

Read the package leaflet before use. 

For use only with the inhaler provided in the pack. 

Do not swallow capsules. 

Inhalation use 

 

 

6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 

 

Keep out of the sight and reach of children. 

 

 

7. OTHER SPECIAL WARNING(S), IF NECESSARY 

 

 

8. EXPIRY DATE 

 

EXP 

The inhaler in each pack should be disposed of after all capsules in that pack have been used. 

 

 



38 

9. SPECIAL STORAGE CONDITIONS 

 

Store in the original package in order to protect from light and moisture. 

 

 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 

APPROPRIATE 

 

 

11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 

 

Novartis Europharm Limited 

Vista Building 

Elm Park, Merrion Road 

Dublin 4 

Ireland 

 

 

12. MARKETING AUTHORISATION NUMBER(S) 

 

EU/1/20/1440/005 150 (15 packs of 10 x 1) capsules + 15 inhalers 

 

 

13. BATCH NUMBER 

 

Lot 

 

 

14. GENERAL CLASSIFICATION FOR SUPPLY 

 

 

15. INSTRUCTIONS ON USE 

 

 

16. INFORMATION IN BRAILLE 

 

Zimbus Breezhaler 

 

 

17. UNIQUE IDENTIFIER – 2D BARCODE 

 

 

18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 

  



39 

 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 

 

INNER LID OF 

 OUTER CARTON OF UNIT PACK 

 INTERMEDIATE CARTON OF UNIT PACK CONTAINING SENSOR, AND 

 INTERMEDIATE CARTON OF MULTIPACK 

 

 

1. OTHER 

 

1  Insert 

2  Pierce and release 

3  Inhale deeply 

Check  Check capsule is empty 

 

Read the leaflet before use. 

  



40 

 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 

 

INNER LID OF OUTER CARTON OF UNIT PACK CONTAINING SENSOR 

 

 

1. OTHER 

 

Please read the package leaflet in the Zimbus Breezhaler pack and the instructions for use provided in 

the sensor pack. 

  



41 

 

MINIMUM PARTICULARS TO APPEAR ON BLISTERS OR STRIPS 

 

BLISTERS 

 

 

1. NAME OF THE MEDICINAL PRODUCT 

 

Zimbus Breezhaler 114 mcg/46 mcg/136 mcg inhalation powder 

indacaterol/glycopyrronium/mometasone furoate 

 

 

2. NAME OF THE MARKETING AUTHORISATION HOLDER 

 

Novartis Europharm Limited 

 

 

3. EXPIRY DATE 

 

EXP 

 

 

4. BATCH NUMBER 

 

Lot 

 

 

5. OTHER 

 

Inhalation use only 

  



42 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. PACKAGE LEAFLET 



43 

Package leaflet: Information for the user 

 

Zimbus Breezhaler 114 micrograms/46 micrograms/136 micrograms inhalation powder, hard 

capsules 
indacaterol/glycopyrronium/mometasone furoate 

 

Read all of this leaflet carefully before you start using this medicine because it contains 

important information for you. 

- Keep this leaflet. You may need to read it again. 
- If you have any further questions, ask your doctor, pharmacist or nurse. 
- This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, 

even if their signs of illness are the same as yours. 

- If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible 
side effects not listed in this leaflet. See section 4. 

 

What is in this leaflet: 

 

1. What Zimbus Breezhaler is and what it is used for 

2. What you need to know before you use Zimbus Breezhaler 

3. How to use Zimbus Breezhaler 

4. Possible side effects 

5. How to store Zimbus Breezhaler 

6. Contents of the pack and other information 

Instructions for use of Zimbus Breezhaler inhaler 

 

 

1. What Zimbus Breezhaler is and what it is used for 

 

What Zimbus Breezhaler is and how it works 

Zimbus Breezhaler contains three active substances: 

- indacaterol 
- glycopyrronium 
- mometasone furoate 
 

Indacaterol and glycopyrronium belong to a group of medicines called bronchodilators. They work in 

different ways to relax the muscles of the small airways in the lungs. This helps to open the airways 

and makes it easier for air to get in and out of the lungs. When they are taken regularly, they help the 

small airways to remain open. 

 

Mometasone furoate belongs to a group of medicines called corticosteroids (or steroids). 

Corticosteroids reduce the swelling and irritation (inflammation) in the small airways in the lungs and 

so gradually ease breathing problems. Corticosteroids also help to prevent attacks of asthma. 

 

What Zimbus Breezhaler is used for 

Zimbus Breezhaler is used regularly as treatment for asthma in adults. 

 

Asthma is a serious, long-term lung disease where the muscles around the smaller airways become 

tight (bronchoconstriction) and inflamed. Symptoms come and go and include shortness of breath, 

wheezing, chest tightness and cough. 

 

You should use Zimbus Breezhaler every day and not only when you have breathing problems or other 

symptoms of asthma. This will ensure that it controls your asthma properly. Do not use this medicine 

to relieve a sudden attack of breathlessness or wheezing. 

 

If you have any questions about how Zimbus Breezhaler works or why this medicine has been 

prescribed for you, ask your doctor. 

 



44 

 

2. What you need to know before you use Zimbus Breezhaler 

 

Follow all the doctor’s instructions carefully. 

 

Do not use Zimbus Breezhaler 

- if you are allergic to indacaterol, glycopyrronium, mometasone furoate, or any of the other 
ingredients of this medicine (listed in section 6). If you think you may be allergic, ask your 

doctor for advice. 

 

Warnings and precautions 

Talk to your doctor, pharmacist or nurse before using Zimbus Breezhaler if any of the following 

applies to you: 

- if you have heart problems, including an irregular or fast heartbeat. 
- if you have thyroid gland problems. 
- if you have ever been told you have diabetes or high blood sugar. 
- if you suffer from seizures or fits. 
- if you have severe kidney problems. 
- if you have severe liver problems. 
- if you have a low level of potassium in your blood. 
- if you have an eye problem called angle-closure glaucoma. 
- if you have difficulty passing urine. 
- if you have tuberculosis (TB) of the lung, or any long standing or untreated infections. 

 

During treatment with Zimbus Breezhaler 

Stop using this medicine and get medical help immediately if you have any of the following: 

- tightness of the chest, coughing, wheezing or breathlessness immediately after using Zimbus 
Breezhaler (signs the medicine is unexpectedly tightening the airways, known as paradoxical 

bronchospasm). 

- difficulty breathing or swallowing, swelling of the tongue, lips or face, skin rash, itching and 
hives (signs of allergic reaction). 

- eye pain or discomfort, temporary blurring of vision, visual haloes (seeing bright circles around 
lights) or coloured images in association with red eyes (signs of an attack of angle-closure 

glaucoma). 

 

Children and adolescents 

Do not give this medicine to children or adolescents (below the age of 18 years) because it has not 

been studied in this age group. 

 

Other medicines and Zimbus Breezhaler 

Tell your doctor or pharmacist if you are using, have recently used or might use any other medicines. 

In particular, tell your doctor or pharmacist if you are using: 

- medicines that decrease the level of potassium in your blood. These include diuretics (which 
increase urine production and can be used to treat high blood pressure, e.g. 

hydrochlorothiazide), other bronchodilators such as methylxanthines used for breathing 

problems (e.g. theophylline) or corticosteroids (e.g. prednisolone). 

- tricyclic antidepressants or monoamine oxidase inhibitors (medicines used in the treatment of 
depression). 

- any medicines that may be similar to Zimbus Breezhaler (contain similar active substances); 
using them together may increase the risk of possible side effects. 

- medicines called beta blockers used to treat high blood pressure or other heart problems (e.g. 
propranolol) or to treat glaucoma (e.g. timolol). 

- ketoconazole or itraconazole (medicines used to treat fungal infections). 
- ritonavir, nelfinavir or cobicistat (medicines used to treat HIV infection). 
 



45 

Pregnancy and breast-feeding 

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask 

your doctor for advice before taking this medicine. Your doctor will discuss with you whether you can 

use Zimbus Breezhaler. 

 

Driving and using machines 

It is unlikely that this medicine will affect your ability to drive and use machines. 

 

Zimbus Breezhaler contains lactose 

This medicine contains about 25 mg of lactose per capsule. If you have been told by your doctor that 

you have an intolerance to some sugars, speak with your doctor before taking this medicine. 

 

 

3. How to use Zimbus Breezhaler 

 

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor 

or pharmacist if you are not sure. 

 

How much Zimbus Breezhaler to inhale 

The usual dose is to inhale the content of one capsule each day. You only need to use the medicine 

once a day. Do not use more than your doctor tells you to use. 

 

You should use Zimbus Breezhaler every day, even when your asthma is not troubling you. 

 

When to inhale Zimbus Breezhaler 

Inhale Zimbus Breezhaler at the same time each day. This will help control your symptoms throughout 

the day and night. It will also help you to remember to use it. 

 

How to inhale Zimbus Breezhaler 
- Zimbus Breezhaler is for inhalation use. 
- In this pack, you will find an inhaler and capsules that contain the medicine. The inhaler enables 

you to inhale the medicine in the capsule. Only use the capsules with the inhaler provided in this 

pack. The capsules should remain in the blister until you need to use them. 

- Peel the backing away from the blister to open it, do not push the capsule through the foil. 
- When you start a new pack, use the new inhaler supplied in this new pack. 
- Dispose of the inhaler in each pack after all capsules in that pack have been used. 
- Do not swallow the capsules. 

- Please read the instructions for use on the other side of this leaflet for more information 
on how to use the inhaler. 

 

If your pack contains a sensor for Zimbus Breezhaler 
- The sensor and App are not required in order for you to take your medicine. The sensor does not 

need to be connected to the App when taking your medicine. 

- Your doctor will decide whether use of the sensor and App is appropriate for you. 
- The electronic sensor for Zimbus Breezhaler is to be attached to the base of the Zimbus 

Breezhaler inhaler. 

- The sensor confirms that you have used the Zimbus Breezhaler inhaler by recording and 
monitoring its actuations and the whirring noise of the spinning capsule during inhalation but it 

will not monitor whether you have received the dose of your medicine. 

- The sensor is to be used with the Propeller App on your smart phone or another suitable device. 
The sensor links with the Propeller App via Bluetooth. 

- Please read the instructions for use provided in the sensor pack and the App for more 
information on how to use the sensor for Zimbus Breezhaler and the App. 

- After all Zimbus Breezhaler capsules in a pack have been used, move the sensor to the new 
inhaler in the next Zimbus Breezhaler pack. 

 



46 

If your symptoms do not improve 

If your asthma is not getting better or if it gets worse after you have started using Zimbus Breezhaler, 

talk to your doctor. 

 

If you use more Zimbus Breezhaler than you should 

If you accidently inhale too much of this medicine, contact your doctor or hospital for advice 

immediately. You may need medical attention. 

 

If you forget to use Zimbus Breezhaler 

If you forget to inhale a dose at the usual time, inhale one as soon as possible on that day. Then inhale 

the next dose at the usual time on the next day. Do not inhale two doses on the same day. 

 

If you stop using Zimbus Breezhaler 

Do not stop using Zimbus Breezhaler unless your doctor tells you to. Your asthma symptoms may 

come back if you stop using it. 

 

If you have any further questions on the use of this medicine, ask your doctor or pharmacist. 

 

 

4. Possible side effects 

 

Like all medicines, this medicine can cause side effects, although not everybody gets them. 

 

Some side effects could be serious 

Stop using Zimbus Breezhaler and get medical help immediately if you have any of the following: 

 

Common: may affect up to 1 in every 10 people 

- difficulty breathing or swallowing, swelling of the tongue, lips or face, skin rash, itching and 
hives (signs of allergic reaction). 

 

Other side effects 

Other side effects include the following listed below. If these side effects become severe, please tell 

your doctor, pharmacist or nurse. 

 

Very common: may affect more than 1 in 10 people 

- sore throat 
- runny nose 
- sudden difficulty breathing and feeling of tightness in chest with wheezing or coughing 
 

Common: may affect up to 1 in every 10 people 

- oral thrush (sign of candidiasis). After you have finished taking your dose, rinse your mouth 
with water or a mouthwash solution and then spit this out. This will help to prevent thrush. 

- a frequent urge to urinate and pain or burning when urinating (signs of urinary tract infection) 
- headache 
- fast heart beat 
- cough 
- voice alteration (hoarseness) 
- diarrhoea, abdominal cramps, nausea, and vomiting (gastroenteritis) 
- pain in muscles, bones or joints (signs of musculoskeletal pain) 
- muscle spasm 
- fever 
 

  



47 

Uncommon: may affect up to 1 in every 100 people 

- dry mouth 
- rash 

- high level of sugar in the blood 
- skin itching 

- difficulty and pain when passing urine (signs of dysuria) 

- clouding of the lens of your eyes (signs of cataract) 
 

Reporting of side effects 

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side 

effects not listed in this leaflet. You can also report side effects directly via the national reporting 

system listed in Appendix V. By reporting side effects you can help provide more information on the 

safety of this medicine. 

 

 

5. How to store Zimbus Breezhaler 

 

- Keep this medicine out of the sight and reach of children. 
- Do not use this medicine after the expiry date which is stated on the carton and blister after 

“EXP”. The expiry date refers to the last day of that month. 

- This medicinal product does not require any special temperature storage conditions. 
- Store the capsules in the original blister, in order to protect from light and moisture, and do not 

remove until immediately before use. 

- Do not throw away any medicines via wastewater. Ask your pharmacist how to throw away 
medicines you no longer use. These measures will help protect the environment. 

- If your pack contains an electronic sensor for Zimbus Breezhaler, see the Instructions for Use 
provided in the sensor pack for detailed instructions on how to store and when to discard it. 

 

 

6. Contents of the pack and other information 

 

What Zimbus Breezhaler contains 

- The active substances are indacaterol (as acetate), glycopyrronium (as bromide) and 
mometasone furoate. Each capsule contains 150 micrograms of indacaterol (as acetate), 

63 micrograms of glycopyrronium bromide (equivalent to 50 micrograms of glycopyrronium) 

and 160 micrograms of mometasone furoate. Each delivered dose (the dose that leaves the 

mouthpiece of the inhaler) contains 114 micrograms of indacaterol (as acetate), 58 micrograms 

of glycopyrronium bromide (equivalent to 46 micrograms of glycopyrronium) and 

136 micrograms of mometasone furoate. 

- The other ingredients are lactose monohydrate and magnesium stearate (see “Zimbus Breezhaler 
contains lactose” in section 2). 

 

What Zimbus Breezhaler looks like and contents of the pack 

In this pack, you will find an inhaler together with capsules in blisters. Some packs also contain a 

sensor device. The capsules are transparent and contain a white powder. They have a black product 

code “IGM150-50-160” printed above two black bars on the body with a logo printed in black and 

surrounded by a black bar on the cap. 

 

The following pack sizes are available: 

Single pack containing 10 x 1, 30 x 1 or 90 x 1 hard capsules, together with 1 inhaler. 

Pack containing 30 x 1 hard capsules, together with 1 inhaler and 1 sensor. 

Multipacks comprising 15 cartons, each containing 10 x 1 hard capsules together with 1 inhaler. 

 

Not all pack sizes may be available in your country. 

 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


48 

Marketing Authorisation Holder 

Novartis Europharm Limited 

Vista Building 

Elm Park, Merrion Road 

Dublin 4 

Ireland 

 

Manufacturer 

Novartis Pharma GmbH 

Roonstraße 25 

D-90429 Nuremberg 

Germany 

 

Novartis Farmacéutica, S.A. 

Ronda de Santa Maria, 158 

08210 Barberà del Vallés (Barcelona) 

Spain 

 

For any information about this medicine, please contact the local representative of the Marketing 

Authorisation Holder: 

 

België/Belgique/Belgien 

Novartis Pharma N.V. 

Tél/Tel: +32 2 246 16 11 

 

Lietuva 

SIA Novartis Baltics Lietuvos filialas 

Tel: +370 5 269 16 50 

 

България 

Novartis Bulgaria EOOD 

Тел: +359 2 489 98 28 

 

Luxembourg/Luxemburg 

Novartis Pharma N.V. 

Tél/Tel: +32 2 246 16 11 

 

Česká republika 

Novartis s.r.o. 

Tel: +420 225 775 111 

 

Magyarország 

Novartis Hungária Kft. 

Tel.: +36 1 457 65 00 

Danmark 

Novartis Healthcare A/S 

Tlf: +45 39 16 84 00 

 

Malta 

Novartis Pharma Services Inc. 

Tel: +356 2122 2872 

Deutschland 

Novartis Pharma GmbH 

Tel: +49 911 273 0 

 

Nederland 

Novartis Pharma B.V. 

Tel: +31 88 04 52 111 

Eesti 

SIA Novartis Baltics Eesti filiaal 

Tel: +372 66 30 810 

 

Norge 

Novartis Norge AS 

Tlf: +47 23 05 20 00 

Ελλάδα 

Novartis (Hellas) A.E.B.E. 

Τηλ: +30 210 281 17 12 

 

Österreich 

Novartis Pharma GmbH 

Tel: +43 1 86 6570 

España 

Novartis Farmacéutica, S.A. 

Tel: +34 93 306 42 00 

 

Polska 

Novartis Poland Sp. z o.o. 

Tel.: +48 22 375 4888 

France 

Novartis Pharma S.A.S. 

Tél: +33 1 55 47 66 00 

 

Portugal 

Novartis Farma - Produtos Farmacêuticos, S.A. 

Tel: +351 21 000 8600 



49 

Hrvatska 

Novartis Hrvatska d.o.o. 

Tel. +385 1 6274 220 

 

România 

Novartis Pharma Services Romania SRL 

Tel: +40 21 31299 01 

Ireland 

Novartis Ireland Limited 

Tel: +353 1 260 12 55 

 

Slovenija 

Novartis Pharma Services Inc. 

Tel: +386 1 300 75 50 

Ísland 

Vistor hf. 

Sími: +354 535 7000 

 

Slovenská republika 

Novartis Slovakia s.r.o. 

Tel: +421 2 5542 5439 

 

Italia 

Novartis Farma S.p.A. 

Tel: +39 02 96 54 1 

Suomi/Finland 

Novartis Finland Oy 

Puh/Tel: +358 (0)10 6133 200 

 

Κύπρος 

Novartis Pharma Services Inc. 

Τηλ: +357 22 690 690 

 

Sverige 

Novartis Sverige AB 

Tel: +46 8 732 32 00 

 

Latvija 

SIA Novartis Baltics 

Tel: +371 67 887 070 

 

United Kingdom 

Novartis Pharmaceuticals UK Ltd. 

Tel: +44 1276 698370 

 

 

This leaflet was last revised in 

 

Other sources of information 
Detailed information on this medicine is available on the European Medicines Agency web site: 

http://www.ema.europa.eu. 

  

http://www.ema.europa.eu/


50 

Instructions for Use of Zimbus Breezhaler 

 

Please read full instructions for use of Zimbus Breezhaler inhaler before use. 
 

 

 

 

  
Insert Pierce and release Inhale deeply Check capsule is empty 

 
  

 

 
   

 
   

 

 

 

 

 

 

  
Step 1a: 

Pull off cap 
Step 2a: 

Pierce capsule once 

Hold the inhaler upright. 

Pierce capsule by firmly 

pressing both side 

buttons at the same time. 

Step 3a: 

Breathe out fully 

Do not blow into the 

inhaler. 

Check capsule is empty 

Open the inhaler to see if 

any powder is left in the 

capsule. 

   

You should hear a noise 

as the capsule is pierced. 

Only pierce the capsule 

once. 

 

If there is powder left in 

the capsule: 

 Close the inhaler. 

 Repeat steps 3a to 3d. 

Step 1b: 

Open inhaler 

 
Step 2b: 

Release side buttons 

Step 3b: 
Inhale medicine deeply 

Hold the inhaler as 

shown in the picture. 

Place the mouthpiece in 

your mouth and close 

your lips firmly around 

it. 

Do not press the side 

buttons. 

  
Powder Empty 

remaining 

1 
 

2 
 

3 
 

Check 
 



51 

 

 

 Breathe in quickly and as 
deeply as you can. 

During inhalation you 

will hear a whirring 

noise. 

You may taste the 

medicine as you inhale. 

 

Step 1c: 

Remove capsule 

Separate one of the 

blisters from the blister 

card. 

Peel open the blister and 

remove the capsule. 

Do not push the capsule 

through the foil. 

Do not swallow the 

capsule. 

 

 
Step 3c: 

Hold breath 

Hold your breath for up 

to 5 seconds. 

 

 

Step 3d: 

Rinse mouth 

Rinse your mouth with 

water after each dose and 

spit it out. 

Remove empty capsule 

Put the empty capsule in 

your household waste. 

 

Close the inhaler and 

replace the cap. 



52 

 
Step 1d: 

Insert capsule 

Never place a capsule 

directly into the 

mouthpiece. 

 

  Important Information 
 Zimbus Breezhaler 

capsules must always be 

stored in the blister card 

and only removed 

immediately before use. 

 Do not push the capsule 
through the foil to 

remove it from the 

blister. 

 Do not swallow the 
capsule. 

 Do not use the Zimbus 
Breezhaler capsules with 

any other inhaler. 

 Do not use the Zimbus 
Breezhaler inhaler to 

take any other capsule 

medicine. 

 Never place the capsule 
into your mouth or the 

mouthpiece of the 

inhaler. 

 Do not press the side 
buttons more than once. 

 Do not blow into the 
mouthpiece. 

 Do not press the side 
buttons while inhaling 

through the mouthpiece. 

 Do not handle capsules 
with wet hands. 

 Never wash your inhaler 
with water. 

 
Step 1e: 

Close inhaler 

 



53 

Your Zimbus Breezhaler Inhaler pack contains: 

 One Zimbus Breezhaler inhaler 

 One or more blister cards, each containing 
10 Zimbus Breezhaler capsules to be used in 

the inhaler 

 

 

Frequently Asked 

Questions 

 

Why didn’t the inhaler 

make a noise when I 

inhaled? 

The capsule may be stuck 

in the capsule chamber. If 

this happens, carefully 

loosen the capsule by 

tapping the base of the 

inhaler. Inhale the 

medicine again by 

repeating steps 3a to 3d. 

 

What should I do if there 

is powder left inside the 

capsule? 

You have not received 

enough of your medicine. 

Close the inhaler and 

repeat steps 3a to 3d. 

 

I coughed after inhaling 

– does this matter? 

This may happen. As long 

as the capsule is empty 

you have received enough 

of your medicine. 

 

I felt small pieces of the 

capsule on my tongue – 

does this matter? 

This can happen. It is not 

harmful. The chances of 

the capsule breaking into 

small pieces will be 

increased if the capsule is 

pierced more than once. 

Cleaning the inhaler 

Wipe the mouthpiece 

inside and outside with a 

clean, dry, lint-free cloth to 

remove any powder 

residue. Keep the inhaler 

dry. Never wash your 

inhaler with water. 

Disposing of the inhaler 

after use 

Each inhaler should be 

disposed of after all 

capsules have been used. 

Ask your pharmacist how 

to dispose of medicines 

and inhalers that are no 

longer required. 

 

Base 

Cap 

Side 

buttons 

Blister 

Screen 

Capsule 

chamber 

Inhaler Inhaler base Blister card 

Mouthpiece 


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