Adair Tablet

Adair Tablet — Roflumilast

Generic Name: Roflumilast 500mcg

Manufacturer: Beximco Pharmaceuticals Ltd.

Drug Class: Phosphodiesterase-4 (PDE4) Inhibitor — Anti-inflammatory for COPD

Dosage Form: Tablet

Prescription Status: Prescription Only (Rx)

Mechanism of Action

Roflumilast is a highly selective inhibitor of phosphodiesterase type 4 (PDE4), the dominant phosphodiesterase in inflammatory cells. By inhibiting PDE4, roflumilast increases intracellular cyclic AMP (cAMP) levels in lung immune cells — including neutrophils, macrophages, T-lymphocytes, and eosinophils — suppressing the release of pro-inflammatory cytokines (TNF-α, IL-8, IL-6) and reducing neutrophilic airway inflammation. This addresses the underlying chronic inflammation driving COPD exacerbations.

Unlike bronchodilators, roflumilast does not directly relax airway smooth muscle — its benefit is anti-inflammatory and exacerbation-preventive.

Relevance to Diabetes

COPD and Type 2 Diabetes commonly co-exist due to shared risk factors (smoking, systemic inflammation, physical inactivity). Roflumilast has been studied in metabolic contexts — preclinical data and some clinical observations suggest PDE4 inhibition may improve insulin sensitivity and reduce adipose tissue inflammation. Diabetic patients with COPD who experience frequent exacerbations (often requiring oral corticosteroids — which worsen glycaemic control) benefit from roflumilast reducing exacerbation frequency and thus reducing steroid exposure.

Indications

• Severe COPD (FEV1 <50% predicted) associated with chronic bronchitis and a history of frequent exacerbations — as add-on to bronchodilator therapy
• Not indicated as monotherapy or for acute bronchospasm
• Used in combination with long-acting bronchodilators (LABA, LAMA)

Dosage and Administration

Contraindications

• Moderate to severe hepatic impairment (Child-Pugh B or C)
• Hypersensitivity to roflumilast or any excipient
• Pregnancy and breastfeeding
• Concomitant theophylline (additive PDE inhibition)
• Immunosuppressive therapy (except short-term corticosteroids)

Warnings and Precautions

• Weight loss: Unexplained and significant weight loss is common — monitor body weight monthly; discontinue if weight loss is unintended and severe
• Psychiatric effects: Insomnia, anxiety, depression, and suicidal ideation have been reported — use with caution in patients with psychiatric history; discontinue if symptoms emerge
• Not a rescue inhaler: Does not relieve acute bronchospasm — patients must continue bronchodilator therapy
• Diabetes: Weight loss may improve insulin sensitivity and reduce blood glucose — monitor glycaemic control and adjust antidiabetic medications accordingly

Drug Interactions

Side Effects

Storage

Store below 30°C. Protect from moisture. Keep out of reach of children.