Generic Name

Aclidinium Bromide

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Classification

FDA Approved Indications

• Maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema

Mechanism of Action

Aclidinium bromide selectively antagonizes M3 muscarinic receptors in airway smooth muscle, leading to inhibition of parasympathetic bronchoconstriction and resulting in bronchodilation.

Dosage and Administration

Adult: Use one inhalation (400 mcg) twice daily at approximately 12-hour intervals.

Pediatric: Not indicated for pediatric use.

Geriatric: No specific dosage adjustment; monitor for anticholinergic side effects.

Renal Impairment: No specific adjustment recommended.

Hepatic Impairment: No specific adjustment recommended.

Pharmacokinetics

Absorption: Rapidly absorbed with peak plasma levels in approximately 5 minutes.

Distribution: Widely distributed; high plasma protein binding.

Metabolism: Hydrolyzed quickly by esterases; minimal CYP450 involvement.

Excretion: Primarily via urine as inactive metabolites; minor via feces.

Half Life: Approximately 12 hours.

Contraindications

• Hypersensitivity to aclidinium bromide or quaternary ammonium compounds.

Precautions

• Use with caution in patients with urinary retention, glaucoma, or prostate enlargement due to anticholinergic effects.
• Not a rescue inhaler; not for acute bronchospasm.

Adverse Reactions - Common

• Headache (Common)
• Sore throat, cough (Common)
• Nasopharyngitis (Common)

Adverse Reactions - Serious

• Acute bronchospasm (Rare)
• Paradoxical bronchospasm (Rare)
• Ulcers or throat irritation (Rare)

Drug-Drug Interactions

• Other anticholinergic agents; increased anticholinergic side effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Instruct on correct inhaler use and cleaning.
• Advise to report any signs of paradoxical bronchospasm, such as worsening breathing or wheezing.
• Counsel about common side effects like dry mouth and thirst.

Special Considerations

Black Box Warnings:

• None currently

Genetic Factors: None specified.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe anticholinergic effects such as dry mouth, blurred vision, urinary retention, tachycardia, hallucinations.

Treatment: Supportive care, activated charcoal if recent ingestion, and symptomatic management. No specific antagonist.

Storage and Handling

Storage: Store at room temperature below 30°C (86°F); keep inhaler dry.

Stability: Stable until the expiration date printed on the packaging.