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Aclidinium Bromide; Indications, Dosage, Side Effects, Drug Interaction, Pregnancy

Aclidinium is a synthetic anticholinergic agent that is used as an inhalant for treatment of acute bronchospasm due to chronic bronchitis or emphysema. Aclidinium has not been implicated in causing liver enzyme elevations or clinically apparent acute liver injury.

Aclidinium bromide (INN) is an anticholinergic for the long-term management of chronic obstructive pulmonary disease (COPD). It has a much higher propensity to bind to muscarinic receptors than nicotinic receptors. It is a long-acting, inhaled muscarinic antagonist (LAMA) approved in the US on July 24, 2012, as a maintenance treatment for the chronic obstructive pulmonary disease (COPD). Evidence shows that it can improve quality of life and prevent hospitalization in those with COPD. However, it does not appear to affect the risk of death or the frequency steroids are needed. It is unclear if it differs from the similar medication tiotropium or other commonly used medications from the class of LAMAs.

Mechanism of Action of Aclidinium

Aclidinium is a long-acting, competitive, and reversible anticholinergic drug that is specific for the acetylcholine muscarinic receptors. It binds to all 5 muscarinic receptor subtypes to a similar affinity. Aclidinium’s effects on the airways are mediated through the M3 receptor at the smooth muscle to cause bronchodilation. Prevention of acetylcholine-induced bronchoconstriction effects was dose-dependent and lasted longer than 24 hours.

Indications of Aclidinium

Chronic obstructive pulmonary disease (COPD).
COPD, Maintenance
Asthma, Maintenance
Emphysema
Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Asthma Bronchial
Chronic Obstructive Pulmonary Disease (COPD)
Long-term maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; to reduce exacerbations in COPD patients.
Indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD).
Treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD).

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Contra-Indications of Aclidinium

Closed-angle glaucoma
Blockage of Urinary Bladder
Enlarged Prostate
Cannot Empty Bladder
Chronic kidney disease stage 3A (moderate)
Chronic kidney disease stage 3B (moderate)
Chronic kidney disease stage 4 (severe)
Chronic kidney disease stage 5 (failure)
Allergies to anticholinergics – Quaternary
Ipratropium Analogues

Dosage of Aclidinium

Strengths: 400 mcg/inh

Chronic Obstructive Pulmonary Disease

400 mcg (1 inhalation) orally twice a day

Side Effects of Aclidinium

The most common

dry mouth
a sore throat
a cough
constipation
blurred vision or vision changes
pain with urination
stomach pain or cramping
diarrhea
a headache
dizziness
confusion
stomach pain;
back pain, joint or muscle pain.
problems with your vision (including color vision);
sudden chest pain or trouble breathing;
pain or swelling in one or both legs;
a migraine headache;
pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or

More common

Abdominal or stomach pain, discomfort, or tenderness
chills or fever
difficulty with moving
a headache, severe and throbbing
joint or back pain
muscle aching or cramping
muscle pains or stiffness
chest pressure or squeezing pain in the chest
discomfort in arms, shoulders, neck or upper back
excessive sweating
feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
sudden tingling or coldness in an arm or leg
sudden slow or difficult speech
sudden drowsiness or need to sleep
fast breathing
sharp pain when taking a deep breath
fast or slow heartbeat
coughing up blood
rust colored urine
decreased amount of urine

Rare

Anxiety
change in vision
chest pain or tightness
confusion
cough
Agitation
arm, back, or jaw pain
blurred vision
chest pain or discomfort
convulsions
extra heartbeats
fainting
hallucinations
a headache
irritability
lightheadedness
mood or mental changes
muscle pain or cramps
muscle spasm or jerking of all extremities
nervousness

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Drug Interactions of Aclidinium

Aclidinium bromide may interact with following drugs, supplements & may change the efficacy of drugs

antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
beta 2 agonists (e.g., salbutamol, formoterol, terbutaline)
beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
long-acting beta agonists (e.g., indacaterol, salmeterol)
citalopram
decongestant cold medications (e.g., phenylephrine, pseudoephedrine)
decongestant eye drops and nose sprays (e.g., naphazoline, oxymetazoline, xylometazoline)
diuretics (e.g., furosemide, hydrochlorothiazide)
domperidone
escitalopram
ipratropium
macrolide antibiotics (e.g., clarithromycin, erythromycin, telithromycin)
methadone
mirabegron
monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
quinolone antibiotics (e.g., levofloxacin moxifloxacin ofloxacin)
serotonin antagonists (anti-emetic medications; e.g., ondansetron granisetron, )
theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
tolterodine
topiramate
tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)

Pregnancy Catagory of Aclidinium

FDA Pregnancy Risk Category C

Pregnancy

There are no data available on the use of aclidinium bromide in pregnant women.Studies in animals have shown fetotoxicity only at dose levels much higher than the maximum human exposure to aclidinium bromide. Aclidinium bromide should only be used during pregnancy if the expected benefits outweigh the potential risks.

Lactation

It is unknown whether aclidinium bromide/metabolites are excreted in human milk. Animal studies have shown excretion of small amounts of aclidinium bromide/metabolites into milk. A risk to newborns/infants cannot be excluded. A decision must be made whether to discontinue breastfeeding or to discontinue/abstain from Eklira Genuair therapy taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.

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