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).

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

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  

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