aclidinium bromide + formoterol: clinical use

Prescribing considerations

• Confirm COPD indication and that maintenance, rather than acute rescue, treatment is intended.
• Assess whether the patient can generate an effective strong, deep inhalation through the dry-powder device and demonstrate correct Genuair technique.
• Avoid duplicate long-acting antimuscarinic or beta-2 agonist therapy.
• Use caution with severe cardiovascular disease, arrhythmia or QT prolongation, convulsive disorders, thyrotoxicosis, phaeochromocytoma, symptomatic prostatic hyperplasia, urinary retention and narrow-angle glaucoma.
• Review rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption because the formulation contains lactose.

Contraindications and cautions

• Hypersensitivity to aclidinium, formoterol or an excipient.

Monitoring

• COPD symptoms, functional response and exacerbations
• Adherence and inhaler technique
• Pulse, blood pressure and cardiac symptoms; consider ECG assessment where arrhythmia or QT risk is relevant
• Potassium and glucose when clinical risk factors or interacting treatments make disturbances more likely
• New urinary retention, ocular symptoms and persistent dry mouth or dental problems

Clinical pharmacology

Aclidinium is a locally acting, competitive muscarinic antagonist with longer residence at M3 than M2 receptors. Formoterol is a selective beta-2 agonist that relaxes airway smooth muscle through adenylate cyclase and cyclic AMP. Aclidinium is rapidly hydrolysed in plasma, limiting systemic exposure.

Formulation and product differences

• The selected product is a multidose inhalation powder delivered through the Genuair device, with an integral dose indicator and colour control window.
• The formulation contains lactose monohydrate.
• Device operation and inspiratory technique should not be assumed to be interchangeable with other dry-powder inhalers.

Inhaled preparation

Route: Inhaled

Strengths: 340 micrograms + 12 micrograms