aclidinium bromide: clinical use

Prescribing considerations

• Confirm COPD and that maintenance bronchodilation—not acute symptom relief—is intended.
• Assess whether the patient can generate an effective strong, deep inhalation through the dry-powder device.
• Teach device technique and verify that the control window changes appropriately.
• Review treatment if symptoms worsen or reliance on rescue treatment increases.
• The formulation contains lactose; consider the listed rare hereditary carbohydrate-intolerance contraindications.

Contraindications and cautions

• Hypersensitivity to aclidinium bromide or any excipient.
• Use caution with narrow-angle glaucoma, symptomatic prostatic hyperplasia, bladder-neck obstruction, cardiac arrhythmia or arrhythmia risk factors.

Monitoring

• COPD symptoms, functional benefit and exacerbations
• Inhaler technique and ability to actuate the device correctly
• Palpitations or other possible arrhythmia symptoms
• Urinary retention and ocular anticholinergic symptoms
• Dry mouth and oral health

Clinical pharmacology

Aclidinium is a competitive, selective muscarinic antagonist with longer residence at M3 than M2 receptors. Lung action produces bronchodilation; unchanged systemic exposure is low because it undergoes rapid, extensive hydrolysis to inactive metabolites.

Formulation and product differences

• The selected product is a multidose, breath-actuated dry-powder Genuair inhaler.
• It has an integral dose indicator, a green loading button and a colour control window that confirms preparation and inhalation.
• The powder contains lactose monohydrate.
• The device must be kept dry and the mouthpiece cleaned only with a dry tissue.

Inhaled preparation

Route: Inhaled

Strengths: 322 micrograms