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aclidinium bromide

General

Pronunciation:
a-kli-din-ee-um


Trade Name(s)

  • Tudorza

Pregnancy Category
Category C

Ther. Class.
copd agents

Pharm. Class.
anticholinergics

Indications

  • Long-term maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema.
  • Not for acute (rescue) use.

Action

Acts as an anticholinergic by inhibiting the M3 receptor in bronchial smooth muscle.

Therapeutic Effect(s):

Bronchodilation with lessened symptoms of COPD.

Pharmacokinetics

Absorption: 6% systemically absorbed following inhalation.

Distribution: Unknown.

Metabolism and Excretion: Rapidly hydrolyzed; metabolites are not pharmacologically active. Metabolites are eliminated in urine (54–65%) and feces (20–33%). 1% excreted unchanged in urine.

Half-life: 5–8 hr.

TIME/ACTION PROFILE (improvement in FEV1)

ROUTEONSETPEAKDURATION
Inhalnwithin 1 hr2–4 hr12 hr

Contraindication/Precautions

Contraindicated in:

  • None noted.

Use Cautiously in:

  • Narrow-angle glaucoma;
  • Prostatic hyperplasia, bladder neck obstruction;
  • Severe hypersensitivity to milk proteins;
  • History of hypersensitivity to atropine (cross-sensitivity may occur);
  • OB: Use during pregnancy only if potential benefit justifies potential risk to the fetus;
  • Lactation:Use cautiously during lactation;
  • Pedi: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

CNS: headache

EENT: worsening of narrow-angle glaucoma

Resp: paradoxical bronchospasm

GU: urinary retention

Misc: immediate hypersensitivity reactions

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

↑ risk of adverse anticholinergic effects with other anticholingerics.

Route/Dosage

Inhaln: (Adults) One inhalation (400 mcg) twice daily.

Availability

Dry powder metered-dose inhaler: 400 mcg/actuation

Assessment

  • Inhaln: Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult health care professional about alternative medication if severe bronchospasm is present; onset of action is too slow for patients in acute distress. If paradoxical bronchospasm (wheezing) occurs, withhold medication and notify health care professional immediately.

Potential Diagnoses

Implementation

  • Inhaln: Administer every 12 hr. See medication administration techniques for administration of inhalation medications.
    • When aclidinium is administered concurrently with other inhalation medications, administer adrenergic bronchodilators first, followed by aclidinium, then corticosteroids. Wait 5 min between medications.

Patient/Family Teaching

  • Instruct patient in proper use of inhaler and to take medication as directed. Omit missed doses and take next dose at the usual time; do not double doses. Advise patient to read Medication Guide before beginning therapy and with each Rx refill in case of changes.
  • Advise patient to have a rapid-acting bronchodilator available for use at all times to treat sudden symptoms. Notify health care professional immediately if sudden shortness of breath occurs immediately after using aclidinium inhaler, if breathing becomes worse, if rescue inhaler is needed more often than usual, or if rescue inhaler does not work as well at relieving symptoms.
  • Caution patient to avoid getting powder into eyes.
  • Advise patient to inform health care professional if symptoms of new or worsened increased eye pressure (eye pain or discomfort, nausea or vomiting, blurred visions, seeing halos or bright colors around lights, red eyes), new or worsened urinary retention (difficulty urinating, painful urination, urinating frequently, urination in a weak stream or drips), or allergic reactions (rash, hives, swelling of the face, mouth, and tongue, breathing problems) occur.
  • Advise patient to consult health care professional before taking any Rx, OTC, or herbal products or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
  • Advise patient to notify health care professional if pregnancy is planned or suspected, or if nursing.
  • Explain need for pulmonary function tests prior to and periodically during therapy to determine effectiveness of medication.

Evaluation/Desired Outcomes

Decreased dyspnea.
  • Improved breath sounds.
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Citation

Quiring, Courtney, et al. "Aclidinium Bromide." Davis's Drug Guide, 16th ed., F.A. Davis Company, 2019. www.drugguide.com/ddo/view/Davis-Drug-Guide/110538/all/aclidinium_bromide.
Quiring C, Sanoski CA, Vallerand AH. Aclidinium bromide. Davis's Drug Guide. 16th ed. F.A. Davis Company; 2019. https://www.drugguide.com/ddo/view/Davis-Drug-Guide/110538/all/aclidinium_bromide. Accessed April 24, 2019.
Quiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Aclidinium bromide. In Davis's Drug Guide. Available from https://www.drugguide.com/ddo/view/Davis-Drug-Guide/110538/all/aclidinium_bromide
Quiring C, Sanoski CA, Vallerand AH. Aclidinium Bromide [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2019. [cited 2019 April 24]. Available from: https://www.drugguide.com/ddo/view/Davis-Drug-Guide/110538/all/aclidinium_bromide.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - aclidinium bromide ID - 110538 A1 - Quiring,Courtney, AU - Sanoski,Cynthia A, AU - Vallerand,April Hazard, BT - Davis's Drug Guide UR - https://www.drugguide.com/ddo/view/Davis-Drug-Guide/110538/all/aclidinium_bromide PB - F.A. Davis Company ET - 16 DB - Davis's Drug Guide DP - Unbound Medicine ER -