aclidinium bromide
Brand: Tudorza Pressair
Prototype: tiotropium
Drug Class: muscarinic receptor antagonist (LAMA)
Drug Family: bronchodilator
Subclass: long-acting anticholinergic — twice-daily LAMA
Organ Systems: respiratory
Mechanism of Action
Long-acting selective M3 muscarinic antagonist that binds to M3 receptors in bronchial smooth muscle, preventing acetylcholine-mediated bronchoconstriction; faster systemic hydrolysis by plasma esterases than tiotropium, potentially reducing systemic anticholinergic burden.
M3 muscarinic receptors (airway smooth muscle)
Indications
- COPD maintenance bronchodilator therapy
Contraindications
- hypersensitivity to aclidinium or atropine derivatives
- severe milk protein allergy (lactose excipient)
Adverse Effects
Common
- headache
- nasopharyngitis
- cough
- diarrhea
Serious
- acute urinary retention
- narrow-angle glaucoma
- paradoxical bronchospasm
Pharmacokinetics (ADME)
| Absorption | inhaled; rapidly absorbed; absolute systemic bioavailability approximately 6% |
| Distribution | Vd approximately 300 L; 87% protein bound |
| Metabolism | rapid chemical and enzymatic hydrolysis by plasma esterases to inactive carboxylic acid and alcohol metabolites; not significantly CYP-metabolized |
| Excretion | renal (~1% unchanged) and fecal (~20-30% unchanged) |
| Half-life | approximately 2-3 hours (plasma, ester hydrolysis); pulmonary duration 12 hours |
| Onset | within 15 minutes |
| Peak | approximately 10 minutes |
| Duration | 12 hours (requires twice-daily dosing) |
| Protein Binding | 87% |
| Vd | approximately 300 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| other anticholinergic agents | additive anticholinergic effects | moderate |
Nursing Considerations
- Administer via Pressair inhaler twice daily (morning and evening); teach patients to hear an audible 'click' confirming dose delivery; the control window changes from green to red confirming successful inhalation.
- Twice-daily dosing is a critical counseling point distinguishing aclidinium from once-daily LAMAs (tiotropium, umeclidinium); missed evening doses should be taken as soon as remembered unless close to the next scheduled dose.
- Screen for narrow-angle glaucoma and BPH; counsel patients to report any signs of urinary difficulty or acute eye pain with vision changes immediately.
- Instruct patients that aclidinium is not a rescue inhaler; a SABA must be prescribed for breakthrough symptoms.
Clinical Pearls
- Aclidinium's rapid hydrolysis by plasma esterases to inactive metabolites means systemic anticholinergic side effects (dry mouth, constipation, urinary retention) are less frequent than with tiotropium, despite twice-daily dosing.
- Head-to-head trials show aclidinium and tiotropium provide similar bronchodilation and symptom control in COPD; twice-daily dosing may offer more consistent 24-hour symptom coverage for patients with nighttime or early-morning symptom burden.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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