Aclidinium

Aclidinium is a twice-daily long-acting muscarinic antagonist for COPD with onset in about 30 minutes.

Classification. Long-acting antimuscarinic.

Mechanism. M3 receptor blockade; rapid hydrolysis in plasma limits systemic effect.

Pharmacokinetics. Very low systemic exposure. Short plasma half-life.

First-line, COPD. 322 micrograms (delivered dose) twice daily by dry powder inhaler. In some regions the labelled dose is 400 micrograms (metered).

Fixed combination. With formoterol 340/12 micrograms twice daily.

Titration. None. No loading dose.

Contraindications. Hypersensitivity, milk protein allergy.

Serious adverse effects. Urinary retention, glaucoma, paradoxical bronchospasm.

Common adverse effects. Headache, nasopharyngitis, cough.

Interactions. Other anticholinergics.

Common prescribing errors. Once daily dosing.

Special groups.

• Pregnancy and breastfeeding: avoid unless needed.

• Kidney and liver impairment: no adjustment.

Formulations. Multidose dry powder inhaler.

Baseline. Eye and urinary history.

Monitoring. Symptoms, exacerbations.

Stop and reduce rules. Stop for glaucoma symptoms or retention. Therapeutic drug monitoring is not used.

Referral and escalation. Escalate to combination therapy for persistent exacerbations.