Dosing & Uses
Dosage Forms & Strengths
metered-dose inhaler (dry powder)
- 400mcg/actuation
Chronic Obstructive Pulmonary Disease
Breath-activated dry powder inhaler indicated for maintenance treatment of chronic obstructive pulmonary disease (COPD)
400 mcg (1 actuation) inhaled PO BID
Dosage Modifications
Renal impairment: No dosage adjustment required
Hepatic impairment: Not studied
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- umeclidinium bromide/vilanterol inhaled
aclidinium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Duplicate therapy.
Serious - Use Alternative (4)
- glucagon
glucagon increases toxicity of aclidinium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- glucagon intranasal
glucagon intranasal increases toxicity of aclidinium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .
- pramlintide
pramlintide, aclidinium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.
- revefenacin
revefenacin and aclidinium both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.
Monitor Closely (97)
- abobotulinumtoxinA
abobotulinumtoxinA increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .
- amantadine
aclidinium, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.
- amitriptyline
aclidinium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- amoxapine
aclidinium and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- anticholinergic/sedative combos
anticholinergic/sedative combos and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- aripiprazole
aclidinium decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.
aripiprazole increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - atracurium
atracurium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine
atropine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine IV/IM
atropine IV/IM and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- belladonna alkaloids
belladonna alkaloids and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- belladonna and opium
belladonna and opium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- benperidol
aclidinium decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.
benperidol increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - benztropine
benztropine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- bethanechol
bethanechol increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbachol
carbachol increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cevimeline
cevimeline increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpromazine
aclidinium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.
chlorpromazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - cisatracurium
cisatracurium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clomipramine
aclidinium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clozapine
aclidinium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.
clozapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - cyclizine
cyclizine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- darifenacin
darifenacin and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- desipramine
aclidinium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- dicyclomine
dicyclomine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- donepezil
donepezil increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- donepezil transdermal
donepezil transdermal, aclidinium. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.
- dosulepin
aclidinium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- doxepin
aclidinium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- droperidol
aclidinium decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.
droperidol increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - echothiophate iodide
echothiophate iodide increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fesoterodine
fesoterodine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- flavoxate
flavoxate and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- fluphenazine
aclidinium decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.
fluphenazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - galantamine
galantamine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- glycopyrrolate
glycopyrrolate and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- glycopyrrolate inhaled
glycopyrrolate inhaled and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- glycopyrronium tosylate topical
glycopyrronium tosylate topical, aclidinium. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.
- haloperidol
aclidinium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.
haloperidol increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - henbane
henbane and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- homatropine
homatropine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- huperzine A
huperzine A increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hyoscyamine
hyoscyamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- hyoscyamine spray
hyoscyamine spray and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- iloperidone
aclidinium decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.
iloperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - imipramine
aclidinium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- ipratropium
ipratropium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- levodopa
aclidinium, levodopa. Other (see comment). Use Caution/Monitor. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .
- lofepramine
aclidinium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- loxapine
aclidinium decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
aclidinium decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.
loxapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - loxapine inhaled
loxapine inhaled increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
aclidinium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - maprotiline
aclidinium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- meclizine
meclizine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- methscopolamine
methscopolamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- neostigmine
neostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
aclidinium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- olanzapine
aclidinium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
aclidinium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.
olanzapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - oliceridine
aclidinium increases toxicity of oliceridine by Other (see comment). Use Caution/Monitor. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.
- onabotulinumtoxinA
onabotulinumtoxinA and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- orphenadrine
aclidinium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin
oxybutynin and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin topical
oxybutynin topical and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin transdermal
oxybutynin transdermal and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- paliperidone
aclidinium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - pancuronium
pancuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- perphenazine
aclidinium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.
perphenazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - physostigmine
physostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pilocarpine
pilocarpine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
aclidinium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
pimozide increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - pralidoxime
pralidoxime and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- prochlorperazine
aclidinium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.
prochlorperazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - promethazine
aclidinium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.
promethazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - propantheline
propantheline and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- protriptyline
aclidinium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- pyridostigmine
pyridostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quetiapine
aclidinium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.
quetiapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - rapacuronium
rapacuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- rimantadine
aclidinium, rimantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS side effects.
- risperidone
aclidinium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.
risperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - rivastigmine
rivastigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rocuronium
rocuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- scopolamine
scopolamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- solifenacin
solifenacin and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- succinylcholine
succinylcholine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
aclidinium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.
thioridazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - thiothixene
aclidinium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.
thiothixene increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - tolterodine
aclidinium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trazodone
aclidinium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trifluoperazine
aclidinium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.
trifluoperazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - trihexyphenidyl
aclidinium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trimipramine
aclidinium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trospium chloride
aclidinium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.
- umeclidinium bromide
umeclidinium bromide and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents
- vecuronium
aclidinium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- ziprasidone
aclidinium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
ziprasidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - zotepine
aclidinium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.
Minor (4)
- dimenhydrinate
dimenhydrinate increases toxicity of aclidinium by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.
- donepezil
donepezil decreases effects of aclidinium by pharmacodynamic antagonism. Minor/Significance Unknown.
- galantamine
galantamine decreases effects of aclidinium by pharmacodynamic antagonism. Minor/Significance Unknown.
- rimantadine
rimantadine increases effects of aclidinium by pharmacodynamic synergism. Minor/Significance Unknown.
Adverse Effects
1-10%
Headache (6.6%)
Nasopharyngitis (5.5%)
Cough (3%)
Diarrhea (2.7%)
Sinusitis (1.7%)
Rhinitis (1.6%)
Toothache (1.1%)
Fall (1.1%)
Vomiting (1.1%)
Postmarketing reports
Anaphylaxis
Angioedema (including swelling of lips and tongue or throat)
Urticaria
Rash
Bronchospasm
Itching
Nausea
Dysphonia
Blurred vision
Urinary retention
Tachycardia
Stomatitis
Warnings
Contraindications
Hypersensitivity to drug or formulation components or severe hypersensitivity to milk proteins
Cautions
Not for acute episodes of bronchospasm (ie, not for rescue therapy)
May cause paradoxical bronchospasm; if this occurs, discontinue and consider other treatments
Worsening of narrow-angle glaucoma may occur; use with caution in patients with narrow-angle glaucoma; prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (eg,eye pain or discomfort, blurred vision, visual halos, or colored images in association with red eyesfrom conjunctival congestion and corneal edema; instruct patients to consult a physician immediately if it occurs
Worsening of urinary retention may occur (eg, prostatic hyperplasia, bladder-neck obstruction); use with caution in patients with prostatic hyperplasia or bladder-neck obstruction; instruct patients to consult a physician immediately if it occurs
Immediate hypersensitivity reactions, including angioedema, bronchospasm, or anaphylaxis, may occur after administration; if hypersensitivity occurs, discontinue immediately and consider alternate treatment
Coadministration with other anticholinergics may increase risk for adverse effects
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies of aclidinium in pregnant women to assess drug-associated risks
Animal studies
- No adverse developmental effects were seen with inhalation administration of aclidinium bromide to pregnant rats and rabbits during organogenesis at 15 or 20 times, respectively, the maximum recommended human daily inhaled dose (MRHDID)
Lactation
There are no available data on the breastfed child or on milk production or presence in human milk
Aclidinium bromide is present in rat milk; when a drug is present in animal milk, it is likely that the drug will be present in human milk
Animal studies
- Aclidinium bromide reduced pup weights when pregnant rats continued inhalation administration through lactation at 5 times the MRHDID
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Long-acting muscarinic antagonist (LAMA), often referred to as an anticholinergic; selective muscarinic antagonist with affinity for the M3 (subscript) receptor in the airways; produces bronchodilation by inhibiting acetylcholine’s effect on muscarinic receptors in the airway smooth muscle
Absorption
~55% of administered dose is swallowed, but negligible oral absorption is observed; fraction of inhaled dose that reaches systemic circulation is low (<5%)
Peak Plasma Time: 10-15 minutes (in COPD)
Peak Plasma Concentration: 80 pg/mL (in COPD)
Distribution
Whole lung deposition: 30% of the metered dose
Vd: 300 L (IV administration)
Metabolism
Aclidinium bromide is rapidly hydrolyzed in plasma into its alcohol (LAS34823) and acid (LAS34850) metabolites by both enzymatic and non-enzymatic cleavage; neither of these metabolites are active
Elimination
Half-life: 5-8 hr following repeat BID administration
Renal clearance: Low
Total clearance: 170 L/hr (IV administration)
Excretion: Urine 0.1% (as aclidinium bromide), 65% (as metabolites); feces 33% (as metabolites)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Tudorza Pressair inhalation - | 400 mcg/actuation aerosol |  | |
| Tudorza Pressair inhalation - | 400 mcg/actuation aerosol |  | |
| Tudorza Pressair inhalation - | 400 mcg/actuation aerosol |  | |
| Tudorza Pressair inhalation - | 400 mcg/actuation aerosol |  |
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