aclidinium

General

Pronunciation:
a-kli-din-ee-um

Trade Name(s)

• Tudorza Genuair 
• Tudorza Pressair

Ther. Class.

bronchodilators

Pharm. Class.

anticholinergics

Indications

Maintenance treatment of COPD (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 oral 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)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity to aclidinium or any of the excipients
• Severe hypersensitivity to milk proteins.

Use Cautiously in:

• Narrow-angle glaucoma
• Prostatic hyperplasia or bladder-neck obstruction
• History of hypersensitivity to atropine (cross-sensitivity may occur)
• OB:  Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
• Pedi:  Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

EENT: worsening of narrow-angle glaucoma

GU: urinary retention

Neuro: headache

Resp: paradoxical bronchospasm

Misc: HYPERSENSITIVITY REACTIONS (including anaphylaxis and angioedema)

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

Interactions

Drug-Drug

May ↑ risk of anticholinergic effects with other  anticholinergics.

Route/Dosage

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

Availability

Dry powder metered-dose inhaler: 400 mcg/actuation

In Combination with: formoterol (Duaklir Pressair). See combination drugs.

Assessment

• Assess lung sounds, BP, and HR before administration and during peak of medication. Note amount, color, and character of sputum produced. Closely monitor patients on higher dose for adverse effects.
• Monitor pulmonary function tests before initiating and periodically during therapy to determine effectiveness.
• Observe for paradoxical bronchospasm (wheezing, dyspnea, tightness in chest).  If bronchospasm occurs,  hold medication and notify health care provider immediately.
• Monitor for signs/symptoms of hypersensitivity reactions (rash, urticaria, pruritus, flushing, dizziness, vomiting, abdominal pain) and angioedema (swelling of throat, lips, tongue, or face; dyspnea; wheezing; hoarseness), especially in patients with a history of hypersensitivity reactions to atropine.  If hypersensitivity reaction or angioedema occurs, discontinue aclidinium.
• Monitor for signs/symptoms of acute narrow-angle glaucoma (eye pain or discomfort, blurred vision, visual halos).
• Monitor for signs/symptoms of urinary retention (difficulty passing urine, dysuria), especially in patients with prostatic hyperplasia or bladder-neck obstruction.
• Inhaln Onset of action is too slow for patients in acute distress; it is not intended as a rescue inhaler. Consult health care provider about alternative medication if severe bronchospasm is present.

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 1st, followed by aclidinium and then corticosteroids. Wait 5 min between medications.

Patient/Family Teaching

• Explain the purpose and side effects of aclidinium. Instruct patient to use as directed. Do not discontinue therapy without discussing with health care provider, even if feeling better. If a dose is missed, skip it and take next dose at regularly scheduled time. Do not double doses. Use a rapid-acting bronchodilator if symptoms occur before next dose is due. Caution patient not to use more than once a day; excess use may lead to adverse effects, paradoxical bronchospasm, or loss of effectiveness of medication. Instruct patient to review  Patient Information  before starting therapy and with each Rx refill in case of changes.
• Advise patient to have a rapid-acting inhaled bronchodilator available for use at all times to treat sudden symptoms. Notify health care provider 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.
• Explain need for pulmonary function tests prior to and periodically during therapy to determine effectiveness of medication.
• Caution patient to avoid getting powder into eyes.
• Advise patient to inform health care provider if symptoms of new or worsened ↑ 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 occur.
• Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care provider before taking any new Rx, OTC, or herbal products or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
• Rep:  Advise patient to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Bronchodilation with lessened symptoms of COPD.