General

Pronunciation:
a-kli-din-ee-um


Trade Name(s)

  • Tudorza Genuair Canadian Tradename
  • Tudorza Pressair

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:

  • 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;
  • Severe hypersensitivity to milk proteins;
  • History of hypersensitivity to atropine (cross-sensitivity may occur);
  • OB: Use only if potential benefit justifies potential risk to the fetus;
  • Lactation:Use cautiously;
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

CNS: headache

EENT: worsening of narrow-angle glaucoma

Resp: paradoxical bronchospasm

GU: urinary retention

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS, ANGIOEDEMA, URTICARIA, RASH, BRONCHOSPASM, OR ITCHING)

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

Interactions

Drug-Drug

↑ risk of 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.
  • Monitor for signs and symptoms of hypersensitivity reactions (angioedema [swelling of the lips, tongue, or throat], bronchospasm, urticaria, rash, itching, anaphylaxis) during therapy, especially in patients with a history of hypersensitivity reactions to atropine or milk products. Discontinue aclidinium if symptoms occur.

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 breast feeding.
  • 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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TY - ELEC T1 - aclidinium ID - 110345 Y1 - 2019 PB - Davis's Drug Guide UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110345/all/aclidinium ER -