Aclidinium Bromide: Effects, Uses & Risks

Aclidinium bromide is one of the anticholinergics. It is used to treat adults with chronic obstructive pulmonary disease (COPD). The drug comes as a powder for inhalation.

What is aclidinium bromide?

Aclidinium bromide is one of the anticholinergics. It is used to treat adults with chronic obstructive pulmonary disease (COPD). The active ingredient aclidinium bromide is marketed in the EU under the trade names Eklira Genuair and Bretaris Genuair. The drug is approved for the long-term symptomatic bronchodilator treatment of adults with chronic obstructive pulmonary disease (COPD). It improves symptoms such as chronic cough and shortness of breath. It is taken as a dry powder via a Genuair inhaler at a usual frequency of twice a day. The drug is suitable for long-term therapy. The long-acting drug dilates the bronchi and has parasympathologic properties. Aclidinium bromide is rapidly absorbed by the lungs. It usually takes effect within 15 minutes. Thus, it represents a good therapy for chronic patients. However, as a long-acting bronchodilator, it is not suitable for an emergency situation. Similarly, it is not suitable as an asthma medication.

Pharmacologic Action

Aclidinium bromide improves pulmonary function and is used to treat COPD in adults. The effects of aclidinium bromide administration are shown to be bronchodilator as well as parasympatholytic. Initial relief of symptoms occurs within 15 minutes after inhalation. The action of aclidinium bromide is due to antagonism at muscarinic receptors within the airways. Aclidinium bromide binds longer to M3 receptors (muscarinic receptors M3) and shorter to M2 receptors (muscarinic receptors M2). M3 receptors are responsible for smooth muscle contractions in the airways. If this function is blocked by administration of aclidinium bromide, there is a prolonged inhibition of bronchoconstriction caused by acetylcholine. In plasma, aclidinium bromide is rapidly hydrolyzed to an inactive alcohol metabolite and a carboxylic acid metabolite, which reduces the risk of potential side effects outside the lungs. As an anticholinergic agent, administration of aclidinium bromide may affect the heart and blood vessels. Therefore, possible cardiovascular effects should be monitored closely. In patients with certain pre-existing cardiovascular conditions, aclidinium bromide should be used with extreme caution. As is generally possible with inhalation treatments, paradoxical bronchospasm may occur with inhalation of aclidinium bromide. In such a case, discontinue treatment immediately and contact the physician.

Medicinal use and application

In chronic obstructive pulmonary disease – COPD for short – the lungs are permanently damaged. The airways – the bronchi – are chronically narrowed, making it difficult to breathe. Bronchodilators – drugs that expand the bronchial tubes – provide relief from the symptoms. There are two types of bronchodilators: long-acting for permanent use and short-acting for use in acute respiratory distress. Aclidinium bromide is available as a long-acting bronchodilator. The drug inhibits acetylcholine, an endogenous neurotransmitter, thereby dilating the airways. It helps relieve symptoms of shortness of breath and chronic cough. Aclidinium bromide is taken as a dry powder via a reusable Genuair inhaler twice daily at a dosage of 375 μg. The device is sold ready-filled and can be used immediately. The effect occurs within 15 minutes after inhalation. Because of its twice-daily use, aclidinium bromide is also an excellent fit for patients with symptoms that increase at night or at the beginning of the day.

Risks and side effects

Up to 10% of those treated with aclidinium bromide experienced these complaints as the most common side effects:

  • Headache
  • Sinusitis
  • Combined nasal and pharyngeal inflammation
  • Cough
  • Diarrhea

Aclidinium bromide should be used with extreme caution in certain cardiovascular conditions, for example:

  • Previous myocardial infarction within 6 months.
  • Unstable angina pectoris
  • Arrhythmia
  • Heart failure – stages NYHA III or IV

Similarly, caution is advised during therapy with aclidinium bromide in the presence of existing narrow-angle glaucoma, benign prostatic hyperplasia, and urinary obstruction in the bladder neck. Aclidinium bromide is contraindicated in case of hypersensitivity to the active substance and to parasympatholytics related in their structure. Pregnant women should take this drug only if the expected benefits exceed potential risks. Breastfeeding women are advised against its use.