Maintenance treatment of COPD (not for acute [rescue] use).
Action⬆⬇
Acts as an anticholinergic by inhibiting the M3 receptor in bronchial smooth muscle.
Therapeutic effects:
Bronchodilation with lessened symptoms of COPD.
Pharmacokinetics⬆⬇
Absorption: 6% systemically absorbed following inhalation.
Distribution: Unknown.
Metabolism/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)
ROUTE
ONSET
PEAK
DURATION
Inhaln
within 1 hr
2–4 hr
12 hr
Contraind./Precautions⬆⬇
Contraindicated in:
Hypersensitivity to aclidinium or any of the excipients;
In combination with: formoterol (Duaklir Pressair). See Appendix [not included in this PDA edition].
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.
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.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional 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.
Advise patient to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.
Explain need for pulmonary function tests prior to and periodically during therapy to determine effectiveness of medication.