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# Aclidinium Bromide (Walethmade)
## Overview
Aclidinium bromide is a long-acting muscarinic antagonist (LAMA) that acts as a bronchodilator by inhibiting M3 receptors in airway smooth muscle. It is formulated as a dry powder inhaler (DPI).
## Primary Indications
Maintenance treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.
## Adult Dosing
400 mcg (one inhalation) via Pressair DPI twice daily (every 12 hours). Do not exceed 800 mcg in 24 hours.
## Pediatric Dosing
Not indicated for use in pediatric patients. Safety and efficacy have not been established.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment required.
* **Hepatic Impairment:** No dose adjustment required.
* **Geriatric:** No dose adjustment required.
## Contraindications
* Hypersensitivity to aclidinium bromide, atropine, or derivatives.
* Not indicated for the relief of acute bronchospasm (rescue therapy).
## Adverse Effects
* **Common:** Headache, nasopharyngitis, cough, sinusitis.
* **Serious:** Paradoxical bronchospasm (discontinue immediately), worsening of narrow-angle glaucoma, worsening of urinary retention, anticholinergic effects (dry mouth, blurred vision).
## Key Drug Interactions
Use caution when co-administering with other anticholinergic-containing agents (e.g., ipratropium, tiotropium) due to the risk of additive anticholinergic effects.
## Monitoring
* Monitor for signs of paradoxical bronchospasm after administration.
* Monitor for systemic anticholinergic effects (urinary retention, eye pain/blurred vision).
* Assess COPD symptoms and lung function periodically.
## Clinical Pearls
* **Administration:** Ensure the patient understands how to use the Pressair DPI device; inhalation is signaled by a "click" sound and a color change in the control window.
* **Rescue Inhaler:** Patients must be counseled that this is a maintenance medication and will not provide immediate relief for an acute COPD exacerbation.
* **Storage:** Store in the sealed pouch until use to protect from moisture.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and prescribing information may change; always verify specific dosing and contraindications against the current FDA-approved package insert or local institutional protocols before prescribing or administering medication.
