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# Aclidinium bromide
## Overview
Aclidinium bromide is a long-acting, inhaled muscarinic antagonist (LAMA) that acts as a bronchodilator by inhibiting M3 receptors on airway smooth muscle. It is formulated for delivery via a multidose dry powder inhaler (DPI).
## Primary Indications
Maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Not indicated for the relief of acute bronchospasm (rescue therapy).
## Adult Dosing
400 mcg (one inhalation) administered orally via the Genuair/Pressair inhaler twice daily (every 12 hours). Do not exceed 400 mcg per dose or 800 mcg per 24 hours.
## Pediatric Dosing
Not indicated for pediatric use. Efficacy and safety have not been established in patients <18 years.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment required.
* **Hepatic Impairment:** No dose adjustment required.
## Contraindications
Hypersensitivity to aclidinium bromide, atropine, or derivatives thereof.
## Adverse Effects
* **Common:** Headache, nasopharyngitis, cough, sinusitis.
* **Serious:** Paradoxical bronchospasm, cardiovascular effects (tachycardia, arrhythmia), worsening of urinary retention, worsening of narrow-angle glaucoma.
## Key Drug Interactions
Additive anticholinergic effect if used with other anticholinergic medications (e.g., tiotropium, ipratropium). Avoid concomitant use.
## Monitoring
* Monitor for paradoxical bronchospasm (discontinue if it occurs).
* Monitor for signs of urinary retention or ocular pain/blurred vision (narrow-angle glaucoma flare).
* Assess lung function (symptoms and spirometry) periodically.
## Clinical Pearls
* **Inhaler Technique:** Ensure the patient understands the "click" mechanism of the Genuair inhaler and the color-coded control window (green indicates correct preparation; red/blank indicates incorrect).
* **Rescue Inhaler:** Patients should be provided with a short-acting bronchodilator for acute symptom relief.
* **Administration:** Instruct patient to inhale forcefully and deeply through the inhaler mouthpiece.
* **Storage:** Store in the protective pouch until immediately before use to protect from moisture.
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*Disclaimer: This information is for educational purposes only. Clinical practice and therapeutic protocols may vary. Always verify current prescribing information, package inserts, and institution-specific guidelines before prescribing or administering medication.*
