aclidinium

aclidinium

(a-kli-din-ee-um) ,

Tudorza

(trade name)

Classification

Therapeutic: copd agents
Pharmacologic: anticholinergics
Pregnancy Category: C

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 effects

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

Contraindications/Precautions

Contraindicated in: None noted.
Use Cautiously in: Narrow-angle glaucoma;Prostatic hyperplasia, bladder neck obstruction;Severe hypersensitivity to milk proteins;History of hypersensitivity to atropine (cross-sensitivity may occur); Obstetric: Use during pregnancy only if potential benefit justifies potential risk to the fetus; Lactation: Use cautiously during lactation; Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Central nervous system

  • headache

Ear, Eye, Nose, Throat

  • worsening of narrow-angle glaucoma

Respiratory

  • paradoxical bronchospasm

Genitourinary

  • urinary retention

Miscellaneous

  • immediate hypersensitivity reactions

Interactions

Drug-Drug interaction

↑ risk of adverse anticholinergic effects with other anticholingerics.

Route/Dosage

Inhalation (Adults) One inhalation (400 mcg) twice daily.

Availability

Dry powder metered-dose inhaler: 400 mcg/actuation

Nursing implications

Nursing assessment

  • Inhalation: 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.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Activity intolerance (Indications)

Implementation

  • Inhalation: Administer every 12 hr. See 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 nursing.
  • 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.
References in periodicals archive ?
- The US Food and Drug Administration has approved Duaklir Pressair (aclidinium bromide and formoterol fumarate) for the maintenance treatment of patients with chronic obstructive pulmonary disease, US-based Circassia Pharmaceuticals Inc said.
US Food and Drug Administration Approves Duaklir Pressair for Patients with Chronic Obstructive Pulmonary Disease
United States Food and Drug Administration (USFDA) has granted approval to UK-based Circassia Pharmaceuticals' DUAKLIR PRESSAIR (aclidinium bromide and formoterol fumarate) product for the treatment of chronic obstructive pulmonary disease, it was reported yesterday.
USFDA grants approval to Circassia Pharmaceuticals' DUAKLIR PRESSAIR
Bronchodilators, which improve lung function, decrease hyperinflation, and improve exercise performance by decreasing airway smooth muscle tone, are the cornerstone of COPD treatment and include short- and long-acting [[beta].sub.2]-agonists (SABAs [eg, albuterol/salbutamol and levalbuterol] and LABAs [eg, formoterol, indacaterol, olodaterol, and salmeterol]), and shortand long-acting muscarinic antagonists (SAMAs [eg, ipratropium bromide] and LAMAs [eg, aclidinium, glycopyrronium bromide, umeclidinium, and tiotropium]).
COPD Management in the Primary Care Setting
These medications improve pulmonary function and reduce acute bronchial exacerbations with good safety.[7] Glycopyrronium bromide and aclidinium bromide are two represent LAMAs.
Classical and Emerging Therapies against Chronic Obstructive Pulmonary Disease
Duaklir Genuair is a recently approved two-component inhalation mixture of aclidinium and formoterol used to relieve symptoms in adult patients with chronic obstructive pulmonary disease [1].
Different Spectrophotometric Methods Manipulating Ratio Spectra Applied for the Analysis of Aclidinium in Duaklir[R] Genuair[R] Inhalation Powder
Puente-Maestu et al., "Aclidinium improves exercise endurance, dyspnea, lung hyperinflation, and physical activity in patients with COPD: a randomized, placebo-controlled, crossover trial," BMC Pulmonary Medicine, vol.
Verification of a Motion Sensor for Evaluating Physical Activity in COPD Patients
AstraZeneca today announced positive top-line results of the Phase IV ASCENT trial for Tudorza Pressair (aclidinium bromide 400 ?g, twice-daily), a long-acting muscarinic antagonist (LAMA), in patients with moderate to very severe chronic obstructive pulmonary disease (COPD), with a history of cardiovascular disease and/or significant cardiovascular risk factors.
China,United States : Tudorza reduces exacerbations and demonstrates cardiovascular safety in COPD patients
Peiro et al., "Aclidinium inhibits cigarette smoke-induced lung fibroblast-to- myofibroblast transition," European Respiratory Journal, vol.
Ginsenoside Rg1 Ameliorates Cigarette Smoke-Induced Airway Fibrosis by Suppressing the TGF-[beta]1/Smad Pathway In Vivo and In Vitro
* Tudorza (aclidinium; AstraZeneca): Could patients' difficulties with its unique inhaler be preventing Detractors from recommending Tudorza?
New Study: NPS+ Asthma/COPD (US)
Upon completion of the transaction, AstraZeneca will own the development and commercial rights to Tudorza Pressair (aclidinium bromide inhalation powder), a twice-daily long-acting muscarinic antagonist (LAMA) for chronic obstructive pulmonary disease (COPD), and Daliresp (roflumilast), a once-daily oral PDE4 inhibitor currently on the market for COPD.
Covington's Dargan and Osborne lead on AstraZeneca deal with Actavis
AstraZeneca owns the development and commercial rights in the US and Canada to Tudorza Pressair (aclidinium bromide inhalation powder), a twice-daily long-acting muscarinic antagonist for chronic obstructive pulmonary disease, and to Daliresp (roflumilast), the only once-daily oral PDE4 inhibitor currently on the market for COPD, in the US.
AstraZeneca Acquires N. American Drug Portfolio from Actavis
Following the sale, AstraZeneca will own the development and commercial rights in the US and Canada to Tudorza Pressair (aclidinium bromide inhalation powder), a twice-daily long-acting muscarinic antagonist (LAMA) for chronic obstructive pulmonary disease (COPD).
Actavis announces divestiture of branded respiratory portfolio rights in the US and Canada to focus on core strategic therapeutic categories
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