Aclidinium bromide

Aclidinium bromide

Clinical data
Trade names	Bretaris Genuair, Eklira Genuair, Tudorza Pressair
AHFS/Drugs.com	tudorza
License data	US FDA: Aclidinium
Pregnancy category	US: C (Risk not ruled out)
Routes of administration	Inhalation
ATC code	R03BB05 (WHO)
Legal status
Legal status	US: ℞-only
Pharmacokinetic data
Bioavailability	<5% (in system) 30% (in lung)
Metabolism	Ester hydrolysis
Biological half-life	2–3 hrs
Duration of action	>24 hrs
Excretion	65% urine, 33% faeces
Identifiers
IUPAC name [(8R)-1-(3-Phenoxypropyl)-1-azoniabicyclo[2.2.2]octan-8-yl] 2-hydroxy-2,2-dithiophen-2-ylacetate bromide
CAS Number	320345-99-1 N
PubChem (CID)	11519741
DrugBank	DB08897 N
ChemSpider	9694529 N
UNII	UQW7UF9N91 N
KEGG	D08837 Y
ChEBI	CHEBI:65344 N
ChEMBL	CHEMBL551466 N
Chemical and physical data
Formula	C26H30BrNO4S2
Molar mass	564.55 g·mol−1
3D model (Jmol)	Interactive image
SMILES [Br-].O=C(O[C@@H]3C2CC[N+](CCCOc1ccccc1)(CC2)C3)C(O)(c4sccc4)c5sccc5
InChI InChI=1S/C26H30NO4S2.BrH/c28-25(26(29,23-9-4-17-32-23)24-10-5-18-33-24)31-22-19-27(14-11-20(22)12-15-27)13-6-16-30-21-7-2-1-3-8-21;/h1-5,7-10,17-18,20,22,29H,6,11-16,19H2;1H/q+1;/p-1/t20?,22-,27?;/m0./s1 N Key:XLAKJQPTOJHYDR-QTQXQZBYSA-M N
NY (what is this?)

Aclidinium bromide (INN) is a long-acting, inhaled muscarinic antagonist (LAMA) approved in the US on July 24, 2012 as a maintenance treatment for chronic obstructive pulmonary disease (COPD).

Evidence shows that it can improve quality of life and prevent hospitalization in those with COPD. However, it does not appear to affect the risk of death or the frequency steroids are needed. It is unclear if it differs from the similar medication tiotropium or other commonly used medications from the class of LAMAs.

Aclidinium is delivered via a multidose dry powder inhaler, the Genuair inhaler.

The substance is generally well tolerated. Common side effects (in more than 1% of patients) are sinusitis, nasopharyngitis, headache, cough, diarrhoea and nausea. The latter is less common under the drug than under placebo. Skin reactions such as rash, as well as side effects that are typical of muscarinic antagonists (fast heart rate, palpitations, and urinary retention), occur in less than 1% of patients.

A small increase of cardiovascular risk cannot be excluded from available data. Patients with relevant cardiovascular diseases were excluded from studies.

No systematic interaction studies have been performed. It is expected that adverse effects of aclidinium increase if it is combined with other muscarinic antagonists. In clinical practice, no interactions with other COPD medications such as glucocorticoids, β₂-adrenergic agonists and theophylline have been described. As aclidinium does not relevantly interact with liver enzymes or P-glycoprotein, and is quickly metabolized as soon as it reaches the bloodstream, it is considered to have a very low potential for interactions.