Long-acting muscarinic antagonist (LAMA) Pregnancy: Avoid unless essential — limited human data; minimal systemic absorption.

Aclidinium bromide

Brand names: Eklira Genuair, Bretaris Genuair

Adult dose

Dose: 322 micrograms (1 inhalation) BD via Genuair dry-powder inhaler

Route: Inhalation

Frequency: Twice daily

For maintenance bronchodilator treatment of COPD. Not for acute symptom relief. NOT licensed for asthma.

Clinical pearls

Twice-daily dosing differentiates it from once-daily tiotropium / glycopyrronium / umeclidinium — useful when patients report waning effect at end of dosing interval.
Genuair inhaler has an audible click and colour-change feedback to confirm correct dose delivery — useful in patients struggling with technique.
Combination Duaklir Genuair (aclidinium + formoterol) available for LAMA + LABA in COPD.
Onset of action ~30 min; peak at 1–2 hours.
ASCENT-COPD trial (2019) showed no significant cardiovascular signal vs placebo.

Contraindications

Hypersensitivity to atropine derivatives
Acute bronchospasm
Asthma (not licensed)

Side effects

Dry mouth (less than tiotropium in head-to-head studies)
Headache, nasopharyngitis
Cough, dyspnoea (paradoxical bronchospasm — rare)
Urinary retention (caution in BPH)
Blurred vision, narrow-angle glaucoma exacerbation (rare)
Constipation

Interactions

Other antimuscarinics (oral or inhaled): avoid combination — additive antimuscarinic effects
No clinically significant CYP interactions

Monitoring

FEV1 / symptom response at 4–8 weeks
Inhaler technique

Reference: BNF 90; SmPC Eklira Genuair; NICE NG115 (COPD 2019); GOLD 2024 Report; ASCENT-COPD AJRCCM 2019. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways