LAMA + LABA inhaler Pregnancy: No data available on use in pregnant women; animal studies have shown foetotoxicity only at dose levels much higher than the maximum human exposure to aclidinium, and adverse effects in reproduction studies with formoterol at very high systemic exposure levels. Should only be used during pregnancy if the expected benefits outweigh the potential risks. Breast-feeding: it is unknown whether aclidinium (and/or its metabolites) or formoterol are excreted in human milk; as rat studies show excretion of small amounts into milk, use by breast-feeding women should only be considered if the expected benefit to the woman is greater than any possible risk to the infant.

Aclidinium bromide with formoterol

Brand names: Duaklir Genuair

A fixed-dose inhaled combination of aclidinium (a long-acting muscarinic antagonist) and formoterol (a long-acting beta-2 agonist) for maintenance treatment of COPD. The dual bronchodilator is delivered by dry-powder inhaler for regular use.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One inhalation twice daily (aclidinium 340 micrograms / formoterol fumarate dihydrate 12 micrograms per inhalation)

Route: Inhalation (Genuair dry powder inhaler) — source product: Duaklir Genuair 340 micrograms/12 micrograms inhalation powder

Frequency: Twice daily

Source: UK SPC (eMC) §4.2 for Duaklir Genuair 340 micrograms/12 micrograms inhalation powder (https://www.medicines.org.uk/emc/product/14789/smpc). Verbatim: 'The recommended dose is one inhalation twice daily.' The 340/12 microgram strength is taken from the product name in the source; §4.2 itself states only 'one inhalation twice daily'. MISSED DOSE: take as soon as possible and take the next dose at the usual time; a double dose should not be taken to make up for a forgotten dose. ELDERLY: no dose adjustments required. HEPATIC IMPAIRMENT: no dose adjustments required. PAEDIATRIC: 'There is no relevant use of Duaklir Genuair in children and adolescents (under 18 years of age) for the indication of COPD' — no paediatric dose is stated, so paedDose is null; verify any under-18 use against a children's formulary. ADMINISTRATION: for inhalation use; patients should be instructed on how to administer the product correctly as the Genuair inhaler may work differently from inhalers they have used previously, and should be told to read the Instructions for Use in the Package Leaflet. Before first use tear open the sealed bag, remove the inhaler and discard the bag and desiccant. §4.4: should NOT be used in asthma (no clinical studies in asthma); not indicated for the treatment of acute episodes of bronchospasm. No maximum dose is stated in §4.2.

Dose adjustments

Renal

No dose adjustments are required in patients with renal impairment

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to the excipient (lactose)

Side effects

Nasopharyngitis (7.9%) and headache (6.8%) — the most frequently reported adverse reactions
Urinary tract infection, sinusitis, tooth abscess (common); insomnia and anxiety (common)
Dizziness, tremor (common); cough (common); diarrhoea, nausea, dry mouth (common)
Myalgia, muscle spasms and blood creatine phosphokinase increased (common)
Uncommon: cardiac arrhythmias including atrial fibrillation and paroxysmal tachycardia, tachycardia, QTc prolongation on ECG, palpitations, angina pectoris, hypokalaemia, hyperglycaemia, urinary retention, blurred vision

Interactions

Co-administration with other anticholinergic and/or long-acting beta2-adrenergic agonist containing medicinal products has not been studied and is not recommended
Medicinal products affecting the QTc interval — use long-acting beta2-adrenergic agonists with caution in patients with known or a history of QTc prolongation or treated with such medicines
Concomitant treatment (with hypoxia in severe COPD) may potentiate hypokalaemia, which increases susceptibility to cardiac arrhythmias
Note: the §4.5 text was truncated at the source-fetch limit — the full interactions section was not retrieved; verify against the complete SPC

Clinical monograph

How it works

Aclidinium blocks M3 muscarinic receptors while formoterol stimulates beta-2 adrenoceptors, together relaxing airway smooth muscle through complementary pathways for greater bronchodilation. Formoterol additionally has a relatively rapid onset.

Prescribing in practice

The antimuscarinic component can trigger acute angle-closure glaucoma and urinary retention while the beta-2 agonist can cause tachycardia, tremor and hypokalaemia — counsel on glaucoma and urinary warning signs as the key caution and use cautiously in cardiovascular disease.
It is maintenance therapy only and must not be relied on for acute symptom relief; ensure a separate short-acting reliever is available.
Hypokalaemia risk is increased by concomitant corticosteroids, diuretics or xanthines, and paradoxical bronchospasm warrants immediate discontinuation.

Monitoring

Monitor symptom control, exacerbations, heart rate and inhaler technique, with attention to antimuscarinic and beta-agonist adverse effects.

Counselling the patient

Take regularly to prevent symptoms, not to treat a sudden flare-up.
Report palpitations, tremor, eye pain or difficulty passing urine.
Maintain correct dry-powder inhaler technique at each use.

Evidence & guidelines

Trials of the LAMA/LABA combination demonstrate greater improvement in lung function and breathlessness than either component alone, in line with NICE dual-bronchodilator recommendations for COPD.

Reference: NICE NG115; GOLD 2024; SmPC Duaklir; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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