Long-acting muscarinic antagonist (LAMA) Pregnancy: No data available on use in pregnant women; animal studies have shown foetotoxicity only at dose levels much higher than maximum human exposure. Should only be used during pregnancy if the expected benefits outweigh the potential risks. Breast-feeding: it is unknown whether aclidinium bromide/metabolites are excreted in human milk (animal studies show excretion of small amounts) and a risk to newborns/infants cannot be excluded — decide whether to discontinue breast-feeding or the medicinal product (§4.6).

Aclidinium bromide

Brand names: Eklira Genuair, Bretaris Genuair

Aclidinium bromide is an inhaled long-acting muscarinic antagonist (LAMA) used as maintenance bronchodilator therapy for chronic obstructive pulmonary disease. It is delivered by dry-powder inhaler, not for acute relief.

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 of 322 micrograms aclidinium

Route: Inhalation — for inhalation use via the Genuair inhaler

Frequency: Twice daily

SOURCE: eMC UK SPC, productName 'Eklira Genuair 322 micrograms inhalation powder' (https://www.medicines.org.uk/emc/product/14790/smpc), §4.2. VERBATIM: 'The recommended dose is one inhalation of 322 micrograms aclidinium twice daily.' PRODUCT CHECK: this bundle is the SINGLE-AGENT aclidinium product, which matches this page. An earlier fetch for this id returned the fixed aclidinium/formoterol combination (Duaklir Genuair 340/12 micrograms) — confirm the product name on the SPC before publishing, because a combination inhaler carries a long-acting beta2-agonist that this page does not describe. MISSED DOSE: if a dose is missed the next dose should be taken as soon as possible; however, if it is nearly time for the next dose, the missed dose should be skipped. ELDERLY: no dose adjustments are required. HEPATIC IMPAIRMENT: no dose adjustments are required. PAEDIATRIC: 'There is no relevant use of Eklira Genuair in children and adolescents (under 18 years of age) for the indication of COPD' — hence paedDose is null. ADMINISTRATION: 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 instructed to read the Instructions for Use in the package leaflet. NOT A RESCUE THERAPY (§4.4): aclidinium bromide is a maintenance bronchodilator and should not be used for the relief of acute episodes of bronchospasm; if the patient considers additional rescue medication is required, re-evaluate the patient and the treatment regimen. Administration may cause paradoxical bronchospasm — if this occurs, stop treatment and consider other treatments.

Dose adjustments

Renal

No dose adjustments are required for patients with renal impairment (§4.2).

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 aclidinium bromide or to the excipients (the product contains lactose)

Side effects

Headache (6.6%) — the most frequently reported adverse reaction (common)
Nasopharyngitis (5.5%) and sinusitis (common)
Cough (common)
Diarrhoea and nausea (common); dry mouth and stomatitis (uncommon)
Cardiac arrhythmias including atrial fibrillation and paroxysmal tachycardia, tachycardia and palpitations (uncommon); dizziness, blurred vision, rash, pruritus and urinary retention (uncommon); hypersensitivity (rare), angioedema and anaphylactic reaction (not known)

Interactions

Other anticholinergic-containing medicinal products — co-administration has not been studied and is not recommended (§4.5)
Sympathomimetic bronchodilators, methylxanthines, and oral and inhaled steroids — inhaled aclidinium bromide has been used concomitantly with these other COPD medicinal products without clinical evidence of drug interactions, although no formal in vivo interaction studies have been performed (§4.5)
P-glycoprotein (P-gp) substrates, and substrates of cytochrome P450 (CYP450) enzymes and esterases — in vitro studies show aclidinium bromide and its metabolites at the therapeutic dose are not expected to cause interactions (§4.5)

Clinical monograph

How it works

It blocks muscarinic M3 receptors on airway smooth muscle, reducing cholinergic bronchoconstriction and producing sustained bronchodilation. Its design favours airway selectivity with limited systemic exposure.

Prescribing in practice

As an antimuscarinic it can precipitate acute angle-closure glaucoma and urinary retention, so use cautiously in patients with glaucoma or bladder-outflow obstruction and advise on warning symptoms — the foremost safety point.
It is for regular maintenance only and must not be used to relieve sudden breathlessness, for which a short-acting reliever is needed.
Paradoxical bronchospasm can occur immediately after inhalation; if it does, stop the inhaler and reassess therapy.

Monitoring

Review inhaler technique, symptom control and exacerbation frequency at follow-up, checking for antimuscarinic adverse effects.

Counselling the patient

Use it every day for prevention, not to relieve a sudden attack.
Seek advice if vision becomes painful or blurred or passing urine becomes difficult.
Demonstrate and keep good dry-powder inhaler technique.

Evidence & guidelines

Randomised trials show aclidinium improves lung function, symptoms and quality of life in COPD, supporting NICE-endorsed LAMA maintenance therapy.

Reference: SmPC Eklira Genuair; NICE NG115 (COPD 2019); GOLD 2024 Report; ASCENT-COPD AJRCCM 2019; 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.

Calculators

Pathways