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Long-acting muscarinic antagonist (LAMA) bronchodilator Pregnancy: Avoid unless clearly necessary — limited data.

Aclidinium Bromide (Eklira Genuair)

Brand names: Eklira Genuair (322 mcg per inhalation)

Adult dose

Dose: 322 mcg twice daily (one inhalation BD)
Route: Inhaled (Genuair dry powder inhaler)
Frequency: Twice daily (12 hours apart)
Max: 644 mcg/day (2 inhalations/day)
COPD maintenance bronchodilation. Alternative LAMA to tiotropium (once daily) or glycopyrronium. Aclidinium has a faster onset than tiotropium (5–15 min vs 30 min) — some benefit for morning symptom relief. Genuair device incorporates a feedback mechanism confirming successful inhalation.

Paediatric dose

Route: N/A
Frequency: N/A
Max: Not licensed in children
Not established in paediatric patients.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required in mild-moderate hepatic impairment.

Clinical pearls

  • Alternative LAMA for COPD patients who prefer a twice-daily regimen (some patients find BD dosing easier to remember than OD)
  • Genuair device: click-feedback mechanism confirms successful inhalation — useful for patients with poor coordination or uncertain technique
  • Faster onset than tiotropium HandiHaler: useful for patients with prominent early morning symptoms (AM COPD symptom burden is significant)
  • ACCORD COPD trials: aclidinium BD significantly improves FEV₁, exercise tolerance, and health status vs placebo
  • Can be combined with a LABA (formoterol) — fixed combination available as Duaklir Genuair (aclidinium 340 mcg / formoterol 12 mcg BD)

Contraindications

  • Symptomatic prostatic hypertrophy / bladder neck obstruction
  • Acute angle-closure glaucoma (relative)
  • Hypersensitivity to aclidinium or atropine derivatives

Side effects

  • Dry mouth (most common — less than tiotropium in some studies)
  • Nasopharyngitis
  • Headache
  • Urinary retention (elderly males)
  • Tachycardia (rare)

Interactions

  • Other anticholinergic drugs — additive anticholinergic effects; avoid combination with other LAMAs
  • Ipratropium — do not co-prescribe

Monitoring

  • FEV₁ and CAT score
  • Exacerbation frequency
  • Inhaler technique (Genuair feedback mechanism)
  • Symptoms of urinary retention

Reference: BNFc; BNF; GOLD COPD Guidelines 2024; ACCORD COPD I and II Trials; NICE NG115 COPD. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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