Long-acting muscarinic antagonist (LAMA) bronchodilator Pregnancy: No data available in pregnant women; animal studies showed 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: excretion in human milk unknown; animal studies show excretion of small amounts into milk and a risk to newborns/infants cannot be excluded — decide whether to discontinue breast-feeding or the medicine.

Aclidinium Bromide (Eklira Genuair)

Brand names: Eklira Genuair (322 mcg per inhalation)

Aclidinium bromide is an inhaled long-acting muscarinic antagonist (LAMA) used as maintenance bronchodilator therapy in chronic obstructive pulmonary disease.

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 twice daily

Route: Inhalation (Genuair dry powder inhaler) — for inhalation use — source product: Eklira Genuair 322 micrograms inhalation powder

Frequency: Twice daily

eMC SPC §4.2 — 'The recommended dose is one inhalation of 322 micrograms aclidinium twice daily.' 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 required. Renal impairment: no dose adjustments required. Hepatic impairment: no dose adjustments required. Paediatric: there is no relevant use of Eklira Genuair in children and adolescents (under 18 years) for the indication of COPD. Patients should be instructed on correct technique, as the Genuair inhaler may work differently from inhalers they have used previously. §4.4 states aclidinium is a maintenance bronchodilator and should not be used for relief of acute episodes of bronchospasm (i.e. as rescue therapy). No maximum dose is stated in §4.2.

Dose adjustments

Renal

No dose adjustments are required for 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 aclidinium bromide or to the excipients

Side effects

Headache (6.6%, common) and nasopharyngitis (5.5%, common); sinusitis (common)
Cough (common); dysphonia (uncommon)
Diarrhoea, nausea (common); dry mouth, stomatitis (uncommon)
Cardiac arrhythmias including atrial fibrillation and paroxysmal tachycardia, tachycardia, palpitations (uncommon)
Urinary retention (uncommon); blurred vision, dizziness (uncommon); rash, pruritus (uncommon)

Interactions

Co-administration with other anticholinergic-containing medicinal products has not been studied and is not recommended
No formal in vivo drug interaction studies performed; inhaled aclidinium has been used concomitantly with other COPD medicines including sympathomimetic bronchodilators, methylxanthines, and oral and inhaled steroids without clinical evidence of drug interactions
In vitro, aclidinium and its metabolites at therapeutic dose are not expected to interact with substrates of P-glycoprotein, or with substances metabolised by cytochrome P450 enzymes and esterases

Clinical monograph

How it works

It competitively and reversibly blocks acetylcholine at muscarinic receptors on airway smooth muscle, producing sustained bronchodilation.

Prescribing in practice

It is for regular maintenance and not for relief of acute bronchospasm, which still requires a short-acting reliever.
Use with caution in symptomatic prostatic hyperplasia, bladder-outflow obstruction or narrow-angle glaucoma owing to antimuscarinic effects.
It is delivered by a dry-powder inhaler (Genuair), so correct device technique should be confirmed.

Monitoring

Monitor symptom control and inhaler technique at review, and check for antimuscarinic adverse effects such as dry mouth or urinary retention.

Counselling the patient

Use the inhaler regularly as prescribed, not for sudden breathlessness.
Report eye pain, blurred vision, or difficulty passing urine.
Rinse the mouth if dryness occurs and demonstrate your inhaler technique at reviews.

Evidence & guidelines

NICE guidance positions LAMAs such as aclidinium within COPD maintenance bronchodilator pathways.

Reference: GOLD COPD Guidelines 2024; ACCORD COPD I and II Trials; NICE NG115 COPD; 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