aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)donepezil decreases effects of aclidinium by pharmacodynamic antagonism. Minor/Significance Unknown.donepezil transdermalMonitor Closely (1)donepezil transdermal, aclidinium. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.dosulepinMonitor Closely (1)aclidinium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.doxepinMonitor Closely (1)aclidinium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.droperidolMonitor Closely (2)aclidinium decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor. droperidol increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.echothiophate iodideMonitor Closely (1)echothiophate iodide increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.fesoterodineMonitor Closely (1)fesoterodine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.flavoxateMonitor Closely (1)flavoxate and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.fluphenazineMonitor Closely (2)aclidinium decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor. fluphenazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.galantamineMonitor Closely (1)galantamine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)galantamine decreases effects of aclidinium by pharmacodynamic antagonism. Minor/Significance Unknown.glucagonSerious - Use Alternative (1)glucagon increases toxicity of aclidinium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .glucagon intranasalSerious - Use Alternative (1)glucagon intranasal increases toxicity of aclidinium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .glycopyrrolateMonitor Closely (1)glycopyrrolate and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.glycopyrrolate inhaledMonitor Closely (1)glycopyrrolate inhaled and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.glycopyrronium tosylate topicalMonitor Closely (1)glycopyrronium tosylate topical, aclidinium. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.haloperidolMonitor Closely (2)aclidinium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor. haloperidol increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.henbaneMonitor Closely (1)henbane and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.homatropineMonitor Closely (1)homatropine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.huperzine AMonitor Closely (1)huperzine A increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.hyoscyamineMonitor Closely (1)hyoscyamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.hyoscyamine sprayMonitor Closely (1)hyoscyamine spray and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.iloperidoneMonitor Closely (2)aclidinium decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor. iloperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.imipramineMonitor Closely (1)aclidinium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.ipratropiumMonitor Closely (1)ipratropium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.levodopaMonitor Closely (1)aclidinium, levodopa. Other (see comment). Use Caution/Monitor. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .lofepramineMonitor Closely (1)aclidinium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.loxapineMonitor Closely (3)aclidinium decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. aclidinium decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor. loxapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.loxapine inhaledMonitor Closely (2)loxapine inhaled increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. aclidinium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.maprotilineMonitor Closely (1)aclidinium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.meclizineMonitor Closely (1)meclizine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.methscopolamineMonitor Closely (1)methscopolamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.neostigmineMonitor Closely (1)neostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylineMonitor Closely (1)aclidinium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.olanzapineMonitor Closely (3)aclidinium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. aclidinium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.oliceridineMonitor Closely (1)aclidinium increases toxicity of oliceridine by Other (see comment). Use Caution/Monitor. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.onabotulinumtoxinAMonitor Closely (1)onabotulinumtoxinA and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.orphenadrineMonitor Closely (1)aclidinium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutyninMonitor Closely (1)oxybutynin and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin topicalMonitor Closely (1)oxybutynin topical and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin transdermalMonitor Closely (1)oxybutynin transdermal and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.paliperidoneMonitor Closely (2)aclidinium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.pancuroniumMonitor Closely (1)pancuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.perphenazineMonitor Closely (2)aclidinium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor. perphenazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.physostigmineMonitor Closely (1)physostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pilocarpineMonitor Closely (1)pilocarpine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pimozideMonitor Closely (2)aclidinium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor. pimozide increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.pralidoximeMonitor Closely (1)pralidoxime and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.pramlintideSerious - Use Alternative (1)pramlintide, aclidinium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.prochlorperazineMonitor Closely (2)aclidinium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor. prochlorperazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.promethazineMonitor Closely (2)aclidinium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor. promethazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.propanthelineMonitor Closely (1)propantheline and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.protriptylineMonitor Closely (1)aclidinium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.pyridostigmineMonitor Closely (1)pyridostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.quetiapineMonitor Closely (2)aclidinium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor. quetiapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rapacuroniumMonitor Closely (1)rapacuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.revefenacinSerious - Use Alternative (1)revefenacin and aclidinium both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.rimantadineMonitor Closely (1)aclidinium, rimantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS side effects.Minor (1)rimantadine increases effects of aclidinium by pharmacodynamic synergism. Minor/Significance Unknown.risperidoneMonitor Closely (2)aclidinium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor. risperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rivastigmineMonitor Closely (1)rivastigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.rocuroniumMonitor Closely (1)rocuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.scopolamineMonitor Closely (1)scopolamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.solifenacinMonitor Closely (1)solifenacin and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.succinylcholineMonitor Closely (1)succinylcholine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.thioridazineMonitor Closely (2)aclidinium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor. thioridazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.thiothixeneMonitor Closely (2)aclidinium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. thiothixene increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tolterodineMonitor Closely (1)aclidinium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.trazodoneMonitor Closely (1)aclidinium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.trifluoperazineMonitor Closely (2)aclidinium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor. trifluoperazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.trihexyphenidylMonitor Closely (1)aclidinium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor.trimipramineMonitor Closely (1)aclidinium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.trospium chlorideMonitor Closely (1)aclidinium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.umeclidinium bromideMonitor Closely (1)umeclidinium bromide and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agentsumeclidinium bromide/vilanterol inhaledContraindicated (1)aclidinium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Duplicate therapy.vecuroniumMonitor Closely (1)aclidinium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.ziprasidoneMonitor Closely (2)aclidinium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor. ziprasidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.zotepineMonitor Closely (1)aclidinium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. 1-10% Headache (6.6%) Nasopharyngitis (5.5%) Cough (3%) Diarrhea (2.7%) Sinusitis (1.7%) Rhinitis (1.6%) Toothache (1.1%) Fall (1.1%) Vomiting (1.1%) Postmarketing reports Anaphylaxis Angioedema (including swelling of lips and tongue or throat) Urticaria Rash Bronchospasm Itching Nausea Dysphonia Blurred vision Urinary retention Tachycardia Stomatitis Contraindications Hypersensitivity to drug or formulation components or severe hypersensitivity to milk proteins Cautions Not for acute episodes of bronchospasm (ie, not for rescue therapy) May cause paradoxical bronchospasm; if this occurs, discontinue and consider other treatments Worsening of narrow-angle glaucoma may occur; use with caution in patients with narrow-angle glaucoma; prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (eg,eye pain or discomfort, blurred vision, visual halos, or colored images in association with red eyesfrom conjunctival congestion and corneal edema; instruct patients to consult a physician immediately if it occurs Worsening of urinary retention may occur (eg, prostatic hyperplasia, bladder-neck obstruction); use with caution in patients with prostatic hyperplasia or bladder-neck obstruction; instruct patients to consult a physician immediately if it occurs Immediate hypersensitivity reactions, including angioedema, bronchospasm, or anaphylaxis, may occur after administration; if hypersensitivity occurs, discontinue immediately and consider alternate treatment Coadministration with other anticholinergics may increase risk for adverse effects Pregnancy There are no adequate and well-controlled studies of aclidinium in pregnant women to assess drug-associated risks Animal studies No adverse developmental effects were seen with inhalation administration of aclidinium bromide to pregnant rats and rabbits during organogenesis at 15 or 20 times, respectively, the maximum recommended human daily inhaled dose (MRHDID) Lactation There are no available data on the breastfed child or on milk production or presence in human milk Aclidinium bromide is present in rat milk; when a drug is present in animal milk, it is likely that the drug will be present in human milk Animal studies Aclidinium bromide reduced pup weights when pregnant rats continued inhalation administration through lactation at 5 times the MRHDID Pregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Long-acting muscarinic antagonist (LAMA), often referred to as an anticholinergic; selective muscarinic antagonist with affinity for the M3 (subscript) receptor in the airways; produces bronchodilation by inhibiting acetylcholine’s effect on muscarinic receptors in the airway smooth muscle Absorption ~55% of administered dose is swallowed, but negligible oral absorption is observed; fraction of inhaled dose that reaches systemic circulation is low (<5%) Peak Plasma Time: 10-15 minutes (in COPD) Peak Plasma Concentration: 80 pg/mL (in COPD) Distribution Whole lung deposition: 30% of the metered dose Vd: 300 L (IV administration) Metabolism Aclidinium bromide is rapidly hydrolyzed in plasma into its alcohol (LAS34823) and acid (LAS34850) metabolites by both enzymatic and non-enzymatic cleavage; neither of these metabolites are active Elimination Half-life: 5-8 hr following repeat BID administration Renal clearance: Low Total clearance: 170 L/hr (IV administration) Excretion: Urine 0.1% (as aclidinium bromide), 65% (as metabolites); feces 33% (as metabolites) BRAND FORM. UNIT PRICE PILL IMAGE Tudorza Pressair inhalation- 400 mcg/actuation aerosolTudorza Pressair inhalation- 400 mcg/actuation aerosolTudorza Pressair inhalation- 400 mcg/actuation aerosolTudorza Pressair inhalation- 400 mcg/actuation aerosolCopyright © 2010 First DataBank, Inc.Print Patient Educationaclidinium bromide inhalation ACLIDINIUM POWDER INHALER - ORAL INHALATION (A-kli-DIN-ee-um) COMMON BRAND NAME(S): Tudorza USES: Aclidinium is used to control and prevent symptoms (such as wheezing, shortness of