Long-acting muscarinic antagonist for inhalation (LAMA)
ATC code: R03BB05 (Aclidinium)
Brand names
Tudorza Pressair
Competitive antagonist at muscarinic M1–M3 receptors of bronchial smooth muscle. Rapidly hydrolysed in plasma to inactive metabolites – systemic anticholinergic effects are smaller than with tiotropium. Dosed twice daily via the Genuair device with feedback (click and colour indicator confirm inhalation). Duration about 12 hours; comparable to tiotropium in exacerbations and FEV1 (Cochrane Network 2018).
First line
Aclidinium is a LAMA for COPD maintenance. 2024 and GesEPOC 2024 list aclidinium as a first-line option in group B and in LABA+LAMA combinations (aclidinium+formoterol: Brimica Genuair, Duaklir Genuair) in group E. The Cochrane 2018 network meta-analysis (Oba) found no advantage over tiotropium in exacerbations or mortality. Marketing as a «newest-generation LAMA with superior efficacy» is not supported.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Aclidinium is not used in asthma. AEMPS and approved it only for COPD. Of inhaled LAMAs, only tiotropium Respimat is approved for severe asthma ( 2024). Use of aclidinium in asthma patients as a «universal long-acting bronchodilator» is off-label without RCT support. If aclidinium was prescribed for asthma, consider seeking a second opinion.
Not recommended
Aclidinium is offered off-label «for endurance gains» without a COPD diagnosis. In healthy people there is no meaningful FEV1 effect: bronchodilation provides benefit only with baseline obstruction. WADA does not prohibit the drug, but chronic anticholinergic exposure without a diagnosis is unjustified. If aclidinium is suggested «to improve cardio» without a COPD diagnosis, consider seeking a second opinion.
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FDA Category C. Pregnancy data are limited. AEMPS advises use only when benefit outweighs risk. Pregnant patients with COPD are uncommon; tiotropium with a longer observational record is usually preferred.
Probably compatible. Hale L3. Systemic bioavailability is low. Continuation is decided individually with the pulmonologist.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Aclidinium is evaluated for the following indications with varying evidence strength: Chronic obstructive pulmonary disease (evidence tier A), Asthma (evidence tier F), Athletic endurance (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Aclidinium (≥ 1 in 100): Headache, Throat irritation, Cough, Dry mouth, Nasopharyngitis. See the Safety section for uncommon and serious reactions.
FDA category C. FDA Category C. Pregnancy data are limited. AEMPS advises use only when benefit outweighs risk. Pregnant patients with COPD are uncommon; tiotropium with a longer observational record is usually preferred.
Probably compatible. Hale L3. Systemic bioavailability is low. Continuation is decided individually with the pulmonologist.
Aclidinium is contraindicated in: Hypersensitivity to aclidinium, atropine or excipients; Angle-closure glaucoma (relative); Symptomatic prostatic hyperplasia with urinary retention (relative). Full list in the Safety section.