Brands of aclidinium
Inhaled: Eklira Genuair®,
Inhaled (combination product, with beta-2 adrenoceptor agonist): Duaklir Genuair®
Issues for surgery
Increased risk of exacerbation of chronic obstructive pulmonary disease (COPD) if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue (including combination product).
Combination product: Aclidinium and formoterol – also see Formoterol monograph
Advise patients who are prescribed regular inhaled aclidinium preparations but do not usually take them regularly to do so pre-operatively to optimise breathing prior to anaesthesia.
Confirm the inhaler brand, device, and strength with the patient.
Post-operative advice
Restart post-operatively as soon as next dose is due.
If patients are unable to resume their usual inhaled medication post-operatively consider nebulised ipratropium if clinically appropriate.
Interactions with common anaesthetic agents
Antimuscarinic action
The antimuscarinic action of aclidinium may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium. Concomitant administration of aclidinium with other medication known to have antimuscarinic effects has not been studied and is therefore not recommended by the manufacturers; however, in practice monitor patient for adverse effects.
Interactions with other common medicines used in the perioperative period
Antimuscarinic action
Antiemetics
The antimuscarinic action of aclidinium action may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine.
Nefopam
The antimuscarinic action of aclidinium may be additive with nefopam which also has antimuscarinic effects.
Concomitant administration of aclidinium with other medication known to have antimuscarinic effects has not been studied and is therefore not recommended by the manufacturers; however, in practice monitor patient for adverse effects.
Further information
None relevant.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 4th February 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 4th February 2021]
Summary of Product Characteristics – Eklira® (aclidinium) Genuair 322 micrograms inhalation powder. AstraZeneca UK Limited. Accessed via www.medicines.org.uk 04/02/2021 [date of revision of the text November 2019]