Aclidinium: what it treats, how to inhale it, side effects
Last updated September 6, 2026.
**Aclidinium is a long-acting inhaled anticholinergic, also called a long-acting muscarinic antagonist or LAMA, used as a maintenance treatment for chronic obstructive pulmonary disease (COPD).** It blocks muscarinic receptors in the airway muscle, so the muscle stays relaxed and the airways stay wider for about 12 hours at a time. The most important safety point is that aclidinium is a controller, not a rescue medicine: it works too slowly to help a sudden attack, so you still need a fast-acting inhaler such as albuterol for those moments.
What does it treat?
Aclidinium is approved for the long-term, twice-daily maintenance treatment of airflow obstruction in adults with COPD, which includes chronic bronchitis and emphysema. It is used by people who have ongoing daily symptoms such as breathlessness on exertion, chronic cough, morning chest tightness, and sputum production, and it is also used to reduce COPD exacerbations. It is a daily background medicine, so the benefit shows up as fewer bad days and easier walking rather than an immediate change after one dose. In the United States it is sold as a dry powder inhaler under the brand name Tudorza Pressair, and as a combination product, Duaklir Pressair, which pairs aclidinium with the long-acting beta agonist formoterol in one device. Aclidinium is not approved for asthma and has not been shown to be safe in asthma when used without an inhaled corticosteroid.
How do you take it?
Aclidinium comes only as a breath-activated dry powder inhaler that delivers 400 mcg per actuation. The label dose for adults is one inhalation twice a day, roughly 12 hours apart, for example morning and evening. That means the daily ceiling is two inhalations, or 800 mcg total, and taking extra doses does not open the airways further. Food does not matter, since the powder goes to your lungs and not your stomach, but rinsing your mouth after each dose helps with dry mouth and throat irritation. Use it as a schedule, not as needed. To take a dose, remove the cap, press and release the green button while holding the inhaler level, breathe out away from the device, then inhale forcefully and deeply through the mouthpiece until you hear a click and the control window turns from green to red. If you miss a dose, take it when you remember unless your next dose is close, then skip it; never take two doses at once. Do not stop on your own if your breathing worsens, because stopping a controller usually makes symptoms worse. Call your doctor if your COPD symptoms get worse, if your rescue inhaler stops working as well as it used to, or if you need your rescue inhaler more often than usual.
Side effects to know
- Common: The most commonly reported effects are headache, sore throat and cold symptoms, cough, sinus congestion, diarrhea, and dry mouth, and many people notice little or nothing beyond mild throat dryness.
- Serious: Stop aclidinium and get medical help right away if you have paradoxical bronchospasm, meaning your breathing gets suddenly and clearly worse right after a dose, or signs of an allergic reaction such as hives, swelling of the lips, tongue, or throat, or trouble breathing or swallowing. Also seek prompt care for eye pain, blurred vision, halos around lights, or red eye, which can mean acute narrow-angle glaucoma, and for inability to urinate or painful, dribbling urination, which can mean urinary retention.
Who should not take it?
Do not use aclidinium if you have had an allergic reaction to it or to any anticholinergic inhaler, and do not use it if you are allergic to milk proteins, because the powder is carried in lactose that contains milk protein. Talk with your doctor first if you have narrow-angle glaucoma, an enlarged prostate, bladder neck obstruction, or any past trouble emptying your bladder, since aclidinium can worsen all of these. Tell your clinician about every inhaler and pill you use, especially other anticholinergics such as tiotropium, umeclidinium, glycopyrrolate, or ipratropium, because using two of them together adds side effects without adding benefit; also mention oral or eye anticholinergics such as oxybutynin, tolterodine, scopolamine, and some antihistamines and tricyclic antidepressants. For pregnancy, FDA labeling reports no adequate and well-controlled human data, so aclidinium is used in pregnancy only when the benefit of controlling your COPD justifies the possible risk, and poorly controlled COPD itself carries risk for a pregnancy. It is not known whether aclidinium passes into human milk, so weigh breastfeeding plans with your doctor. There is no known interaction between aclidinium and alcohol, but heavy drinking can worsen breathing problems and make you less likely to take daily doses on time.
When is it an emergency?
Call 911 if you collapse, if your lips or fingertips turn blue or gray, if you cannot speak a full sentence between breaths, or if your throat, tongue, or lips swell after a dose. Get emergency care for a sudden severe worsening of breathing right after inhaling, for chest pain with shortness of breath, or for sudden eye pain with blurred vision, halos, and a red eye. If someone takes too many inhalations or a child swallows or plays with the device, call Poison Control at 1-800-222-1222 right away, even if the person looks fine. Signs of too much anticholinergic medicine include a very dry mouth, blurred vision, flushed hot skin, a fast or pounding heartbeat, confusion, and being unable to urinate. Because aclidinium breaks down quickly in the blood, serious overdose effects are uncommon, but the call still gives you a plan and a record.
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Common questions
What is the maximum amount of aclidinium I can use in a day?
Two inhalations a day, one in the morning and one in the evening, about 12 hours apart. Each inhalation delivers 400 mcg, so the daily ceiling is 800 mcg. Extra doses do not open your airways any further and only raise the chance of dry mouth, blurred vision, and urinary trouble. If two doses a day are not controlling your symptoms, the answer is a regimen change, not more inhalations. Call your doctor rather than adding doses on your own.
Can I drink alcohol while using aclidinium?
There is no known interaction between alcohol and aclidinium, and the label does not tell you to avoid drinking. Aclidinium is inhaled and breaks down quickly in the blood, so it does not compete with alcohol the way many pills do. That said, heavy drinking worsens breathing problems, disrupts sleep, and makes it easy to miss your evening dose. If you drink, keep it moderate and keep your dose schedule steady. Tell your clinician if you drink daily, since that also affects other COPD medicines.
Is aclidinium safe during pregnancy or while breastfeeding?
FDA labeling reports no adequate and well-controlled studies of aclidinium in pregnant people, so there is no clear human safety answer. Doctors weigh that against a known risk: uncontrolled COPD lowers the oxygen your baby gets, which is a real harm. Many clinicians continue effective inhaled therapy in pregnancy for that reason. It is not known whether aclidinium passes into human milk, so nursing is a shared decision with your doctor. Tell your clinician as soon as you are pregnant or planning to be, rather than stopping the inhaler first.
Do I need to take aclidinium with food, and should I rinse my mouth?
Food has nothing to do with it, because the powder goes into your lungs rather than your digestive tract. You can take it before or after meals, whatever keeps you consistent. Rinsing your mouth with water and spitting after each dose is still a good habit, since it reduces dry mouth and throat irritation. Keep the inhaler dry, do not wash it, and do not use it after the number in the dose indicator reaches zero. Store it in its sealed pouch until you start it.
What are the signs that I have taken too much?
Watch for a very dry mouth, blurred vision, flushed and hot skin, a racing or pounding heartbeat, confusion, and being unable to urinate. These are anticholinergic effects, and they show up more if you are also taking bladder or motion sickness medicines. Serious overdose from aclidinium alone is uncommon because it is broken down quickly in the blood. Call Poison Control at 1-800-222-1222 for any suspected overdose, including a child getting hold of the device. Call 911 for collapse, chest pain, or trouble breathing.
Can I use aclidinium as a rescue inhaler when I suddenly cannot breathe?
No. Aclidinium works too slowly for a sudden attack and is only for twice-daily maintenance. Always carry a short-acting rescue inhaler such as albuterol for sudden breathlessness, wheezing, or chest tightness. If your rescue inhaler is not helping the way it used to, or you are using it more often than usual, that is a signal to be seen rather than to add aclidinium doses. Sudden worsening right after an aclidinium dose can mean paradoxical bronchospasm, which means stopping the drug and getting help right away.
What other medicines interact with aclidinium?
The main issue is stacking anticholinergics. Do not use aclidinium together with tiotropium, umeclidinium, glycopyrrolate, or ipratropium, since doubling up adds dry mouth, vision changes, and urinary retention without adding benefit. Oral anticholinergics matter too, including oxybutynin and tolterodine for bladder, scopolamine for nausea, some older antihistamines, and tricyclic antidepressants. Bring a full list of your medicines, including over-the-counter sleep aids and cold remedies, to every visit. If you use the aclidinium and formoterol combination, tell your clinician about any other long-acting beta agonist so you do not double that up either.