Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Inhaled Anticholinergic Drugs
Viola Nasserallah, Regional Pharmacist Manager, Ward MM
Inhaled anticholinergic drugs are mainly used in the treatment of COPD, but can also can also be used in asthma. They work by causing bronchodilation by inhibiting cholinergic bronchomotor tone. Common adverse effects are dry mouth and throat irritation.
- There is one short-acting inhaled anticholinergic (ipratropium) and four long-acting inhaled anticholinergics; aclidinium, glycopyrronium, tiotropium and umeclidinium.
- Ipratropium is also described as a short-acting muscarinic antagonist (SAMA). It can be used instead of short-acting beta2 agonists (SABAs) in the initial management of symptoms such as breathlessness in mild COPD. When SABA therapy is inadequate in acute asthma, ipratropium can be used.
- Aclidinium , glycopyrronium, tiotropium and umeclidinium are long acting inhaled anticholinergics. They are also referred to as long-acting muscarinic antagonists (LAMAs). They are all given once daily (except aclidinium which is given twice daily) for treatment of COPD when symptoms are not controlled by short-acting bronchodilators.
- The most extensively studied inhaled anticholinergic is tiotropium as it has the strongest evidence of benefit in terms of clinical outcome. There is strong evidence for its reduction of exacerbations and hospital admissions in moderate-to-severe COPD. There is also less safety and efficacy data for the other LAMAs.
- They are available as a single formulation or in combination with various long-acting beta agonists for the treatment of COPD.
- Spiriva Respimat® (also tiotropium) is marketed for the treatment of adults in asthma maintenance if it is not controlled with an inhaled corticosteroid/long acting beta agonist combination.
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