aclidinium/formoterol (Rx)

Brand and Other Names:Duaklir Pressair
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

aclidinium bromide/formoterol fumarate

powder for inhalation

  • (400mcg/12mcg)/actuation by breath-actuated dry powder metered-dose inhaler

Chronic Obstructive Pulmonary Disease

Indicated for maintenance treatment of chronic obstructive pulmonary disease (COPD)

1 inhalation PO BID

Not to exceed 1 inhalation BID

Dosage Modifications

Renal or hepatic impairment: Formal pharmacokinetic studies not conducted; however, based on available data, no dosage adjustment required

Dosing Considerations

Limitations of use: Not indicated for treatment of acute bronchospasm or asthma

Safety and efficacy not established

No overall differences in safety or effectiveness were observed between adults aged ≥60 yr compared with younger adults

See adult dosing

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Interactions

Interaction Checker

and aclidinium/formoterol

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            Contraindicated (1)

            • umeclidinium bromide/vilanterol inhaled

              aclidinium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Duplicate therapy.

            Serious - Use Alternative (63)

            • amitriptyline

              amitriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              amitriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amoxapine

              amoxapine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              amoxapine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • arformoterol

              arformoterol and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether/lumefantrine

              formoterol and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • chlorpromazine

              chlorpromazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              clarithromycin and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • clomipramine

              clomipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              clomipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • desipramine

              desipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              desipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • disopyramide

              disopyramide and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • dofetilide

              dofetilide and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • doxepin

              doxepin and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              doxepin, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dronedarone

              dronedarone and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • droperidol

              droperidol and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              formoterol and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • epinephrine

              epinephrine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • epinephrine racemic

              epinephrine racemic and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin base

              erythromycin base and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              erythromycin lactobionate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin stearate

              erythromycin stearate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

            • fluconazole

              fluconazole and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • fluphenazine

              fluphenazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • glasdegib

              formoterol and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • glucagon

              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 intranasal

              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. .

            • haloperidol

              formoterol and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • ibutilide

              formoterol and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • imipramine

              imipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              imipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • indapamide

              formoterol and indapamide both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              inotuzumab and formoterol both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

            • isocarboxazid

              isocarboxazid increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • ivosidenib

              ivosidenib and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

            • ketoconazole

              formoterol and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • linezolid

              linezolid increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • lofepramine

              lofepramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              lofepramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • lumefantrine

              formoterol and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              macimorelin and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • maprotiline

              maprotiline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              maprotiline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • mobocertinib

              mobocertinib and formoterol both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • moxifloxacin

              formoterol and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • nilotinib

              formoterol and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

            • nortriptyline

              nortriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              nortriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • octreotide

              formoterol and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

            • octreotide (Antidote)

              formoterol and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

            • ondansetron

              formoterol and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • panobinostat

              formoterol and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • pentamidine

              formoterol and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • perphenazine

              perphenazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • phenelzine

              phenelzine increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • pimozide

              formoterol and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

            • pitolisant

              formoterol and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • pramlintide

              pramlintide, aclidinium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • procainamide

              formoterol and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • prochlorperazine

              prochlorperazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • promazine

              promazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • promethazine

              promethazine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • protriptyline

              protriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              protriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • quinidine

              quinidine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • revefenacin

              revefenacin and aclidinium both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.

            • sotalol

              formoterol and sotalol both increase QTc interval. Avoid or Use Alternate Drug. Drugs known to prolong the QTc interval may potentiate the cardiovascular effects of formoterol.

              sotalol and formoterol both increase QTc interval. Avoid or Use Alternate Drug. Drugs known to prolong the QTc interval may potentiate the cardiovascular effects of formoterol.

            Monitor Closely (340)

            • abobotulinumtoxinA

              abobotulinumtoxinA increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

            • acebutolol

              acebutolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              acebutolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • aceclofenac

              aceclofenac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • acemetacin

              acemetacin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • albuterol

              albuterol and formoterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and formoterol both decrease sedation. Use Caution/Monitor.

              albuterol and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • alfentanil

              alfentanil increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfuzosin

              formoterol and alfuzosin both increase QTc interval. Use Caution/Monitor.

              alfuzosin and formoterol both increase QTc interval. Use Caution/Monitor.

            • alprazolam

              alprazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amantadine

              aclidinium, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.

            • amiloride

              amiloride increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • amiodarone

              amiodarone and formoterol both increase QTc interval. Use Caution/Monitor.

            • amitriptyline

              aclidinium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              amitriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amobarbital

              amobarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amoxapine

              aclidinium and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • amoxapine

              amoxapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • anticholinergic/sedative combos

              anticholinergic/sedative combos and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • apomorphine

              apomorphine and formoterol both increase QTc interval. Use Caution/Monitor.

            • arformoterol

              arformoterol and formoterol both decrease serum potassium. Use Caution/Monitor.

              arformoterol and formoterol both decrease sedation. Use Caution/Monitor.

              arformoterol and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aripiprazole

              aclidinium decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

              aripiprazole increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              aripiprazole and formoterol both increase QTc interval. Use Caution/Monitor.

              aripiprazole increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • armodafinil

              formoterol and armodafinil both decrease sedation. Use Caution/Monitor.

            • atracurium

              atracurium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • arsenic trioxide

              arsenic trioxide and formoterol both increase QTc interval. Use Caution/Monitor.

            • artemether

              artemether and formoterol both increase QTc interval. Use Caution/Monitor.

            • aspirin

              aspirin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aspirin rectal

              aspirin rectal increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • atenolol

              atenolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              atenolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • atomoxetine

              formoterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

              atomoxetine and formoterol both increase QTc interval. Use Caution/Monitor.

            • atropine

              atropine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine IV/IM

              atropine IV/IM and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • azelastine

              azelastine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • azithromycin

              azithromycin and formoterol both increase QTc interval. Use Caution/Monitor.

            • bedaquiline

              formoterol and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • belladonna alkaloids

              belladonna alkaloids and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • belladonna and opium

              belladonna and opium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bendroflumethiazide

              formoterol and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.

            • benperidol

              aclidinium decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              benperidol increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • benperidol

              benperidol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benzphetamine

              formoterol and benzphetamine both decrease sedation. Use Caution/Monitor.

              formoterol and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • benztropine

              benztropine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • betaxolol

              betaxolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              betaxolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • bethanechol

              bethanechol increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bisoprolol

              bisoprolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              bisoprolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • brompheniramine

              brompheniramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bumetanide

              formoterol and bumetanide both decrease serum potassium. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butabarbital

              butabarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butalbital

              butalbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butorphanol

              butorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • caffeine

              formoterol and caffeine both decrease sedation. Use Caution/Monitor.

            • carbachol

              carbachol increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbenoxolone

              formoterol and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carvedilol

              carvedilol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              carvedilol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • celecoxib

              celecoxib increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • celiprolol

              celiprolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              celiprolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • ceritinib

              ceritinib and formoterol both increase QTc interval. Use Caution/Monitor.

            • cevimeline

              cevimeline increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorothiazide

              formoterol and chlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              aclidinium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

              chlorpromazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • chlorthalidone

              formoterol and chlorthalidone both decrease serum potassium. Use Caution/Monitor.

            • cisatracurium

              cisatracurium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • cinnarizine

              cinnarizine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clemastine

              clemastine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clomipramine

              clomipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              aclidinium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • clonazepam

              clonazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              aclidinium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

              clozapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • clorazepate

              clorazepate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              clozapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • codeine

              codeine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • cyclizine

              cyclizine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              cyclizine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • cyclopenthiazide

              formoterol and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • darifenacin

              darifenacin and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • dasatinib

              dasatinib and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • deflazacort

              formoterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • degarelix

              degarelix and formoterol both increase QTc interval. Use Caution/Monitor.

            • desipramine

              aclidinium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              desipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dicyclomine

              dicyclomine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • dexfenfluramine

              formoterol and dexfenfluramine both decrease sedation. Use Caution/Monitor.

              formoterol and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmethylphenidate

              formoterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.

              formoterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextroamphetamine

              formoterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.

              formoterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextromoramide

              dextromoramide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diamorphine

              diamorphine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dichlorphenamide

              dichlorphenamide and formoterol both decrease serum potassium. Use Caution/Monitor.

              dichlorphenamide, formoterol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • diclofenac

              diclofenac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diethylpropion

              formoterol and diethylpropion both decrease sedation. Use Caution/Monitor.

              formoterol and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diflunisal

              diflunisal increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • digoxin

              digoxin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              diphenhydramine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • donepezil

              donepezil increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dipipanone

              dipipanone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dobutamine

              dobutamine and formoterol both decrease serum potassium. Use Caution/Monitor.

              dobutamine and formoterol both decrease sedation. Use Caution/Monitor.

              dobutamine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dolasetron

              dolasetron and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • dopamine

              formoterol and dopamine both decrease sedation. Use Caution/Monitor.

              formoterol and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopexamine

              dopexamine and formoterol both decrease serum potassium. Use Caution/Monitor.

              dopexamine and formoterol both decrease sedation. Use Caution/Monitor.

              dopexamine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              dopexamine, formoterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • dosulepin

              aclidinium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • doxepin

              aclidinium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              doxepin increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • droperidol

              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.

              droperidol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • drospirenone

              drospirenone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • echothiophate iodide

              echothiophate iodide increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ephedrine

              ephedrine and formoterol both decrease serum potassium. Use Caution/Monitor.

              ephedrine and formoterol both decrease sedation. Use Caution/Monitor.

              ephedrine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine

              epinephrine and formoterol both decrease serum potassium. Use Caution/Monitor.

              epinephrine and formoterol both decrease sedation. Use Caution/Monitor.

              epinephrine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

              formoterol and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.

              formoterol and epinephrine racemic both decrease sedation. Use Caution/Monitor.

              formoterol and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • escitalopram

              escitalopram increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

            • esmolol

              esmolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              esmolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • estazolam

              estazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ethacrynic acid

              formoterol and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.

            • ethanol

              ethanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • etodolac

              etodolac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fenfluramine

              formoterol and fenfluramine both decrease sedation. Use Caution/Monitor.

              formoterol and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • fenoprofen

              fenoprofen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fesoterodine

              fesoterodine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • flavoxate

              flavoxate and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • flecainide

              flecainide and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluoxetine

              fluoxetine and formoterol both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system

            • fluphenazine

              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.

              fluphenazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flurazepam

              flurazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • galantamine

              galantamine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flurbiprofen

              flurbiprofen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • foscarnet

              formoterol and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

            • fostemsavir

              formoterol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • furosemide

              formoterol and furosemide both decrease serum potassium. Use Caution/Monitor.

            • gentamicin

              formoterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

            • glycopyrrolate

              glycopyrrolate and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • glycopyrrolate inhaled

              glycopyrrolate inhaled and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • glycopyrronium tosylate topical

              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.

            • goserelin

              goserelin increases toxicity of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • haloperidol

              haloperidol increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              haloperidol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              aclidinium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

            • henbane

              henbane and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • histrelin

              histrelin increases toxicity of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • homatropine

              homatropine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • huperzine A

              huperzine A increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydrochlorothiazide

              formoterol and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • hydromorphone

              hydromorphone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hyoscyamine

              hyoscyamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • hyoscyamine spray

              hyoscyamine spray and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • ibuprofen

              ibuprofen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen IV

              ibuprofen IV increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • iloperidone

              iloperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              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.

              formoterol and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • imipramine

              aclidinium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              imipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • indapamide

              formoterol and indapamide both decrease serum potassium. Use Caution/Monitor.

            • ipratropium

              ipratropium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • indomethacin

              indomethacin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • isoproterenol

              formoterol and isoproterenol both decrease serum potassium. Use Caution/Monitor.

              formoterol and isoproterenol both decrease sedation. Use Caution/Monitor.

              formoterol and isoproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ketoprofen

              ketoprofen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac

              ketorolac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac intranasal

              ketorolac intranasal increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • ketotifen, ophthalmic

              ketotifen, ophthalmic increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • labetalol

              labetalol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              labetalol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • lapatinib

              formoterol and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • lenvatinib

              formoterol and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • leuprolide

              leuprolide increases toxicity of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • levalbuterol

              formoterol and levalbuterol both decrease serum potassium. Use Caution/Monitor.

              formoterol and levalbuterol both decrease sedation. Use Caution/Monitor.

              formoterol and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • levodopa

              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. .

            • levofloxacin

              formoterol and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • levorphanol

              levorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lisdexamfetamine

              formoterol and lisdexamfetamine both decrease sedation. Use Caution/Monitor.

              formoterol and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • lofepramine

              aclidinium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              lofepramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofexidine

              lofexidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine

              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.

            • loprazolam

              loprazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lorazepam

              lorazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lormetazepam

              lormetazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lornoxicam

              lornoxicam increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine

              loxapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine inhaled

              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.

              loxapine inhaled increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • maprotiline

              aclidinium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              maprotiline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • marijuana

              marijuana increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meclizine

              meclizine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • meclofenamate

              meclofenamate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mefenamic acid

              mefenamic acid increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • melatonin

              melatonin increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meloxicam

              meloxicam increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meperidine

              meperidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meprobamate

              meprobamate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaproterenol

              formoterol and metaproterenol both decrease serum potassium. Use Caution/Monitor.

              formoterol and metaproterenol both decrease sedation. Use Caution/Monitor.

              formoterol and metaproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methadone

              formoterol and methadone both increase QTc interval. Modify Therapy/Monitor Closely.

              methadone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methamphetamine

              formoterol and methamphetamine both decrease sedation. Use Caution/Monitor.

              formoterol and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methscopolamine

              methscopolamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • methyclothiazide

              formoterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              formoterol and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.

              formoterol and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methylphenidate

              formoterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • metolazone

              formoterol and metolazone both decrease serum potassium. Use Caution/Monitor.

            • metoprolol

              metoprolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              metoprolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • midazolam

              midazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midodrine

              formoterol and midodrine both decrease sedation. Use Caution/Monitor.

              formoterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • mifepristone

              mifepristone, formoterol. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • mirtazapine

              mirtazapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • modafinil

              formoterol and modafinil both decrease sedation. Use Caution/Monitor.

            • morphine

              morphine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • motherwort

              motherwort increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • moxonidine

              moxonidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabilone

              nabilone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabumetone

              nabumetone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nadolol

              nadolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nadolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • nalbuphine

              nalbuphine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • naproxen

              naproxen increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nebivolol

              nebivolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nebivolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • neostigmine

              neostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • norepinephrine

              formoterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.

              formoterol and norepinephrine both decrease sedation. Use Caution/Monitor.

              formoterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • nortriptyline

              aclidinium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              nortriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ofloxacin

              formoterol and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • olanzapine

              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.

            • olanzapine

              olanzapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oliceridine

              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.

            • olodaterol inhaled

              formoterol and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

            • onabotulinumtoxinA

              onabotulinumtoxinA and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • opium tincture

              opium tincture increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • orphenadrine

              aclidinium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • osilodrostat

              osilodrostat and formoterol both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and formoterol both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxaliplatin

              oxaliplatin will increase the level or effect of formoterol by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • oxaprozin

              oxaprozin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxazepam

              oxazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxybutynin

              oxybutynin and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin topical

              oxybutynin topical and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin transdermal

              oxybutynin transdermal and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxycodone

              oxycodone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxymorphone

              oxymorphone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ozanimod

              ozanimod and formoterol both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • paliperidone

              paliperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              aclidinium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              formoterol and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              paliperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • pancuronium

              pancuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • papaveretum

              papaveretum increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • parecoxib

              parecoxib increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • paroxetine

              formoterol and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

            • pasireotide

              formoterol and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • pazopanib

              formoterol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • penbutolol

              penbutolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              penbutolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • pentazocine

              pentazocine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pentobarbital

              pentobarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • perphenazine

              aclidinium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              perphenazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              perphenazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • phendimetrazine

              formoterol and phendimetrazine both decrease sedation. Use Caution/Monitor.

              formoterol and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • physostigmine

              physostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenoxybenzamine

              phenoxybenzamine, formoterol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

            • phentermine

              formoterol and phentermine both decrease sedation. Use Caution/Monitor.

              formoterol and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine

              formoterol and phenylephrine both decrease sedation. Use Caution/Monitor.

              formoterol and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine PO

              formoterol and phenylephrine PO both decrease sedation. Use Caution/Monitor.

              formoterol and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pholcodine

              pholcodine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine

              pilocarpine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine ophthalmic

              pilocarpine ophthalmic increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimozide

              aclidinium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

              pimozide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              pimozide increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • pindolol

              pindolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              pindolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • pralidoxime

              pralidoxime and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • pirbuterol

              formoterol and pirbuterol both decrease serum potassium. Use Caution/Monitor.

              formoterol and pirbuterol both decrease sedation. Use Caution/Monitor.

              formoterol and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • piroxicam

              piroxicam increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • posaconazole

              formoterol and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • potassium acid phosphate

              potassium acid phosphate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium chloride

              potassium chloride increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium citrate

              potassium citrate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • primidone

              primidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • procarbazine

              procarbazine increases effects of formoterol by pharmacodynamic synergism. Use Caution/Monitor.

            • prochlorperazine

              aclidinium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              prochlorperazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              prochlorperazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • promethazine

              promethazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              promethazine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              aclidinium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

            • propantheline

              propantheline and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • propranolol

              propranolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              propranolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • propylhexedrine

              formoterol and propylhexedrine both decrease sedation. Use Caution/Monitor.

              formoterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • protriptyline

              protriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              aclidinium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • pseudoephedrine

              formoterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pyridostigmine

              pyridostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quazepam

              quazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quetiapine

              aclidinium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

              quetiapine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              quetiapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • quinine

              formoterol and quinine both increase QTc interval. Use Caution/Monitor.

            • rapacuronium

              rapacuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • ranolazine

              formoterol and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

            • ribociclib

              ribociclib increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

            • rimantadine

              aclidinium, rimantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS side effects.

            • risperidone

              risperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              formoterol and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              aclidinium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • rivastigmine

              rivastigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sacubitril/valsartan

              sacubitril/valsartan increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • rocuronium

              rocuronium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • salicylates (non-asa)

              salicylates (non-asa) increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salmeterol

              formoterol and salmeterol both decrease serum potassium. Use Caution/Monitor.

              formoterol and salmeterol both decrease sedation. Use Caution/Monitor.

              formoterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • salsalate

              salsalate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scopolamine

              scopolamine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • scullcap

              scullcap increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • secobarbital

              secobarbital increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • selpercatinib

              selpercatinib increases toxicity of formoterol by QTc interval. Use Caution/Monitor.

            • shepherd's purse

              shepherd's purse increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              formoterol and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • solifenacin

              solifenacin and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • solriamfetol

              formoterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • sorafenib

              sorafenib and formoterol both increase QTc interval. Use Caution/Monitor.

            • sotalol

              sotalol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • spironolactone

              spironolactone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • succinylcholine

              succinylcholine increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              succinylcholine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sufentanil

              sufentanil increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              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.

            • sulfamethoxazole

              sulfamethoxazole and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • sulfasalazine

              sulfasalazine increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sulindac

              sulindac increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tapentadol

              tapentadol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • telavancin

              formoterol and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

            • temazepam

              temazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • terbutaline

              formoterol and terbutaline both decrease serum potassium. Use Caution/Monitor.

              formoterol and terbutaline both decrease sedation. Use Caution/Monitor.

              formoterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • thioridazine

              thioridazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thiothixene

              thiothixene increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              thiothixene increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              aclidinium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

            • timolol

              timolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • tolterodine

              aclidinium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • tolfenamic acid

              tolfenamic acid increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolmetin

              tolmetin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolvaptan

              tolvaptan increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • topiramate

              topiramate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • torsemide

              formoterol and torsemide both decrease serum potassium. Use Caution/Monitor.

            • tramadol

              tramadol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trazodone

              trazodone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              aclidinium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • triamterene

              triamterene increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • trifluoperazine

              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.

            • triazolam

              triazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • triclofos

              triclofos increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trihexyphenidyl

              aclidinium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • trimethoprim

              formoterol and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

            • trimipramine

              trimipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              aclidinium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • triprolidine

              triprolidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trospium chloride

              aclidinium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • triptorelin

              triptorelin increases levels of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • tropisetron

              formoterol and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • umeclidinium bromide

              umeclidinium bromide and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents

            • vecuronium

              aclidinium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • venlafaxine

              formoterol and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

            • voriconazole

              formoterol and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • xylometazoline

              formoterol and xylometazoline both decrease sedation. Use Caution/Monitor.

              formoterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • yohimbine

              formoterol and yohimbine both decrease sedation. Use Caution/Monitor.

              formoterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ziconotide

              ziconotide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziprasidone

              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.

              ziprasidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • zotepine

              aclidinium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

            Minor (20)

            • bendroflumethiazide

              formoterol, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • bumetanide

              formoterol, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chloroquine

              chloroquine increases toxicity of formoterol by QTc interval. Minor/Significance Unknown.

            • chlorothiazide

              formoterol, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorthalidone

              formoterol, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • cyclopenthiazide

              formoterol, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • dimenhydrinate

              dimenhydrinate increases toxicity of aclidinium by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • donepezil

              donepezil decreases effects of aclidinium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • ethacrynic acid

              formoterol, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • eucalyptus

              eucalyptus increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • furosemide

              formoterol, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • galantamine

              galantamine decreases effects of aclidinium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • green tea

              green tea increases effects of formoterol by pharmacodynamic synergism. Minor/Significance Unknown. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

            • hydrochlorothiazide

              formoterol, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • indapamide

              formoterol, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • methyclothiazide

              formoterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • metolazone

              formoterol, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • noni juice

              noni juice increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • rimantadine

              rimantadine increases effects of aclidinium by pharmacodynamic synergism. Minor/Significance Unknown.

            • sage

              sage increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

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            Adverse Effects

            1-10%

            Upper respiratory tract infection (8.9%)

            Headache (6.3%)

            Back pain (3.8%)

            Cough (1-3%)

            Sinusitis (1-3%)

            Influenza (1-3%)

            Tooth abscess (1-3%)

            Insomnia (1-3%)

            Dizziness (1-3%)

            Dry mouth (1-3%)

            Oropharyngeal pain (1-3%)

            Muscle spasms (1-3%)

            Musculoskeletal pain (1-3%)

            Arthralgia (1-3%)

            Pain in extremity (1-3%)

            Urinary tract infection (1-3%)

            Blood creatine phosphokinase increased (1-3%)

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            Warnings

            Contraindications

            Severe hypersensitivity to milk proteins

            Hypersensitivity to aclidinium bromide, formoterol fumarate, or any product component

            Not indicated for asthma; use of long-acting beta2-adrenergic agonists (LABAs), including formoterol fumarate, without an inhaled corticosteroid is contraindicated in patients with asthma

            Cautions

            Safety and efficacy not established for patients with asthma; not indicated for asthma; use of LABA as monotherapy (without inhaled corticosteroids) for asthma associated with increase asthma-related deaths; available data do not suggest increased risk of death with LABAs in patients with COPD

            Do not initiate in acutely deteriorating COPD, which may be a life-threatening condition; aclidinium/formoterol is intended as maintenance treatment and should not be used for relief of acute symptoms (ie, rescue therapy for acute bronchospasm)

            Instruct patients who have been taking oral or inhaled, short-acting beta2-agonists on a regular basis (eg, 4x/day) to discontinue the regular use of these drugs and use them only for symptomatic relief of acute respiratory symptoms

            As with other inhaled drugs containing beta-agonists, do not use more often than recommended, at higher doses than recommended, or in conjunction with other medications containing LABAs, as an overdose may result; clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs

            May cause paradoxical bronchospasm, which may be life threatening; if paradoxical bronchospasm occurs, treat immediately with an inhaled short-acting bronchodilator; discontinue aclidinium/formoterol and institute alternant therapy

            Immediate hypersensitivity reactions, including anaphylaxis, angioedema, urticaria, rash, bronchospasm, or itching, reported; discontinue aclidinium/formoterol and institute alternant therapy if this occurs

            Beta-agonists can produce clinically significant cardiovascular effects as measured by increases in pulse rate, systolic or diastolic or blood pressure, or symptoms; additionally, may cause ECG changes (eg, flattening of the T wave, prolongation of the QTc interval, and ST-segment depression), although clinical significance is unknown

            Caution with using sympathomimetic amines in patients with convulsive disorders, thyrotoxicosis, and in those who are unusually responsive to sympathomimetic amines; doses of the related beta-agonist albuterol, when administered IV, have been reported to aggravate preexisting diabetes mellitus and ketoacidosis

            Caution with narrow-angle glaucoma; monitor for signs and symptoms of acute narrow-angle glaucoma (eg, eye pain or discomfort, blurred vision, visual halos, colored images in association with red eyes from conjunctival congestion and corneal edema)

            May worsen urinary retention or bladder neck obstruction; monitor for signs and symptoms (eg, difficulty passing urine, painful urination)

            Hypokalemia and hyperglycemia

            • Beta-agonists may produce significant hypokalemia, possibly through intracellular shunting, which has the potential to produce adverse cardiovascular effects; this decrease is usually transient, not requiring potassium supplementation
            • Beta-agonist medications may produce transient hyperglycemia
            • Clinical trials of aclidinium/formoterol over 24-52 weeks' duration did not show evidence of an effect on serum glucose or potassium

            Drug interaction overview

            • Caution with coadministration with additional adrenergic drugs, by any administration route, because additive sympathetic effects
            • Concomitant treatment with xanthine derivatives or steroids may potentiate any hypokalemic effect of beta-adrenergic agonists
            • Caution if coadministered with other drugs that cause hypokalemia (eg, loop or thiazide diuretics)
            • Caution if beta2-agonists are coadministered with MAO inhibitors, tricyclic antidepressants, or other drugs known to prolong the QTc interval, because the action of adrenergic agonists on the cardiovascular system may be potentiated by these agents
            • Formoterol and beta-blockers may inhibit the effect of each other if coadministered; patients with COPD are not typically treated with beta-blockers; however, under certain circumstances (eg, prophylaxis after MI), there may be no acceptable alternatives to the use of beta-blockers in patients with COPD; if needed, consider cautious use of cardioselective beta-blockers
            • Avoid coadministration of other anticholinergic medications with aclidinium, owing to additive effects
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            Pregnancy

            Pregnancy

            There are no adequate and well-controlled studies of aclidinium/formoterol or its individual components 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)
            • Formoterol fumarate alone, administered by the oral route, was teratogenic in rats and rabbits at 1,200 and 49,000 times the MRHDID, respectively
            • Formoterol fumarate was also embryocidal, increased pup loss at birth and during lactation, and decreased pup weight in rats at 85 times the MRHDID

            Labor or delivery

            • No well-controlled human studies
            • Because of the potential for beta-agonist interference with uterine contractility, use of during labor should be restricted to those patients in whom the benefits clearly outweigh the risk

            Lactation

            There are no available data on the breastfed child or on milk production or presence in human milk

            Both aclidinium bromide and formoterol fumarate are 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
            • Formoterol fumarate increased pup loss at birth and during lactation, and decreased pup weight in rats at 85 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.

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            Pharmacology

            Mechanism of Action

            Aclidinium: Long-acting muscarinic antagonist (LAMA), often referred to as an anticholinergic, has specificity for muscarinic receptors 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

            Formoterol: Long-acting selective beta-2 agonist (LABA); elicits bronchial smooth muscle relaxation by stimulation of intracellular adenyl cyclase, the enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3', 5'-adenosine monophosphate (cyclic AMP); increased cyclic AMP levels cause relaxation of bronchial smooth muscle and inhibit release of mediators of immediate hypersensitivity from cells, especially from mast cells

            Absorption

            Peak plasma time: Within 5 minutes after inhalation

            Peak plasma concentration: 128 pg/mL (aclidinium); 17 pg/mL (formoterol)

            Steady-state achieved within 5 days

            Distribution

            Vd (aclidinium; 400 mcg IV): 300 L

            Protein bound (formoterol; 54 mcg inhaled): 46% (RR enantiomer); 58% (SS enantiomer)

            Metabolism

            Aclidinium

            • Major metabolic route is hydrolysis, both chemically and enzymatically by esterases
            • Rapidly and extensively hydrolyzed in plasma to alcohol and dithienylglycolic acid derivatives, neither of which binds to muscarinic receptors and are devoid of pharmacologic activity
            • Owing to the low plasma levels achieved at the clinically relevant doses, aclidinium and its metabolites are not expected to alter the disposition of drugs metabolized by the human CYP450 enzymes

            Formoterol

            • Primarily by direct glucuronidation and by O-demethylation, followed by conjugation to inactive metabolites
            • Secondary metabolic pathways include deformylation and sulfate conjugation; CYP2D6 and CYP2C identified as being primarily responsible for O-demethylation

            Elimination

            Half-life: ~12 hr (aclidinium)

            Total clearance: ~170 L/hr (aclidinium IV)

            Excretion

            • Aclidinium: 54-65% urine; 20-33% feces; <1% excreted as unchanged drug
            • Formoterol: 62% urine; 24% feces
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            Administration

            Oral Inhalation Administration

            Not for relief of acute symptoms; extra doses should not be used for that purpose

            Do not use additional LABAs while taking this combination inhaler

            Breath-actuated inhaler; counsel patients with instructions and images included with inhaler

            Missed dose: Instruct patient to take the next dose at the usual time; do not take 2 doses at one time

            Storage

            Unopened: Store inside the sealed bag and only open immediately before use; discard bag and desiccant sachet

            Opened: Store in dry place at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F)

            Do not store inhaler on a vibrating surface

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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.