Clidinium bromide

Not to be confused with Acridinium bromide or Aclidinium bromide.

Clidinium bromide
Systematic (IUPAC) name

3-[(2-hydroxy-2,2-diphenylacetyl)oxy]-1-methyl-1-azabicyclo[2.2.2]octan-1-ium bromide
Clinical data
AHFS/Drugs.com	monograph
MedlinePlus	a601036
Pregnancy category	US: D (Evidence of risk)
Legal status	US: ℞-only
Routes of administration	Oral
Pharmacokinetic data
Bioavailability	Low
Excretion	Renal and biliary
Identifiers
CAS Registry Number	7020-55-5^Y 3485-62-9
ATC code	A03CA02 (combination with psycholeptics)
PubChem	CID 2784
IUPHAR ligand	351
DrugBank	DB00771^Y
ChemSpider	2682^Y
UNII	BO76JF850N^Y
ChEMBL	CHEMBL1200950^N
Chemical data
Formula	C₂₂H₂₆N O₃⁺
Molecular mass	352.447 g/mol
SMILES O=C(OC2C1CC[N+](CC1)(C)C2)C(O)(c3ccccc3)c4ccccc4
InChI InChI=1S/C22H26NO3/c1-23-14-12-17(13-15-23)20(16-23)26-21(24)22(25,18-8-4-2-5-9-18)19-10-6-3-7-11-19/h2-11,17,20,25H,12-16H2,1H3/q+1 ^Y Key:HOOSGZJRQIVJSZ-UHFFFAOYSA-N ^Y
N (what is this?) (verify)

Clidinium bromide (INN) is an anticholinergic (specifically a muscarinic antagonist) drug.^[1] It may help symptoms of cramping and abdominal/stomach pain by decreasing stomach acid, and slowing the intestines. It is commonly prescribed in combination with chlordiazepoxide (a benzodiazepine derivative) using the brand name Librax.

Uses

Peptic ulcer disease

Used in fixed combination with chlordiazepoxide as adjunctive therapy in the treatment of peptic ulcer disease; however, no conclusive data that antimuscarinics aid in the healing, decrease the rate of recurrence, or prevent complications of peptic ulcers.^[2]

With the advent of more effective therapies for the treatment of peptic ulcer disease, antimuscarinics have only limited usefulness in this condition.

GI motility disturbances

Used in fixed combination with chlordiazepoxide in the treatment of functional GI motility disturbances (e.g., irritable bowel syndrome).

Has limited efficacy in treatment of GI motility disturbance and should only be used if other measures (e.g., diet, sedation, counseling, amelioration of environmental factors) have been of little or no benefit.

Acute enterocolitis

Used in fixed combination with chlordiazepoxide in the treatment of acute enterocolitis. However, antimuscarinics should be used with extreme caution in patients with diarrhea or ulcerative colitis.

Mechanism of action

Clidinium inhibits muscarinic acetylcholine receptors on smooth muscles, secretory glands, and in the central nervous system to relax smooth muscle and decrease biliary tract secretions.^[3]

Preclinical studies

Clidinium is an effective anticholinergic agent with activity approximating that of atropine sulfate against spasms induced by acetylcholine in isolated intestinal strips. On oral administration in mice it proved an effective antisialagogue in preventing salivation induced by pilocarpine. Spontaneous intestinal motility in both rats and dogs is reduced following oral dosing with 0.1 to 0.25 mg/kg. Potent cholinergic ganglionic blocking effects (vagal) are produced with intravenous usage in anesthetized dogs.

Oral doses of 23 mg/kg administered to dogs produced nasal dryness and slight pupillary dilation. In two other species, monkeys and rabbits, doses of 5 mg/kg by mouth, three times a day, for 5 days produced no apparent changes.

References

↑ "Clidinium bromide". Drugs.com. Retrieved August 24, 2013.
↑ "Clidinium Bromide Monograph". Drugs.com. Retrieved August 24, 2013.
↑ 2014 Nurses Drug Handbook (13th ed.). Burlington, MA: Jones & Bartlett Learning. 2014. pp. 245–6. ISBN 978-1-284-03115-7.