Clidinium bromide

Not to be confused with Acridinium bromide or Aclidinium bromide.

Clidinium bromide (INN) is an anticholinergic (specifically a muscarinic antagonist) drug.^[1][2] 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,Normaxin CC.

Clidinium bromide

Clinical data
AHFS/Drugs.com	Monograph
MedlinePlus	a601036
Routes of administration	Oral
ATC code	A03CA02 (WHO) (combination with psycholeptics)
Legal status
Legal status	US: ℞-only
Pharmacokinetic data
Bioavailability	Low
Excretion	Renal and biliary
Identifiers
IUPAC name 3-[(2-hydroxy-2,2-diphenylacetyl)oxy]-1-methyl-1-azabicyclo[2.2.2]octan-1-ium bromide
CAS Number	7020-55-5 Y 3485-62-9
PubChem CID	2784
IUPHAR/BPS	366
DrugBank	DB00771 Y
ChemSpider	2682 Y
UNII	BO76JF850N
KEGG	D00716
ChEMBL	ChEMBL1200950 N
CompTox Dashboard (EPA)	DTXSID6045379
Chemical and physical data
Formula	C22H26NO3+
Molar mass	352.454 g·mol−1
3D model (JSmol)	Interactive image
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
NY (what is this?)  (verify)

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.^[3]

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.^[4] It is said to be a selective muscarinic acetylcholine M₃ receptor antagonist.^[5]