tiotropium

Absorption: Handihaler: 19% absorbed following inhalation; Respimat: 33% absorbed following inhalation.

Distribution: Extensive tissue distribution; due to route of administration ↑ concentrations occur in lung.

Metabolism/Excretion: 74% excreted unchanged in urine; 25% of absorbed drug is metabolized.

Half-Life: 5–6 days.

Time/Action Profile ⬆ ⬇

(bronchodilation)

ROUTE	ONSET	PEAK	DURATION
Inhaln	rapid	5 min	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to tiotropium or ipratropium.

Use Cautiously in:

Hypersensitivity to atropine or milk proteins;
Narrow-angle glaucoma, prostatic hyperplasia, bladder neck obstruction (may worsen condition);
CCr ≤60 mL/min (monitor closely);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Children 6 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: tachycardia

Derm: rash

EENT: glaucoma

GI: dry mouth, constipation

GU: urinary difficulty, urinary retention

Resp: paradoxical bronchospasm

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

Should not be used concurrently with ipratropium due to risk of additive anticholinergic effects.

Route/Dosage ⬆ ⬇

Inhaln
(Adults ): Handihaler: 18 mcg once daily; Respimat: 2 inhalations of 2.5 mcg once daily.
Inhaln
(Adults and Children ≥6 yr): Respimat: 2 inhalations of 1.25 mcg once daily.

Availability ⬆ ⬇

(Generic available)

Dry powder capsules for inhalation (Handihaler): 18 mcg
Inhalation solution (Respimat): 1.25 mcg/inhalation in cartridge (delivers 28 or 60 metered inhalations); 2.5 mcg/inhalation in cartridge (delivers 28 or 60 metered inhalations)

Assessment ⬆ ⬇

Inhaln: Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication effect. Consult health care professional about alternative medication if severe bronchospasm is present; onset of action is too slow for patients in acute distress. If paradoxical bronchospasm (wheezing) occurs, hold medication and notify health care professional immediately.

Implementation ⬆ ⬇

Do not confuse Spiriva with Apidra or Inspra.
Inhaln: See Medication Administration Techniques for administration of inhalation medications.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. Capsules are for inhalation only and must not be swallowed. Take missed doses as soon as remembered unless almost time for the next dose; space remaining doses evenly during day. Do not double doses.
Advise patient that tiotropium is not to be used for acute bronchospasm attacks, but may be continued during an acute exacerbation.
Advise patient to notify health care professional immediately if signs and symptoms of angioedema (swelling of the lips, tongue, or throat, itching, rash) or signs of glaucoma (eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) occur.
Caution patient to avoid spraying medication in eyes; may cause blurring of vision and pupil dilation.
Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth; usually resolves with continued treatment.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, including eye drops.
Rep: Advise females of reproductive potential to inform health care professional if pregnancy is planned or suspected or if breastfeeding.
Handihaler: Instruct patient in proper use and cleaning of the Handihaler inhaler. Review the Patient's Instructions for Use guide with patient. Capsules should be stored in sealed blisters; remove immediately before use or effectiveness of capsules is reduced. Tear blister strip carefully to expose only one capsule at a time. Discard capsules that are inadvertently exposed to air. Spiriva should be administered only via the Handihaler and the Handihaler should not be used with other medications. When disposing of capsule, tiny amount of powder left in capsule is normal.
Respimat: Advise patient to prime inhaler by actuating inhaler toward the ground until an aerosol cloud is visible, then repeat process 3 more times. If not used for >3 days, actuate inhaler once to prepare inhaler for use. If not used for >21 days, actuate inhaler until an aerosol cloud is visible, then repeat 3 more times to prepare inhaler for use. Discard 3 mo from 1st use.

Evaluation/Desired Outcomes ⬆ ⬇

Decreased dyspnea.
- Improved breath sounds.
Fewer exacerbations in patients with COPD and asthma.

US Brand Names ⬆ ⬇

Spiriva Handihaler, Spiriva Respimat

Canadian Brand Names ⬆ ⬇

Pill Image

Code ⬆

NDC Code

0597- Boehringer Ingelheim Pharmaceuticals, Inc.
- 0597-0075- Spiriva HandiHaler
  - 0597-0075-41- 3 BLISTER PACK in 1 CARTON (0597-0075-41) > 10 CAPSULE in 1 BLISTER PACK

0597- Boehringer Ingelheim Pharmaceuticals, Inc.
- 0597-0075- Spiriva HandiHaler
  - 0597-0075-47- 9 BLISTER PACK in 1 CARTON (0597-0075-47) > 10 CAPSULE in 1 BLISTER PACK

0597- Boehringer Ingelheim Pharmaceuticals, Inc.
- 0597-0075- Spiriva HandiHaler
  - 0597-0075-75- 1 BLISTER PACK in 1 CARTON (0597-0075-75) > 5 CAPSULE in 1 BLISTER PACK

50090- A-S Medication Solutions
- 50090-4414- Spiriva
  - 50090-4414-0- 9 BLISTER PACK in 1 CARTON (50090-4414-0) > 10 CAPSULE in 1 BLISTER PACK

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇