tiotropium

Contraindicated in:

Hypersensitivity to tiotropium or ipratropium.

Use Cautiously in:

Hypersensitivity to atropine or milk proteins;
Narrow-angle glaucoma, prostatic hyperplasia, or 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.

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)

Route/Dosage ⬆ ⬇

COPD

Inhaln (Adults ): Handihaler: 18 mcg once daily; Respimat: 2 inhalations of 2.5 mcg once daily.

Asthma

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

US Brand Names ⬆ ⬇

Spiriva Handihaler, Spiriva Respimat

Action ⬆ ⬇

Acts as anticholinergic by selectively and reversibly inhibiting M₃ receptors in smooth muscle of airways.

Therapeutic effects:

Decreased incidence and severity of bronchospasm in COPD and asthma.

Classifications ⬆ ⬇

Therapeutic Classification: bronchodilators

Pharmacologic Classification: anticholinergics

Pharmacokinetics ⬆ ⬇

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.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(bronchodilation)

ROUTE	ONSET	PEAK	DURATION
Inhaln	rapid	5 min	24 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise to read Patient Information before starting therapy. Instruct to take exactly as directed. 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 to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications, including eye drops.
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 provider 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.
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.
Rep: Advise women of reproductive potential to inform health care provider if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇