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Tiotropium

    Brands

    DEA Class;  Rx

    Common Brand Names; Spiriva HandiHaler, Spiriva Respimat

    • Anticholinergics, Respiratory
     

    Inhaled long-acting muscarinic antagonist (LAMA); administered once daily; minimal side effects except for xerostomia
    Used for maintenance treatment of COPD in adults
    Also approved for maintenance treatment of asthma in adult and pediatric patients 6 years and older

    For asthma maintenance treatment.

    For the maintenance treatment of chronic obstructive pulmonary disease (COPD), (e.g., chronic bronchitis or emphysema) and to reduce exacerbations of COPD.

    Oral Inhalation dosage (powder capsule for inhalation; e.g., Spiriva HandiHaler)

    History of hypersensitivity to ipratropium or tiotropium

    History of severe hypersensitivity to milk proteins (excipient in powder contained in capsule)

    Lactose allergy

    • Upper respiratory tract infection (41%)
    • Dry mouth (16%)
    • Sinusitis (11%)
    • Abdominal pain
    • Allergic reaction
    • Angina pectoris (including aggravated angina pectoris)
    • Cataract
    • Chest pain (nonspecific)
    • Constipation
    • Depression
    • Dyspepsia
    • Dysphonia
    • Edema
    • Epistaxis
    • Gastroesophageal reflux

    Not for acute use; not a rescue medication

    Immediate hypersensitivity reactions (eg, angioedema, itching, rash); stop treatment immediately

    Capsule not to be swallowed; to be administered only by PO inhalation via HandiHaler device

    Worsening of narrow-angle glaucoma

    Worsening of urinary retention

    Potential for paradoxical bronchospasm

    Prostatic hyperplasia

    Bladder-neck obstruction

    Wash hands after handling capsules

    The limited human data with therapy during pregnancy are insufficient to inform a drug-associated risk of adverse pregnancy-related outcomes

    There are no data on presence of tiotropium in human milk, effects on breastfed infant, or effects on milk production

    Adults

    2.5 mcg/day for asthma or 5 mcg/day for COPD for inhalation spray; 18 mcg/day for dry powder inhaler.

    Geriatric

    2.5 mcg/day for asthma or 5 mcg/day for COPD for inhalation spray; 18 mcg/day for dry powder inhaler.

    Adolescents

    2.5 mcg/day for inhalation spray.

    Children

    6 to 12 years: 2.5 mcg/day for inhalation spray.
    6 years and younger: Safety and efficacy have not been established.

    Infants

    Safety and efficacy have not been established.

    Tiotropium hydrobromide

    capsule (Spiriva Handihaler; powder for oral inhalation)

    • 18mcg

    solution for inhalation (Spiriva Respimat)

    • 1.25mcg/actuation
    • 2.5mcg/actuation