Top 300 Pharmacy Drug Cards

TIOTROPIUM: Spiriva

Class: Anticholinergic Bronchodilator

Dosage Forms. Inhalation Capsule: 18 mcg

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Common FDA Label Indication, Dosing, and Titration.

1. COPD: Inhale contents of one capsule (18 mcg) daily using manufacturer-provided device (do not swallow capsules)

Off-Label Uses. None

MOA. Tiotropium is a long-acting antimuscarinic agent, which is often referred to as an anticholinergic. It has similar affinity to the subtypes of muscarinic receptors, M1 to M5. In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilation. The bronchodilation following inhalation of tiotropium is predominantly a site-specific effect.

Drug Characteristics: Tiotropium

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Medication Safety Issues: Tiotropium

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Drug Interactions: Tiotropium

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Adverse Reactions: Tiotropium

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Efficacy Monitoring Parameters. Monitor pulmonary function tests, shortness of breath.

Toxicity Monitoring Parameters. Seek medical attention if severe anticholinergic side effects occur, including bladder obstruction, narrow angle glaucoma prostatic hyperplasia, and urinary retention or difficulty.

Key Patient Counseling Points. Advise patients that this drug is not indicated for acute bronchospasm (rescue therapy). This drug may cause increased heart rate, dry mouth, constipation, urinary difficulty and retention, respiratory tract infection, and sinusitis. Warn patients that the drug capsules are for inhalation only and are not to be swallowed; instruct patients on the use of the inhalation device.

Clinical Pearls. Paradoxical bronchospasm has occurred with tiotropium; when it occurs, therapy should be permanently discontinued.