BMA Concise Guide to Medicine & Drugs

Tiotropium

Brand names Spiriva, Spiriva Respimat

Used in the following combined preparations None

QUICK REFERENCE

Drug group Bronchodilator

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Tiotropium is a long-acting anticholinergic bronchodilator that relaxes the muscles surrounding the bronchioles (airways in the lung). It is used in the maintenance treatment of chronic obstructive lung disorders, such as chronic bronchitis. The drug is not suitable for acute attacks of wheezing or in the emergency treatment of asthma, when salbutamol should be used. Tiotropium is taken by inhalation of a powder or solution, and it acts directly and locally on the inner surface of the lungs and not via the blood. The most common side effect is a dry mouth.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Powder in capsules for inhaler, solution for inhalation.

Frequency and timing of doses Once daily, at the same time each day.

Adult dosage range 18mcg daily (powder); 5mcg daily (solution).

Onset of effect 5–30 minutes.

Duration of action 24 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 8 hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Dry mouth is the most common adverse effect of tiotropium; sore throat and a cough are also common. If any of these are severe, discuss with your doctor. Rarely, the drug may cause nosebleeds, an altered sense of taste, changes in the voice, a fast heartbeat or palpitations, difficulty in passing urine, rash, and wheezing after inhalation. Consult your doctor if any of these symptoms occur. If you get the drug in your eye, it could trigger or worsen glaucoma, with symptoms such as eye pain, blurred vision, and visual haloes; if such symptoms occur, call your doctor immediately.

INTERACTIONS

Anticholinergic drugs (e.g. atropine and ipratropium) The effects and toxicity of tiotropium are likely to be increased if it is used at the same time as these drugs.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You are allergic to atropine or ipratropium.

· You have prostate problems.

· You have urinary retention.

· You have glaucoma.

· You have kidney problems.

· You are taking other medicines.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding Safety not established, but the amount present in breast milk is unlikely to harm your baby. Discuss with your doctor.

Infants and children Not recommended under 18 years.

Over 60 No known problems.

Driving and hazardous work No known problems.

Alcohol No known problems.

Protecting your eyes Care must be taken to avoid getting the drug into the eyes as it could trigger glaucoma or make existing glaucoma worse. If you develop eye or vision problems, call your doctor immediately.

PROLONGED USE

No known problems.