Tiotropium

Tiotropium is a prescription medication used daily to treat chronic obstructive pulmonary disease (COPD). Tiotropium inhalation spray is also used for long-term maintenance treatment of asthma. Tiotropium belongs to a group of drugs called antimuscarinics which work by relaxing the smooth muscle of the airways, making it easier to breathe.

This medication comes in capsule form to use with a specially designed inhaler. These capsules are not to be swallowed. Instead, using the Spiriva HandiHaler, the capsule is punctured, and the powder inside the capsule is inhaled into the lungs. Tiotropium is taken once a day.

Tiotropium is also available as an oral inhalation spray and is used once a day.

Common side effects include upper respiratory tract infection, dry mouth, and sinus infection.

Tiotropium is a prescription medication used each day to control symptoms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

Tiotropium inhalation spray (Spiriva Respimat) is also used for long-term maintenance treatment of asthma in people aged six years and older.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Tiotropium may be found in some form under the following brand names:

• Spiriva

• Spiriva Respimat

Tiotropium can cause serious side effects. See "Drug Precautions". 

Other side effects with tiotropium include:

• upper respiratory tract infection
• dry mouth
• sinus infection
• sore throat
• non-specific chest pain
• urinary tract infection
• indigestion
• runny nose
• constipation
• increased heart rate
• blurred vision

These are not all the possible side effects with tiotropium. Tell your doctor if you have any side effect that bothers you or that does not go away.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines and eye drops, vitamins, and herbal supplements. Some of your other medicines or supplements may affect the way tiotropium works. Tiotropium is an anticholinergic medicine. You should not take other anticholinergic medicines while using tiotropium, including ipratropium. Ask your doctor or pharmacist if you are not sure if one of your medicines is an anticholinergic.

Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist when you get a new medicine.

Do not use tiotropium if you are allergic to tiotropium, ipratropium (Atrovent), or any of the ingredients in tiotropium.

Tiotropium can cause serious side effects, including: 

Allergic reaction. Symptoms may include:

• raised red patches on your skin (hives)
• itching
• rash
• swelling of the lips, tongue, or throat that may cause difficulty in breathing or swallowing

If you have these symptoms of an allergic reaction, stop taking tiotropium and call your doctor right away or go to the nearest hospital emergency room.

Sudden narrowing and blockage of the airways into the lungs (bronchospasm). If your breathing suddenly gets worse, stop taking tiotropium and call your doctor right away or go to the nearest hospital emergency room.

New or worsened increased pressure in the eyes (acute narrow-angle glaucoma). Symptoms of acute narrow-angle glaucoma may include:

• eye pain
• blurred vision
• seeing halos (visual halos) or colored images along with red eyes

Using only eye drops to treat these symptoms may not work. If you have these symptoms, stop taking tiotropium and call your doctor right away.

New or worsened urinary retention. Symptoms of blockage in your bladder and/or enlarged prostate may include: 

• difficulty passing urine
• painful urination.

If you have these symptoms of urinary retention, stop taking tiotropium and call your doctor right away.

Do not let the powder from the tiotropium capsule get into your eyes. Your vision may get blurry and the pupil in your eye may get larger (dilate). If this happens, call your doctor.

Tiotropium can cause dizziness and blurred vision. Should you experience these symptoms you should use caution when engaging in activities such as driving a car or operating appliances or other machines.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of tiotropium there are no specific foods that you must exclude from your diet when receiving tiotropium.

Before taking tiotropium, tell your doctor about all your medical conditions, including if you:

• have kidney problems.
• have glaucoma. Tiotropium may make your glaucoma worse.
• have an enlarged prostate, problems passing urine, or a blockage in your bladder. Tiotropium may make these problems worse.
• are pregnant or plan to become pregnant.
• are breastfeeding or plan to breastfeed. 
• have a severe allergy to milk proteins. Ask your doctor if you are not sure.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if tiotropium passes into breast milk. You and your doctor will decide if tiotropium is right for you while you breastfeed.

• Use tiotropium exactly as prescribed. Use tiotropium one time every day.
• Read the "Instructions for Use" contained in the leaflet that comes with tiotropium. Talk with your doctor if you do not understand the instructions.

Tiotropium capsules

• Do not swallow tiotropium capsules.
• Only use tiotropium capsules with the HandiHaler device.
• Do not use the HandiHaler device to take any other medicine.
• Tiotropium comes as a powder in a tiotropium capsule that fits the HandiHaler device. Each tiotropium capsule, containing only a small amount of tiotropium powder, is one full dose of medicine.
• Separate one blister from the blister card. Then take out one of the tiotropium capsules from the blister package right before you use it.
• After the capsule is pierced, take a complete dose of tiotropium by breathing in the powder by mouth two times, using the HandiHaler device (take 2 inhalations from one tiotropium capsule). 
• Throw away any tiotropium capsule that is not used right away after it is taken out of the blister package. Do not leave the tiotropium capsules open to air; they may not work as well.
• If you miss a dose, take it as soon as you remember. Do not use tiotropium more than one time every 24 hours.
• If you use more than your prescribed dose of tiotropium, call your doctor or a poison control center.

Inhalation Spray

Inserting the cartridge and Preparation for use

1) With the green cap closed, press the safety catch and pull off the clear base.

2) Take the cartridge out of the box. Push the narrow end of the cartridge into the inhaler until it clicks into place. The cartridge should be pushed gently against a firm surface to ensure that it has gone all the way in. Do not remove the cartridge once it has been inserted into the inhaler.

3) Replace the clear base. Do not remove the clear base again.

4) Hold the inhaler upright, with the green cap closed. Turn the base in the direction of the red arrows on the label until it clicks (half a turn).

5) Open the green cap until it snaps fully open.

6) Point the inhaler towards the ground. Press the dose release button. Close the green cap.

Repeat steps 4, 5 and 6 until a cloud is visible.

Then repeat steps 4, 5 and 6 three more times to ensure the inhaler is prepared for use. Your inhaler is now ready to use.

Take tiotropium exactly as prescribed. Follow the directions on your prescription label carefully. 

The recommended dose of tiotropium (Spiriva) is two inhalations of the powder contents of one tiotropium capsule, once-daily, with the HandiHaler device.

The recommended dose of tiotropium (Spiriva Respimat) is two inhalations once-daily.

• Treatment of COPD: 2 inhalations of Spiriva Respimat 2.5 mcg once-daily
• Treatment of asthma (6 years and older): 2 inhalations of Spiriva Respimat 1.25 mcg once-daily.

If you take too much tiotropium, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If tiotropium is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.
 

Tiotropium Capsules

• Do not store tiotropium capsules in the HandiHaler device.
• Store tiotropium capsules in the sealed blister package at room temperature between 68°F to 77°F (20° to 25°C).
• Keep tiotropium capsules away from heat and cold (do not freeze).
• Store tiotropium capsules in a dry place. Throw away any unused tiotropium capsules that have been open to air.
• Keep the HandiHaler, tiotropium capsules, and all medicines out of the reach of children.

Tiotropium Inhaler

• Do not use the inhaler after the expiry date which is stated on the carton and on the inhaler.
• Keep the inhaler and all medicines out of the reach of children.
• Store tiotropium inhaler at Room Temperature between 59ºF to 86ºF (15ºC to 30ºC).
• Do not freeze your tiotropium cartridge and inhaler.

Ask your doctor or pharmacist if you have any questions about storing your medication.