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What is Tiotropium
Tiotropium bromide is a quaternary ammonium derivative long-acting muscarinic antagonist (LAMA) that is administered once daily.
Tiotropium is indicated in adults for the maintenance treatment of chronic obstructive pulmonary disease (COPD).
Tiotropium effects on trough and peak FEV-1 and trough FVC are sustained with continued use and may lead to reduction in the use of beta-agonists for maintenance or rescue COPD therapy; data from a 6-month study indicate significant increases in bronchodilation, dyspnea, and health-related quality of life scores (HRQoL) with tiotropium use for COPD.
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, tiotropium may be used as initial monotherapy in all groups of COPD patients; however, combination therapy with a long-acting beta-agonist (LABA) or inhaled corticosteroid (ICS) may be needed in patients in Group D or in patients still experiencing dyspnea or exacerbations upon follow-up
Brand Names
- Spiriva HandiHaler
- Spiriva Respimat
Indications
- asthma
- chronic bronchitis
- chronic obstructive pulmonary disease (COPD)
- emphysema
For the maintenance treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema and to reduce exacerbations of COPD
Side Effects
- abdominal pain
- anaphylactic shock
- anaphylactoid reactions
- angina
- angioedema
- arthralgia
- atrial fibrillation
- blurred vision
- bronchospasm
- candidiasis
- cataracts
- chest pain (unspecified)
- constipation
- corneal edema
- cough
- dehydration
- depression
- diarrhea
- dizziness
- dyspepsia
- dysphagia
- dysphonia
- dysuria
- elevated hepatic enzymes
- epistaxis
- fever
- gastroesophageal reflux
- GI obstruction
- gingivitis
- glossitis
- headache
- hoarseness
- hypercholesterolemia
- hyperglycemia
- hypertension
- ileus
- infection
- insomnia
- laryngeal edema
- laryngitis
- laryngospasm
- maculopapular rash
- musculoskeletal pain
- myalgia
- ocular hypertension
- ocular irritation
- ocular pain
- oral ulceration
- palpitations
- paresthesias
- peripheral edema
- pharyngitis
- prostatic hypertrophy
- pruritus
- rash
- rhinitis
- sinus tachycardia
- sinusitis
- skin ulcer
- stomatitis
- supraventricular tachycardia (SVT)
- throat irritation
- urethral pain
- urinary retention
- urticaria
- visual impairment
- vomiting
- xerosis
- xerostomia
Monitoring Parameters
- pulmonary function tests (PFTs)
Contraindications
- acute bronchospasm
- anticholinergic medications
- bladder obstruction
- breast-feeding
- cardiac arrhythmias
- children
- closed-angle glaucoma
- contact lenses
- driving or operating machinery
- geriatric
- infants
- milk protein hypersensitivity
- ocular exposure
- ophthalmic administration
- pregnancy
- prostatic hypertrophy
- renal impairment
- urinary retention
- urinary tract obstruction
Interactions
- Aclidinium
- Aclidinium; Formoterol
- Anticholinergics
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benztropine
- Chlordiazepoxide; Clidinium
- Dicyclomine
- Flavoxate
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Homatropine; Hydrocodone
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Indacaterol; Glycopyrrolate
- Mepenzolate
- Methacholine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methscopolamine
- Oxybutynin
- Propantheline
- Scopolamine
- Trihexyphenidyl