Tiotropium

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

  1. abdominal pain
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. angina
  5. angioedema
  6. arthralgia
  7. atrial fibrillation
  8. blurred vision
  9. bronchospasm
  10. candidiasis
  11. cataracts
  12. chest pain (unspecified)
  13. constipation
  14. corneal edema
  15. cough
  16. dehydration
  17. depression
  18. diarrhea
  19. dizziness
  20. dyspepsia
  21. dysphagia
  22. dysphonia
  23. dysuria
  24. elevated hepatic enzymes
  25. epistaxis
  26. fever
  27. gastroesophageal reflux
  28. GI obstruction
  29. gingivitis
  30. glossitis
  31. headache
  32. hoarseness
  33. hypercholesterolemia
  34. hyperglycemia
  35. hypertension
  36. ileus
  37. infection
  38. insomnia
  39. laryngeal edema
  40. laryngitis
  41. laryngospasm
  42. maculopapular rash
  43. musculoskeletal pain
  44. myalgia
  45. ocular hypertension
  46. ocular irritation
  47. ocular pain
  48. oral ulceration
  49. palpitations
  50. paresthesias
  51. peripheral edema
  52. pharyngitis
  53. prostatic hypertrophy
  54. pruritus
  55. rash
  56. rhinitis
  57. sinus tachycardia
  58. sinusitis
  59. skin ulcer
  60. stomatitis
  61. supraventricular tachycardia (SVT)
  62. throat irritation
  63. urethral pain
  64. urinary retention
  65. urticaria
  66. visual impairment
  67. vomiting
  68. xerosis
  69. 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
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