Tiotropium (Inhalation)

Tiotropium inhalation is also sold under the brand names Spiriva and Spiriva Respimat and is available only by doctor's prescription to treat chronic obstructive pulmonary disease, chronic bronchitis, asthma and emphysema in adults and children 12 years of age and older.

Overview

What is Tiotropium?

Tiotropium is a member of a family of medicines known as bronchodilators, which are inhaled through the mouth to open bronchial air passages in the lungs. Opening these air passages enables patients to breathe more normally. Patients should not mistake the drug treatment Tiotropium, which is available in an inhaler form, for a rescue inhaler as it is not to treat intense flare-ups of shortness of breath, asthma attacks or other respiratory emergencies. It is, instead, a medical treatment for these diseases that should be taken as prescribed on a regular basis for management of symptoms.

Though damage caused to the lungs by COPD is permanent, as is asthma, treatments such as Tiotropium can help ease symptoms, leading to a better lifestyle for the patient. It is advised that patients being treated for COPD, asthma and other pulmonary illnesses stop smoking. In addition to treatment with a regime of Tiotropium, patients may also receive pulmonary rehabilitation exercises and education to improve their condition.

Tiotropium is also marketed under the brand name Spiriva and Spiriva Respimat. Used to treat chronic obstructive pulmonary disease, chronic bronchitis, emphysema and asthma in adults and children over 12 years of age, Tiotropium has been available for treatment since 2004. It is a medical treatment for these diseases that should be taken as prescribed on a regular basis for management of symptoms.

How does Tiotropium work?

Tiotropium is administered to the patient in the form of an inhaled spray or a dry powder contained within a capsule that is used with a specially designed inhaler. Once per day, the patient is instructed to use the inhaled dose prescribed of Tiotropium to prevent wheezing, shortness of breath, chest tightness and coughing. Tiotropium works by relaxing and opening the bronchial passages in the lungs to make breathing easier for the patient.

The dry powder inhaler for Tiotropium is specially designed for the capsule form of the drug so that it is given in the most effective way. The capsules are not for swallowing but for coming in contact with the specially designed inhaler for distribution in the lungs. Asthma patients are more likely to receive Tiotropium in the form of an inhaled spray, not a capsule.

While Tiotropium is an effective treatment for the symptoms of chronic obstructive pulmonary disease, chronic bronchitis, emphysema, and asthma, it is not a known cure for any of these conditions. Before patients can experience the full benefits of Tiotropium, a consistent treatment regimen of up to a few weeks will need to be followed.

What is chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease is a progressive disease affecting the pulmonary system or lungs. COPD is an umbrella term and may include diseases such as emphysema, chronic bronchitis and some forms of bronchiectasis.

Symptoms of COPD include increasing periods of breathlessness and trouble breathing along with wheezing, productive cough and frequent chest infections. COPD is very common in middle-aged or older adults who smoke or used to smoke. Breathing tests are typically performed on patients who complain of these symptoms to determine the extent of lung damage and course of treatment. There is no known cure for COPD.

What is asthma?

Like COPD, asthma also affects the bronchial system or lungs. Asthma, unlike COPD, typically runs in families and can happen at any age and not necessarily just to smokers, though persons with asthma are strongly encouraged not to smoke.

While there is no one cause that can pinpoint why a person has asthma, conditions such as eczema or allergies often mean that the patient will also suffer from asthma. The patient may have environmental causes such as being around smokers or occupational safety hazards that cause damage to the lungs and bronchial passages. If the patient had lung infections as a child or was born to a mother that smoked while pregnant, this could also lead to the development of asthma symptoms later in life.

Conditions treated

  • Chronic obstructive pulmonary disease (COPD)
  • Chronic bronchitis
  • Emphysema
  • Asthma

Type of medicine

  • Anticholinergic bronchodilator

Side Effects

The following is a list of possible side effects most commonly experienced with treatment of Tiotropium. Keep in mind that not all patients experience side effects that are severe in nature or prolonged in duration. If your side effects are prolonged or severe, report them to your health care professional immediately.

Common side effects include:

  • Pain in arms, back or jaw
  • Chest pain or discomfort
  • Chest tightness or heaviness
  • Irregular heartbeat
  • Nausea
  • Sweating
  • Shortness of breath
  • Cough
  • Difficulty swallowing
  • Dizziness
  • Hives, itching or rash on skin
  • Painful blisters appearing on the body
  • Swelling of the face, eyes, lips or tongue
  • Tiredness or weakness
  • Fainting
  • Hives

These side effects typically don't require medical attention but, as previously stated, should be reported to your physician if they are prolonged or severe in nature.

If the following side effects are experienced, they could be the sign of underlying health issues or allergic reaction to Tiotropium. If you experience the following, contact your physician immediately:

  • Acid reflux/sour stomach
  • Belching
  • Bladder pain
  • Bloody or cloudy urine
  • Body aches or pain
  • Chest pain
  • Chills
  • Difficult, burning, or painful urination
  • Dry mouth or throat
  • Ear congestion
  • Fever
  • Frequent urination
  • Headache
  • Heartburn
  • Hoarseness
  • Indigestion
  • Loss of voice
  • Pain or tenderness around the eyes and cheekbones
  • Runny or stuffy nose
  • Sneezing
  • Sore throat
  • Stomach discomfort, upset, or pain
  • Tender, swollen glands in the neck
  • Voice changes
  • Bloody nose
  • Blurred vision
  • Bone pain
  • Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • Canker sores
  • Difficulty having a bowel movement
  • Discouragement
  • Feeling sad or empty
  • Flushed, dry skin
  • Fruit-like breath odor
  • Increased hunger
  • Increased thirst
  • Increased urination
  • Irritability
  • Lack of appetite
  • Leg pain
  • Loss of interest or pleasure
  • Muscle pain
  • Nausea
  • Painful or difficult urination
  • Sore mouth or tongue
  • Sores, ulcers, or white spots on the lips or tongue or inside the mouth
  • Sweating
  • Swelling or inflammation of the mouth
  • Fatigue
  • Trouble concentrating
  • Trouble sleeping
  • Weight loss
  • Vomiting

This is not a complete list of possible side effects and every patient is different, so any changes to your overall health while using Tiotropium should be discussed with your doctor immediately. To improve the success of the effectiveness of treatment with Tiotropium as well as ensure your safety, you should disclose your full medical history to your doctor prior to treatment. This includes any prescription, non-prescription, vitamin, herbal or holistic medications or treatments you are currently taking or have taken in the past.

Dosage

Different patients have different conditions and the severity of these conditions vary as well. For these reasons, the dosage of Tiotropium will be based on the patient and their unique set of symptoms and circumstances.

In general, however, Tiotropium dosage for asthma is in the form of a spray administered via an inhaler. In adults and children 12 years and older, two puffs are to be inhaled once per day, each puff containing 1.25 micrograms of Tiotropium. Children under 12 years will have their dosage of Tiotropium determined by their doctor to work especially for them based on several health factors.

COPD patients may be prescribed the same liquid spray inhaler format of Tiotropium and will typically be instructed to take two puffs once each day. Each puff contains 2.5 micrograms of Tiotropium. Children with COPD prescribed this liquid spray inhaler dose will have an amount appropriate to their condition, age and symptoms prescribed especially for them.

For COPD patients, adults are typically instructed to take two puffs of the powder found in the capsule of Tiotropium by using the inhaler specially designed for this format of Tiotropium. This will deliver 18 micrograms to the patient once per day. Children suffering from COPD and being treated with the Tiotropium capsule inhaler will have their dose prescribed specifically to them by their health care professional.

Missing a dose of Tiotropium should not cause the patient to double dose; rather, they should skip the missed dose and resume taking the medication at the next regularly scheduled time.

It is important to remember that the inhaler, whether capsule or spray form, is not a rescue inhaler and cannot be used to stop bronchospasms in progress. Your doctor will prescribe you a separate rescue inhaler for emergency purposes in case of an acute attack.

Symptoms of overdose of Tiotropium may include:

  • Dry mouth
  • Stomach pain
  • Constipation
  • Shaking, uncontrollable hand movements
  • Changes in mental state
  • Blurred vision
  • Red eyes
  • Irregular heartbeat
  • Difficulty urinating

If you are experiencing overdose symptoms, contact your physician immediately or your local poison control center. Again, do not swallow Tiotropium capsules, they are intended for inhalation only through a specially designed inhaler.

Interactions

Use of other drugs when on a treatment regimen with Tiotropium inhaler can decrease the effectiveness of one or both drugs and/or cause unwanted health risks and side effects. Inform your health care provider of any prescription, non-prescription, vitamin, herbal or holistic medications or remedies you are taking now or have taken in the past to determine if they will cause unwanted interactions with Tiotropium inhaler medication during treatment.

Tiotropium may cause allergic reactions to patients who are allergic to its main ingredient or to atropine, ipatropium or any other medications. Inform your health care provider of any prescription, non-prescription, vitamin, herbal or holistic supplements, medications or remedies you are taking now or have taken in the past.

Tiotropium has been known to have adverse interactions with the following drugs and combining the two should be avoided:

  • Aclidinium
  • Amantadine
  • Amitriptyline
  • Atropine
  • Baclofen
  • Chlorphenamine
  • Chlorpromazine
  • Clemastine
  • Clomipramine
  • Clozapine
  • Cyclizine
  • Cyclopentolate
  • Cyproheptadine
  • Darifenacin
  • Dicycloverine
  • Dimenhydrinate
  • Disopyramide
  • Dosulepin
  • Doxepin
  • Fesoterodine
  • Flavoxate
  • Glycopyrronium
  • Haloperidol
  • Homatropine
  • Hydroxyzine
  • Hyoscine
  • Imipramine
  • Ipratropium
  • Levodopa
  • Levomepromazine
  • Lofepramine
  • Loxapine
  •  Nefopam
  • Nortriptyline
  • Orphenadrine
  • Oxybutynin
  • Perphenazine
  • Pimozide
  • Prochlorperazine
  • Procyclidine
  • Promethazine
  • Propafenone
  • Propantheline
  • Propiverine
  • Solifenacin
  • Tolterodine
  • Trifluoperazine
  • Trihexyphenidyl
  • Trimipramine
  • Tropicamide
  • Trospium
  • Umeclidinium

While this is not a complete list of drugs known to interact with Tiotropium, it is a basic guideline of known interactions. As with all drug treatment regimens, patients are advised to fully inform their health care provider of any and all health conditions or treatments they are currently experiencing. This includes any prescription or non-prescription medications or vitamin, herbal or holistic supplements or treatments. Inform your doctor of any pre-existing health conditions that you are suffering from now or have been treated for in the past. Your family history is also important information to pass on to your health care provider so that any possible risks can be determined prior to treatment.

Warnings

It is of utmost importance that patients undergoing treatment with Tiotropium inhaler visit their doctor for regular progress checks to make sure it is effectively controlling systems and not causing side effects that could lead to long-term health problems.

This inhaled medication is intended to treat symptoms of chronic obstructive pulmonary disease, chronic bronchitis, emphysema and asthma but is not intended to be used and is ineffective as a rescue inhaler. Your doctor will prescribe you a separate rescue inhaler intended for use during acute breathing attacks.

Tiotropium inhaler may cause allergic reactions such as anaphylaxis and angioedema. Symptoms of allergic reaction to Tiotropium include skin rashes, itching, and shortness of breath, difficulty breathing, and hive-like swelling on the face, lips, tongue, throat, eyes, hands, legs, feet or sex organs after use of the medication. Report these symptoms to your doctor immediately to avoid long-term adverse health effects from infections caused by the use of Tiotropium.

You may experience paradoxical brochospams after using Tiotropium which will make your breathing or wheezing symptoms worse and may be life threatening. Your doctor should be informed immediately if you experience coughing, difficulty breathing, shortness of breath or wheezing after use of Tiotropium inhaled medication.

Any changes in your vision or pain or discomfort in your eyes should be reported to your doctor. You may need to have your eyes examined by an ophthalmologist to make sure no side effects are affecting the long-term health of your eyes or vision.

Your doctor should be informed immediately if you have a decrease in urination in either frequency or volume or any difficulty passing urine. This could be a sign of side effects of Tiotropium that are causing long-term health damage.

Women who are pregnant are not advised to undergo treatment with Tiotropium. Inform your doctor if you are pregnant or may become pregnant while under this treatment regime. Breastfeeding mothers are also not advised to use Tiotropium inhaler as the medication may travel through to their child via their breast milk. Consult with your health care provider on the best course of treatment for you while breastfeeding.

You may experience dizziness or blurred vision after use of Tiotropium, so for this reason, you should avoid driving or operating heavy machinery while using this medication. Do not combine other medications, either prescription or non-prescription, vitamin, herbal or holistic, without first discussing interaction risks with your health care provider.

Storage

Tiotropium inhaler, as with other medications, should be kept out of sight and reach of children. Unused or expired Tiotropium inhalers should be disposed of properly according to the advice given to you by your health care provider.

Leave the capsules in the blister pack until you are ready to use them and open only one at a time. Once opened, the capsule must be used immediately. Once a blister has been opened, the two remaining capsules should be used over the next two consecutive days. Capsules that have been exposed to air and will not be used immediately should be disposed of properly as they are no longer safe or effective.

Store the Tiotropium medication at room temperature away from direct sunlight, heat or moisture in the original packaging. Do not allow the Tiotropium to freeze.

Summary

Tiotropium inhaled medication is prescribed by doctors to provide maintenance treatment of the symptoms of chronic obstructive pulmonary disease or COPD, chronic bronchitis, emphysema and asthma. While COPD and emphysema are primarily present in older adults, asthma can affect people of all ages.

Tiotropium is an inhaled medication found either in spray or capsule form. The capsule form of Tiotropium is administered by a specialized inhaler that delivers the medication in powder form directly into the lung passages. Tiotropium is typically dosed at two puffs taken once each day; the capsule and powder form delivers a higher dose at 18 micrograms total while the spray is 1.25 to 2.5 micrograms per puff. The dosage of Tiotropium is prescribed by your doctor and based on your medical condition, your symptoms and their severity as well as your age and overall health. Follow doctor's instructions for dosage amount and frequency as well as time of day to take Tiotropium.

Tiotropium works by relaxing the bronchial passages in the lungs, allowing the patient to experience relief from symptoms constricting their breathing functions.

Missed doses of Tiotropium should be skipped rather than doubled up on to make up a missed dose. Store this and other medications out of sight and reach of children in the original packaging out of direct sunlight, away from heat and moisture. Outdated or unused Tiotropium should be disposed of per the advice of your health care professional.

Use of Tiotropium could cause allergic reactions in some people. If you experience symptoms of anaphylaxis or angioedema such as skin rashes, itching, shortness of breath, hives around the facial area, hands, legs or feet, report this to your doctor immediately.

Experiencing paradoxical bronchospam after use of Tiotropium is a condition that can be life-threatening. Report any coughing, difficulty breathing, shortness of breath or wheezing symptoms you experience after using Tiotropium to your health care provider immediately.

Other side effects such as mild coughing, nausea, sweating, fatigue, dizziness or shortness of breath are typically mild or short in duration, often over a few minutes after dosing. While annoying, these side effects are typically not an emergency. Any severe or prolonged symptoms when using Tiotropium should be reported to your physician.

Interactions with other drugs are extensive, so it is important to disclose fully all medical history including any prescription or non-prescription medications you are taking now or have taken in the past as well as any medical conditions or family history. Knowing your full medical history can ensure that your health care provider has been able to consider all options of effective, safe treatment of your condition.

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Last Reviewed:
December 24, 2017
Last Updated:
April 23, 2018
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