Spiriva (Tiotropium)

Spiriva is a long-acting muscarinic antagonist used to treat chronic obstructive pulmonary disease (COPD) and asthma. Tiotropium works by blocking muscarinic receptors to relax and open the airways, which may help prevent bronchospasm. This medication is used to keep symptoms from getting worse when used daily. It is not for treating sudden breathing problems.

Directions

For COPD, the HandiHaler dosage is 18 mcg once daily as 2 inhalations using one capsule through the device. The Respimat version is taken as 2 inhalations of 2.5 mcg once daily for a total of 5 mcg per day. For asthma, the Respimat is typically taken as 2 inhalations of 1.25 mcg once daily.

Patients should take their dose at the same time each day for best results. The capsules used with the HandiHaler are for inhalation only and shouldn't be swallowed. It's important to pierce the capsule with the HandiHaler device before inhaling the powder. With the Respimat, patients need to prime the inhaler before first use and if it hasn't been used for more than 3 days.

Both devices need to be used with proper technique to ensure the medication reaches the airways effectively. Do not blow into either inhaler device, as this can affect how the medication works.

Ingredients

The active ingredient in this drug is tiotropium.

Cautions

• Before using this medication, you may want to consult a healthcare provider about the following:
  • Any existing health conditions
  • Any allergies
  • A list of all medications currently being taken
• Spiriva is a maintenance inhaler for COPD and isn't meant to treat sudden breathing problems. You'll still need a rescue inhaler, like albuterol, for quick relief during acute episodes of shortness of breath.
• Serious allergic reactions can happen after using Spiriva. Stop using it and seek medical help right away if you notice hives, swelling of the lips or throat, difficulty breathing, or a severe rash.
• People who have reacted to atropine-type medications or who have a milk protein allergy should use Spiriva with caution.
• Like other inhaled medicines, Spiriva may occasionally cause sudden worsening of breathing, called paradoxical bronchospasm. If this happens, use a rescue inhaler and stop Spiriva until you speak with your doctor.
• Spiriva can also worsen certain eye or urinary conditions. Seek medical help if you suddenly develop eye pain, blurred vision, or visual halos, which may be signs of narrow-angle glaucoma.
• Contact your doctor if you have trouble urinating or experience pain when trying to pass urine, especially if you have prostate or bladder-related issues.
• Because Spiriva is cleared through the kidneys, people with moderate to severe kidney problems may be more likely to experience side effects. Your doctor may monitor you more closely if you have reduced kidney function.

Contraindications

Avoid taking or using this medication if any of the following apply:

• Hypersensitivity to tiotropium
• Hypersensitivity to ipratropium
• Allergy to any ingredient of the product, including lactose (for Spiriva HandiHaler)

Side Effects

Common side effects of Spiriva include:

• Dry mouth
• Pharyngitis (throat irritation)
• Cough
• Sinusitis
• Headache (more common in asthma studies)

These reactions are generally mild and often improve with consistent use. Some people may also notice constipation, dizziness, or mild upper-airway symptoms like hoarseness or nasal congestion.

More serious side effects can occur, including immediate allergic reactions, paradoxical bronchospasm, or worsening of narrow-angle glaucoma or urinary retention. In rare cases, Spiriva may also cause palpitations or changes in heart rhythm. Seek medical attention if you develop sudden eye pain or vision changes, trouble urinating, severe breathing problems after inhalation, or signs of an allergic reaction such as facial swelling, hives, or trouble breathing.