Tiotropium inhalation
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Powder or solution for inhalation containing tiotropium.
Drugs List
Therapeutic Indications
Uses
Asthma: Add-on maintenance treatment
Chronic obstructive pulmonary disease
Dosage
Adults
Inhalation of one capsule once a day (at the same time of day) using the inhalation device provided.
OR
Two puffs of the inhalation solution (5 micrograms tiotropium) to be inhaled once daily (at the same time of day) using the inhalation device provided.
Tiotropium bromide should not be used more frequently than once daily and not as rescue therapy.
Children
Spiriva Respimat 2.5microgram - Severe Asthma: Add-on maintenance treatment
Children aged 6 to 18 years
Two puffs of the inhalation solution (5 micrograms tiotropium) to be inhaled once daily (at the same time of day) using the inhalation device provided.
Contraindications
Children under 6 years
Cystic fibrosis
Precautions and Warnings
Children aged 6 to 18 years
Benign prostatic hyperplasia
Bladder outflow obstruction
Breastfeeding
Cardiac arrhythmias
Galactosaemia
Glucose-galactose malabsorption syndrome
Lactose intolerance
Narrow angle glaucoma
New York Heart Association class III failure
New York Heart Association class IV failure
Pregnancy
Renal impairment - creatinine clearance below 50ml/minute
Within 6 months of a myocardial infarction
Not to be used to relieve an acute asthmatic attack
Advise ability to drive/operate machinery may be affected by side effects
Ensure patient has a fast acting bronchodilator available
Not all available brands are recommended for all age groups
Not all presentations are licensed for all indications
Not to be used as the sole or main treatment for severe or unstable asthma
Some formulations contain lactose
Avoid contact with eyes
Check patient is using correct inhaler technique
Monitor closely patient at risk of cardiovascular disorders
Advise patient to report any blurred vision or any other eye symptoms
Advise patient to report new or worsening signs of cardiac failure
Drug induced bronchospasm may occur
Prolonged treatment may lead to dental caries
Discontinue if paradoxical bronchospasm occurs
Asthma: Advise patients benefit of therapy is apparent after several doses
Contact with the eyes may result in precipitation or worsening of narrow angle glaucoma, eye pain or discomfort, temporary blurring of vision, visual halos or coloured images in association with red eyes from conjunctival congestion and corneal oedema. Should any combination of these symptoms develop, patients should stop using tiotropium bromide and consult a specialist immediately.
Take the risk of cardiovascular side effects into account for patients with conditions that may be affected by the anticholinergic action of tiotropium, including:
Unstable or life threatening cardiac arrhythmia
Cardiac arrhythmia requiring intervention or a change in drug therapy in the past year
Hospitalisation for heart failure (NYHA Class III or IV) within the past year
Pregnancy and Lactation
Pregnancy
Use tiotropium with caution during pregnancy.
The manufacturer does not recommend using tiotropium during pregnancy. At the time of writing there is limited published information regarding the use of tiotropium during pregnancy. Animal studies do not show reproductive toxicity however potential risks remain unknown.
Lactation
Use tiotropium with caution during breastfeeding.
The manufacturer does not recommend breastfeeding whilst taking tiotropium and advises that the patient discontinues tiotropium or discontinues breastfeeding. It is not known if tiotropium is excreted in human breast milk. Effects on exposed infants are unknown.
Side Effects
Anaphylactic reaction
Angioneurotic oedema
Atrial fibrillation
Blurred vision
Bronchospasm
Candidiasis (mouth or throat)
Conjunctival vascular congestion
Constipation
Corneal oedema
Cough
Dehydration
Dizziness
Dry mouth
Dry skin
Dysphagia
Dysphonia
Dysuria
Epistaxis
Eye pain
Gastroesophageal reflux disease
Gingivitis
Glaucoma
Glossitis
Headache
Hypersensitivity reactions
Increase in dental caries
Increased intra-ocular pressure
Insomnia
Intestinal obstruction
Joint swelling
Laryngitis
Nausea
Palpitations
Paralytic ileus
Pharyngitis
Pruritus
Rash
Sinusitis
Skin infection
Skin ulcer
Stomatitis
Supraventricular tachycardia
Tachycardia
Taste disturbances
Urinary retention
Urinary tract infections
Urticaria
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: November 2021
Reference Sources
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 16 November 2021
Summary of Product Characteristics: Acopair 18 microgram inhalation powder, hard capsule. Generics [UK] Ltd t/a Mylan. Revised April 2020.
Summary of Product Characteristics: Braltus 10 microgram inhalation powder, hard capsule. Teva UK Limited. Revised February 2019.
Summary of Product Characteristics: Spiriva 18 microgram inhalation powder, hard capsule. Boehringer Ingelheim Limited. Revised January 2019.
Summary of Product Characteristics: Spiriva Respimat 2.5 microgram, inhalation solution. Boehringer Ingelheim Limited. Revised December 2020.
Summary of Product Characteristics: Tiogiva 18 microgram, inhalation powder, hard capsule. Glenmark Pharmaceuticals Europe Ltd. Revised May 2021.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.