Spiriva (tiotropium) Disease Interactions

There are 2 disease interactions with Spiriva (tiotropium):

Ipratropium and tiotropium are anticholinergic agents. Although systemic effects are rarely seen due to the poor absorption of quaternary ammonium compounds from gastrointestinal and nasal mucosa, there have been reports of increased intraocular pressure and precipitation or exacerbation of angle-closure glaucoma following inadvertent contact of the eye with aerosolized or nebulized drug. Accordingly, therapy with ipratropium and tiotropium should be administered cautiously in patients with urinary retention/obstruction or angle-closure glaucoma. Measures should be taken to minimize ocular exposure to these drugs (e.g., keeping eyes closed during administration by oral inhalation; use of a mouthpiece rather than face mask during nebulization). Urinary retention has been reported occasionally in patients receiving larger doses of ipratropium by nebulizer.

Tiotropium is primarily eliminated unchanged by the kidney. Renal impairment has been associated with increased plasma drug concentrations and reduced drug clearance after both intravenous infusion and dry powder inhalation. Mild renal impairment (CrCl 50 to 80 mL/min), which is often seen in elderly patients, increased tiotropium systemic exposure (AUC) by 39% following intravenous infusion. In COPD patients with moderate to severe renal impairment (CrCl < 50 mL/min), tiotropium AUC increased 82% following intravenous administration, which was confirmed by plasma concentrations after dry powder inhalation. Although generally well tolerated, therapy with ipratropium should be administered cautiously in patients with moderate to severe renal impairment. Patients should be advised of and monitored for potentially increased systemic adverse effects such as constipation, tachycardia, blurred vision, glaucoma, urinary difficulty, and urinary retention.

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Spiriva (tiotropium) drug Interactions

There are 303 drug interactions with Spiriva (tiotropium)

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