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Tiotropium Bromide
Pronunciation: tye-oh-TROE-pee-um BROE-mide
Class: Anticholinergic
Trade Names
Spiriva
- Capsule, powder for inhalation 18 mcg
Pharmacology
Inhibits smooth muscle receptors, leading to bronchodilation.
Pharmacokinetics
Absorption
Bioavailability is approximately 19.5%. T max is 5 min. At steady state, peak and trough plasma levels are 17 to 19 pg/mL and 3 to 4 pg/mL, respectively.
Distribution
Vd is 32 L/kg. Protein binding is 72%.
Metabolism
CYP2D6 and CYP3A4 are involved.
Elimination
Approximately 14% is eliminated unchanged in the urine; the remainder is not absorbed in the gut and is eliminated in the feces. Terminal elimination half-life is 5 to 6 days.
Special Populations
Renal Function ImpairmentReduced Cl and increased plasma concentrations may occur.
Hepatic Function ImpairmentNot studied.
ElderlyAdvanced age is associated with a decrease in tiotropium renal Cl, which may be explained by decreased renal function.
Indications and Usage
Long-term maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema; to reduce exacerbations in COPD patients.
Contraindications
Hypersensitivity to ipratropium or tiotropium.
Dosage and Administration
AdultsInhalation 2 inhalations of 1 capsule daily.
General Advice
- For inhalation only with the HandiHaler device.
- Patients should not swallow capsules.
Storage/Stability
Store at 59° to 86°F. Protect from extreme temperature and moisture. Do not remove capsule from sealed blister until immediately before use. Discard any capsule that is inadvertently removed from the sealed blister and not used immediately. Do not store capsules in inhalation device.
Drug Interactions
None well documented.
Laboratory Test Interactions
None well documented.
Adverse Reactions
Cardiovascular
Angina pectoris, including aggravated angina pectoris (1% to 3%); palpitations, tachycardia (postmarketing).
CNS
Headache (6%); depression, insomnia (4%); dysphonia, paresthesia (1% to 3%); dizziness (postmarketing).
Dermatologic
Rash (4%); dry skin; skin infection; skin ulcer; pruritus, urticaria (postmarketing).
EENT
Pharyngitis (13%); cataract (1% to 3%); oropharyngeal candidiasis; hoarseness, IOP, oral candidiasis, throat irritation (postmarketing).
GI
Dry mouth (16%); dyspepsia (6%); abdominal pain, constipation (5%); vomiting (4%); gastroesophageal reflux, stomatitis (including ulcerative stomatitis) (1% to 3%); gingivitis; dysphagia, intestinal obstruction, including ileus paralytic (postmarketing).
Metabolic-Nutritional
Hypercholesterolemia, hyperglycemia (1% to 3%); dehydration.
Musculoskeletal
Arthralgia, myalgia (4%); skeletal pain (1% to 3%); joint swelling.
Respiratory
Upper respiratory tract infection (41%); sinusitis (11%); rhinitis (6%); epistaxis (4%); coughing (at least 3%); laryngitis (1% to 3%).
Miscellaneous
Accidents (13%); nonspecific chest pain, UTI (7%); dependent edema (5%); infection, moniliasis (4%); arthritis, flu-like symptoms (at least 3%); allergic reaction, herpes zoster infection, leg pain (1% to 3%); application-site irritation (eg, glossitis, mouth ulceration, pharyngolaryngeal pain) (postmarketing).
Precautions
MonitorClosely monitor patients with a history of hypersensitivity reactions to atropine for similar hypersensitivity reactions to tiotropium. Monitor therapy closely in patients with moderate to severe renal impairment. Monitor patients for signs and symptoms of narrow-angle glaucoma and urinary retention. |
Pregnancy
Category C .
Lactation
Undetermined.
Children
Safety and efficacy not established.
Hypersensitivity
Immediate hypersensitivity reactions, including angioedema, have been reported. Use with caution in patients with severe hypersensitivity to milk proteins.
Renal Function
Monitor therapy closely in patients with moderate to severe renal impairment.
Special Risk Patients
Use with caution in patients with narrow-angle glaucoma, prostatic hyperplasia, urinary retention, or bladder-neck obstruction.
Acute bronchospasm
Not indicated for initial treatment of acute episodes of bronchospasm.
Bronchospasm
Paradoxical bronchospasm may occur.
Overdosage
Symptoms
Anticholinergic signs and symptoms.
Patient Information
- Advise patient to continue taking other medications for same condition as prescribed by health care provider.
- Instruct patient on the proper storage, handling, and use of the capsules and inhalation device, referring to the Patient's Instructions for Use instruction sheet included with the medication. Ensure that patient understands how to clean the inhalation device.
- Advise patient that medication should never be administered with a spacer device or with any other inhalation device than that provided. Caution patient not to administer other inhaled medications with the inhalation device.
- Caution patient not to exceed prescribed dose. Inform patient that medication is being inhaled even if the dose being delivered is not tasted or felt.
- Instruct patient not to stop the medication once symptoms have improved. Continued daily use is necessary to control symptoms.
- Advise patient not to change the dose or stop using unless advised by health care provider.
- Warn patient that tiotropium is a maintenance medication and is not to be used for immediate relief of breathing problems. Advise patient to use rescue medication (short-acting bronchodilator) to obtain rapid relief of breathing problems.
- Advise patient that medication does not replace inhaled or oral corticosteroids and to continue to use those drugs as prescribed by health care provider.
- Advise patient to inform health care provider if symptoms do not improve or worsen, if more short-acting bronchodilator than usual is needed, or if the short-acting bronchodilator appears to become less effective.
- Instruct patient to discontinue use and immediately notify health care provider if eye pain or discomfort, blurred vision, vision halos, or colored images develop in association with red eyes. Advise patient that these symptoms may be associated with a serious problem that will require immediate medical care.
- Advise patient to carry medical identification (eg, card, bracelet) indicating that they have COPD.
Copyright © 2009 Wolters Kluwer Health.
Further information
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