Generic Name

Tiotropium

Precaution

Not intended for use as initial treatment for acute bronchospasm and as monotherapy for asthma. Patient w/ narrow-angle glaucoma, prostatic hyperplasia/bladder neck obstruction, cystic fibrosis. History of MI (<6 mth), or unstable or life threatening cardiac arrhythmia w/in the past yr. Moderate to severe renal impairment (CrCl ≤50 mL/min). Pregnancy and lactation. Patient Counselling This drug may cause dizziness and blurred vision, if affected, do not drive or operate machinery. Monitoring Parameters Monitor pulmonary function.

Indication

Tiotropium is indicated for the long term once daily maintenance treatment of bronchospasm and dyspnoea associated with, chronic obstructive pulmonary disease (COPD), including, chronic bronchitis and emphysema.

Contra Indication

Hypersensitivity to atropine and its derivatives (e.g. ipratropium).

Dose

N/A

Side Effect

>10% Upper respiratory tract infection (41%),Dry mouth (16%),Sinusitis (11%) 1-10% Abdominal pain,Allergic reaction,Angina pectoris (including aggravated angina pectoris),Cataract,Chest pain (nonspecific),Constipation,Depression,Dyspepsia,Dysphonia,Edema,Epistaxis,Gastroesophageal reflux,Herpes zoster,Hypercholesterolemia,Hyperglycemia,Infection,Laryngitis,Leg pain,Moniliasis,Myalgia,Paresthesia,Pharyngitis,Rash,Rhinitis,Skeletal pain,Stomatitis (including ulcerative stomatitis),Urinary tract infection,Vomiting <1% Angioedema,Fibrillation,Supraventricular tachycardia,Urinary retention

Pregnancy Category

Mode of Action

Tiotropium bromide, a long-acting quaternary ammonium antimuscarinic, is structurally related to ipratropium. It is a nonselective competitive antagonist of muscarinic (M1-M5) receptors and causes bronchodilation by inhibiting the actions of acetylcholine and other cholinergic stimuli at M3 receptors in the smooth muscle of the respiratory tract.

Interaction

Other anticholinergic agents.

Pregnancy Category Note

Pregnancy The limited human data with therapy during pregnancy are insufficient to inform a drug-associated risk of adverse pregnancy-related outcomes Poorly or moderately controlled asthma in pregnancy increases maternal risk of preeclampsia and infant prematurity, low birth weight, and small for gestational age; level of asthma control should be closely monitored in pregnant women and treatment adjusted as necessary to maintain optimal control Lactation There are no data on presence of tiotropium in human milk, effects on breastfed infant, or effects on milk production; tiotropium is present in milk of lactating rats; however, clinical relevance of these data are not clear. the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal condition

Adult Dose

Inhalation Chronic obstructive pulmonary disease Adult: As Inhaler: 2 puffs (18mcg) once daily. As inhalation cap: 1 cap (18 mcg) daily via inhaler device, at the same time each day.

Child Dose

Inhalation Chronic obstructive pulmonary disease Child> 12 years: As Inhaler: 2 puffs (18mcg) once daily. Child> 18 years: As inhalation cap: 1 cap (18 mcg) daily via inhaler device, at the same time each day.

Renal Dose

Renal impairment: CrCl (ml/min) Dosage Recommendation <50 Use w/ caution.

Administration

N/A