Home Drug Guide Tiotropium Bromide

Drug Guide

Generic Name

Tiotropium Bromide

Brand Names Spiriva, Spiriva Respimat

Classification

Therapeutic: COPD and asthma maintenance treatment

Pharmacological: Anticholinergic (muscarinic receptor antagonist)

FDA Approved Indications

Chronic obstructive pulmonary disease (COPD) management
Asthma (for certain formulations and indications)

Mechanism of Action

Tiotropium bromide is a long-acting muscarinic antagonist that blocks M3 muscarinic receptors in bronchial smooth muscle, leading to prolonged bronchial dilation and reduction of mucus secretion.

Dosage and Administration

Adult: 2 inhalations (1.25 mcg each) once daily via HandiHaler or 2 inhalations (2.5 mcg each) once daily via Respimat.

Pediatric: Not approved for children under 6 years. Dosing for children older than 6 years should be determined by a healthcare provider.

Geriatric: Generally similar to adult dosing; monitor for anticholinergic side effects.

Renal Impairment: Use with caution; no specific dose adjustment recommended but monitor closely.

Hepatic Impairment: Limited data; use with caution.

Pharmacokinetics

Absorption: Minimal systemic absorption from inhalation devices.

Distribution: Not extensively studied.

Metabolism: Primarily metabolized in the liver via quaternary ammonium metabolism; minimal systemic metabolism.

Excretion: Excreted mainly in urine and feces.

Half Life: Approximately 25 hours, allowing once-daily dosing.

Contraindications

Hypersensitivity to tiotropium bromide or any component of the formulation.

Precautions

Use cautiously in patients with urinary retention, glaucoma, or prostate issues. Not recommended for use as a first-line treatment for asthma; reserved for maintenance therapy. Use with caution in patients with kidney impairment.

Adverse Reactions - Common

Dry mouth (Common)
Upper respiratory tract infection (Common)
Pharyngitis (Common)
Sinusitis (Common)

Adverse Reactions - Serious

Anaphylaxis (Rare)
Paradoxical bronchospasm (Rare)
Worsening of urinary retention (Rare)

Drug-Drug Interactions

Other anticholinergic drugs may enhance anticholinergic effects.
Note: Use caution when combined with other respiratory drugs that have anticholinergic properties.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor respiratory status, lung function, and for signs of anticholinergic effects.

Diagnoses:

Impaired respiratory function
Risk for urinary retention
Risk for dry mouth

Implementation: Administer via inhalation device as prescribed. Educate patient on proper inhaler technique.

Evaluation: Assess improvement in pulmonary function and symptom relief; monitor for adverse effects.

Patient/Family Teaching

Use inhaler exactly as prescribed.
Rinse mouth after inhalation to reduce dry mouth and throat irritation.
Report signs of hypersensitivity, paradoxical bronchospasm, or urinary retention.
Do not use for acute bronchospasm; this is a maintenance medication.

Special Considerations

Black Box Warnings:

None specific, but caution in patients with glaucoma or urinary retention.

Genetic Factors: Limited data on pharmacogenomics.

Lab Test Interference: No significant interference.

Overdose Management

Signs/Symptoms: Anticholinergic toxicity: dry mouth, blurred vision, urinary retention, tachycardia, hallucinations.

Treatment: Locate and remove source. Supportive care, symptomatic treatment, and monitoring. No specific antidote.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable in original packaging until expiration date.