Drug Guide
Olodaterol Hydrochloride; Tiotropium Bromide
Classification
Therapeutic: Bronchodilator for COPD
Pharmacological: Combination bronchodilator (long-acting beta2-agonist and anticholinergic)
FDA Approved Indications
- Maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD)
Mechanism of Action
Olodaterol is a long-acting beta2-adrenergic agonist that relaxes airway smooth muscle, leading to bronchodilation. Tiotropium is a long-acting anticholinergic agent that inhibits M3 muscarinic receptors, causing bronchial smooth muscle relaxation and reducing airway constriction.
Dosage and Administration
Adult: Two inhalations once daily via the Respimat inhaler
Pediatric: Not approved for pediatric use
Geriatric: No specific dosage adjustment; monitor for potential increased sensitivity
Renal Impairment: Use with caution; no specific dosage adjustment established
Hepatic Impairment: Use with caution; no specific dosage adjustment established
Pharmacokinetics
Absorption: Rapid absorption of olodaterol and tiotropium in the lungs with minimal systemic absorption
Distribution: Extensively bound to plasma proteins
Metabolism: Olodaterol metabolized mainly via conjugation; tiotropium minimally metabolized
Excretion: Primarily excreted unchanged in urine (tiotropium) and via conjugation pathways (olodaterol)
Half Life: Olodaterol: approximately 45 hours; Tiotropium: approximately 5-6 days
Contraindications
- Known hypersensitivity to olodaterol, tiotropium, or inhalation aerosol components
Precautions
- Use with caution in patients with narrow-angle glaucoma, urinary retention, or prostate hypertrophy
- Monitor for paradoxical bronchospasm
- Not recommended for acute would management
Adverse Reactions - Common
- Dry mouth (Common)
- Pharyngitis (Common)
- Upper respiratory tract infection (Common)
Adverse Reactions - Serious
- Paradoxical bronchospasm (Rare)
- Urinary retention (Uncommon)
- Hypersensitivity reactions including angioedema (Rare)
Drug-Drug Interactions
- Other beta2-agonists or anticholinergic medications may increase side effects
- MAO inhibitors or tricyclic antidepressants may potentiate cardiovascular effects
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor respiratory status, heart rate, blood pressure, and for signs of paradoxical bronchospasm
Diagnoses:
- Impaired gas exchange
- Risk for adverse reactions
Implementation: Administer via prescribed inhaler, educate patient on proper inhaler technique, monitor for side effects
Evaluation: Assess lung function and symptom control regularly
Patient/Family Teaching
- Instruct on proper inhaler use and cleaning
- Report any worsening symptoms or side effects
- Do not use more than prescribed
- Rinse mouth after inhalation to reduce dry mouth
Special Considerations
Black Box Warnings: N/A
Genetic Factors: No specific genetic factors identified affecting drug response
Lab Test Interference: No known interference
Overdose Management
Signs/Symptoms: Severe tachyarrhythmias, hypokalemia, tremors, chest pain
Treatment: Symptomatic treatment, supportive care, and monitoring; activated charcoal if ingestion is recent
Storage and Handling
Storage: Store at room temperature away from moisture and light
Stability: Stable until expiration date when stored properly