Drug Guide

Generic Name

Olodaterol Hydrochloride; Tiotropium Bromide

Brand Names Stiolto Respimat

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/A

Drug-Herb Interactions

N/A

Nursing 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

This guide is for educational purposes only and is not intended for clinical use.