II. Indication
- Chronic Obstructive Pulmonary Disease (COPD)
-
Severe Asthma (third-line agent)
- May be added to high dose Inhaled Corticosteroid and long acting beta Agonist
- However, other standard Asthma agents are preferred first
- (2015) Presc Lett 22(12):71-2
- Kerstgens (2015) Lancet respir med 3(5):367–76 [PubMed]
III. Mechanism
IV. Dosing: COPD
- Spiriva (Tiotropium) Handihaler (Dry powder)
- Inhale one 18 mcg dose once daily
- Spiriva (Tiotropium) Respimat (mist)
- Two 2.5 mg dose inhalations once daily
V. Dosing: Asthma
- Avoid in age <6 years
- Spiriva (Tiotropium) Respimat (half dose of COPD preparation) for age >=6 years
- Two 1.25 mg dose inhalations once daily
VI. Dosing: Combinations
-
Stiolto Respimat (Tiotropium/Olodaterol)
- Long-Acting Beta-2 Agonist (Olodaterol) combined with long-acting Anticholinergic (Tiotropium)
- Inhale once daily
VII. Precautions
- See Long-acting Anticholinergic Bronchodilator
- Avoid use of long-acting Anticholinergic (e.g. Spiriva) with Atrovent or Combivent due to minimal added benefit
- Use Albuterol MDI as short acting rescue medication instead of short acting Ipratropium
- Exception: May use Atrovent or Combivent while starting Spiriva in first 8-10 days
VIII. Efficacy
- Improves mean FEV1, Dyspnea and quality of life
- Decreased COPD exacerbations and hospitalizations
- More effective than Ipratropium Bromide in COPD (10 fold increase in potency)
- At least as effective as Salmeterol in COPD
- Better compliance due to once daily dosing
IX. Adverse Effects
X. Safety
- Pregnancy Category C
- Avoid in Lactation
XI. Resources
XII. References
- (2016) Presc Lett 23(2): 10
- (2015) Presc Lett 22(1): 4-5
- (2012) Presc Lett 19(12): 70
- Panning (2003) Pharmacotherapy 23:183-9 [PubMed]
- Hutton (2004) Am Fam Physician 69(12):2901-2 [PubMed]
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Related Studies
| tiotropium (on 10/18/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| TIOTROPIUM 18 MCG CAP-INHALER | Generic | $13.88 each |
| spiriva (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SPIRIVA HANDIHALER 18 MCG CAP | $16.40 each | |
| SPIRIVA RESPIMAT 1.25 MCG INH | $122.86 per gram | |
| SPIRIVA RESPIMAT 2.5 MCG INH | $122.72 per gram | |