Tiotropium vs. Ipratropium for COPD: Important Differences and Potential Risks.

Spiriva

(tiotropium)

ipratropium nasal spray

Summary for Tiotropium

Prescription only

Spiriva (tiotropium) is a medication used to help control chronic obstructive pulmonary disease (COPD) and asthma. There are two different Spiriva inhalers: Spiriva Respimat is a metered-dose inhaler, and Spiriva HandiHaler is a device that you place a capsule of medication into before you take the medication. The typical dosage for Spiriva (tiotropium) is two inhalations once a day, but the dose depends on the reason you're using it. Side effects include dry mouth, cough, and upper respiratory tract infections. Only Spiriva HandiHaler is also available as a generic version.

Indications for Tiotropium

Chronic obstructive pulmonary disease (COPD)
Asthma in people age 6 years and older - Spiriva Respimat only

Pros and Cons for Tiotropium

Pros

Helps prevent attacks or flare-ups
Has few side effects
Used once daily
Doesn't commonly cause a fast heart rate like some other bronchodilators
Available as a lower-cost generic (Spiriva HandiHaler only)

Cons

Doesn't work fast enough to be used as a rescue inhaler for attacks
Can be difficult for some people to use
Can cause dry mouth as a side effect
Only Spiriva Respimat can be used for asthma in children 6 years and older
Spiriva Respimat is currently only available as brand name

Common Side Effects for Tiotropium

Spiriva HandiHaler and generic

Upper respiratory tract infection (41%)
Dry mouth (16%)
Sinus inflammation (11%)
Sore throat (9%)
Urinary tract infection (7%)
Chest pain (7%)

Spiriva Respimat

Sore throat (12%)
Cough (6%)
Dry mouth (4%)
Sinus inflammation (3%)

Warnings for Tiotropium

Not a rescue inhaler
Allergic reaction
Sudden airway tightening (paradoxical bronchospasm)
Worsening glaucoma
Urination problems
Higher risk for side effects in people with kidney problems

Summary for Ipratropium

Prescription only

Ipratropium nasal spray is a prescription nasal spray used to treat runny nose from allergies and from the common cold. Depending on the strength, it can be used in people ages 5 or 6 years and older. It's only available as a generic medication since the brand name, Atrovent, has been discontinued. Dosing for ipratropium nasal spray typically ranges from 2 sprays in each nostril, 2 to 4 times daily. Although most people experience few to no side effects while using ipratropium nasal spray, some people might have headache or nosebleeds during treatment.