7 Spiriva Side Effects You Should Know About

Spiriva (tiotropium) is an inhaled medication that helps make it easier to breathe. It’s available in two forms: Spiriva HandiHaler and Spiriva Respimat. The HandiHaler is FDA-approved to treat chronic obstructive pulmonary disease (COPD). Spiriva Respimat is approved to treat COPD and asthma.

Spiriva is effective at improving symptoms of COPD and asthma, but it can have side effects. Here, we’ll discuss seven of the most important Spiriva side effects you should know about.

1. Respiratory tract infections

Upper respiratory tract infections are some of the most common Spiriva side effects. They include sinusitis (when your sinuses become inflamed) and pharyngitis (an infection in the back of the throat). Common symptoms of sinusitis include facial pain or pressure, a runny or stuffy nose, and headache. Common symptoms of pharyngitis include cough, sore throat, and pain when swallowing.

Bronchitis (a lower respiratory tract infection) may also occur in people using Spiriva Respimat for asthma. This is an infection affecting airways that go to and from your lungs. Common symptoms include chest pain, cough, and shortness of breath.

Let your healthcare provider know if you have symptoms of a respiratory infection. They may be able to order tests to confirm this. Often, treatment for respiratory tract infections only involves supportive care. This is because they’re often caused by viruses, not bacteria.

Supportive care may include over-the-counter medications like:

• Decongestants, like phenylephrine nasal spray or oral pseudoephedrine (Sudafed)

• Pain relievers, like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol)

• Cough medicine, like guaifenesin (Muxinex) which helps thin mucus and makes it easier to cough up phlegm, or Dextromethorphan (Delsym, Robitussin), which can help suppress a dry cough

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Your healthcare provider may also recommend prescription medications in some cases. These may include inhalers like albuterol (ProAir HFA, Ventolin HFA) and oral steroids like prednisone for those with bronchitis and asthma.

If your infection is bacterial, you may need treatment with antibiotics. For example, bacterial sinusitis is often treated with amoxicillin or Augmentin (amoxicillin/clavulanate).

If you have a respiratory infection and your symptoms worsen, get back in touch with your provider. You should also reach out to them if you’re not feeling better after a week of supportive care (or antibiotics if prescribed).

2. Dry mouth

Dry mouth is a common side effect of Spiriva. It appears to be more common with the Handihaler. It’s also more common with larger doses of Spiriva and in people who are of older age.

Dry mouth may also be more likely if you have kidney problems. This is because Spiriva leaves the body through the kidneys. So if your kidneys aren’t working as well as they could, Spiriva may build up in the body and lead to more side effects.

If you experience dry mouth from Spiriva, you’ll be happy to know it’s usually mild and goes away on its own. But if your symptoms are bothersome, there are a few things you can try:

• First, maintain good oral care so that you don’t experience long-term dental problems. This includes brushing and flossing twice a day.

• Drink cool liquids throughout the day or suck on ice chips to help moisten your mouth. You can also try chewing sugar free gum or sucking on sugar-free hard candy.

• Try an OTC saliva substitute like Biotene or BioXtra, which contain important nutrients found in saliva. This helps prevent dental decay along with improving dry mouth symptoms.

• Talk to your healthcare provider about prescription options for dry mouth if home remedies don’t work. These include pilocarpine (Salagen) and cevimeline (Evoxac).

If your symptoms feel severe or don’t go away with time, let your provider know. They can check for other possible causes. They may also discuss whether you should stop Spiriva and try a different medication.

3. Chest pain

Spiriva may cause chest pain. It’s more common with Spiriva Handihaler.

Chest pain can also be a symptom of many other medical conditions. In severe cases, it may be a sign of a serious medical problem like a heart attack.

If you feel chest pain from Spiriva, reach out to your healthcare provider. If you feel chest pain or tightness along with nausea, shortness of breath, or pain that extends to the left arm, neck, jaw, or back, get emergency help. This may be a sign of a heart attack.

Keep in mind: While you may have chest pain with Spiriva, it isn’t known to cause heart attacks. Older research caused the FDA to issue a safety warning about Spiriva in 2008. But they retracted the warning in 2010 after a large study didn't show a greater risk of heart or blood vessel problems. This includes heart attack and stroke.

4. Serious allergic reactions

It’s possible to experience an immediate allergic reaction after using Spiriva.

Symptoms may include:

• Skin rash

• Itching

• Sudden cough

• Wheezing

• Angioedema (swelling of your lips, tongue, or throat)

• Anaphylaxis (severe whole body allergic reaction and may include trouble breathing)

If you have an allergic reaction to Spiriva, you should stop taking the medication. Your healthcare provider will help you choose another medication to manage your condition. If you’re having trouble breathing, or have swelling of the face, get emergency help.

Of note, the main ingredient in Spiriva (tiotropium) is like another medication called atropine (Isopto Atropine, AtroPen). So if you’ve had a reaction to atropine in the past, you’re more likely to have a reaction to Spiriva.

And if you have a hypersensitivity to milk proteins, you should also be cautious using the Spiriva Handihaler. This is because Spiriva Handihaler has lactose, a sugar found in milk products.

5. Paradoxical bronchospasm

After giving a dose of Spiriva, you may experience something called a paradoxical bronchospasm. This is when you experience an unexpected and sudden tightening of your airways that makes breathing difficult. Though rare, it’s possible with either form of Spiriva.

Treatment for paradoxical bronchospasm involves the immediate use of a rescue inhaler. A common example is albuterol. Rescue inhalers work quickly to relieve symptoms of bronchospasm. If you don’t have one on hand, call 911 or go to the closest emergency room.

Your healthcare provider will also recommend stopping Spiriva. They’ll likely suggest another medication option.

6. Worsening glaucoma

If you have a type of glaucoma called narrow-angle glaucoma, Spiriva could worsen your condition. So make sure your healthcare provider knows if you have narrow-angle glaucoma before you start Spiriva.

While taking Spiriva, talk to your provider right away if you experience eye symptoms. These include new or worsening eye pain or discomfort, blurry vision, or you’re seeing light and images in an abnormal way. This may need immediate treatment.

7. Urinary problems

Spiriva may make it harder for you to pee (urinary retention). This is more likely if you have a medical condition that causes urinary retention. Examples include benign prostatic hyperplasia (BPH) or a blockage in your bladder.

If you’re taking Spiriva and have a harder time peeing or have pain while peeing, contact your healthcare provider. They can help you find out whether it’s safe for you to continue taking Spiriva.

When should I contact my healthcare provider about side effects from Spiriva?

Mild Spiriva side effects like dry mouth may be treated at home. And respiratory infections likely just need supportive care. But it’s still a good idea to check with your provider if you think you have an infection. They can help you figure out if you need an antibiotic.

Serious Spiriva side effects may warrant a discussion with your healthcare provider immediately. Or they may even need emergency care. These include allergic reactions, paradoxical bronchospasm, and worsening glaucoma.

How to save on Spiriva

There are ways to save on Spiriva, which is available as a brand-name and generic medication. GoodRx can help you navigate between GoodRx coupons, copay savings cards, and patient assistance programs to save money on your prescription.

• Save with GoodRx: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of generic tiotropium at an exclusive cash price, which ranges from $75 to $365 — prices vary by pharmacy.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $35 for Spiriva HandiHaler or Sprivia Respimat using a savings card from the manufacturer. A $25 savings card is available for the generic version of Spiriva HandiHaler, too.

• Save with patient assistance programs: If you’re uninsured or underinsured, you may be eligible for Spiriva’s patient assistance program, which offers the medication free of charge.

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Written by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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