Stiolto Respimat
Stiolto Respimat is a combination inhaler containing two bronchodilators: tiotropium (a long-acting muscarinic antagonist, or LAMA) and olodaterol (a long-acting beta agonist, or LABA). It's used to treat chronic obstructive pulmonary disease (COPD) in adults. Stiolto Respimat (tiotropium / olodaterol) is taken once per day as 2 inhalations through the mouth. Possible side effects aren't common but can include upper respiratory tract infections and cough.
What is Stiolto Respimat (tiotropium / olodaterol)?
What is Stiolto Respimat (tiotropium / olodaterol) used for?
Maintenance treatment of COPD
How Stiolto Respimat (tiotropium / olodaterol) works
Stiolto Respimat (tiotropium / olodaterol) is a combination of two medications that work together to help to open up your airways:
Tiotropium is a long-acting muscarinic antagonist (LAMA), a type of anticholinergic medication. It helps you breathe better by blocking a chemical in your lungs called acetylcholine.
Olodaterol is a long-acting beta agonist. It improves your breathing by relaxing the muscles in your airways.
Drug Facts
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What are the side effects of Stiolto Respimat (tiotropium / olodaterol)?
Common Side Effects
- Nose and throat infection (12%)
- Cough (4%)
- Back pain (4%)
Other Side Effects
- Dizziness
- Trouble sleeping
- Blurry vision
- Dry mouth
- Abnormal heartbeat
- Rash
Serious Side Effects
- Sudden narrowing of your airways: difficulty breathing, wheezing, cough, chest pain or tightness
- Heart problems: dizziness, fatigue, weakness, tremor, irregular heartbeat, worsening symptoms of heart problem that you already have
- Serious allergic reaction: hives; swelling of your face, lips, or tongue; difficulty breathing
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Muscle pain or cramps
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Trouble passing urine
- Wheezing or trouble breathing that is worse after use
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Constipation
- Cough
- Dry mouth
- Headache
- Sore throat
- Tremors or shaking
- Trouble sleeping
Pros and cons of Stiolto Respimat (tiotropium / olodaterol)
Pros
Only taken once per day, typically 2 puffs per dose
Produces a slow and fine mist that makes it easier to breathe in
No need to rinse your mouth after use since it doesn't contain a steroid
Cons
Brand-name medication only
Doesn't replace your rescue inhaler for sudden trouble breathing
Might worsen certain medical conditions, such as trouble urinating
Pharmacist tips for Stiolto Respimat (tiotropium / olodaterol)
You're recommended to use Stiolto Respimat (tiotropium / olodaterol) at the same time once per day to prevent COPD attacks. You can take Stiolto Respimat (tiotropium / olodaterol) at any time of the day. But remember to take 2 inhalations at each dose, one after the other.
If you have sudden trouble breathing, use your rescue inhaler. Stiolto Respimat (tiotropium / olodaterol) won't treat a COPD attack as it's happening.
Call your pulmonologist if your breathing or peak flow meter results worsen. Also contact your pulmonologist if you're using your rescue inhaler more often than usual. These could be signs that you need another long-acting medication to help manage your COPD.
Let your prescriber know if you're taking other anticholinergic medications, such as tolterodine (Detrol) or hyoscyamine. They might consider switching you to a different medication because taking more than one anticholinergic raises your risk for side effects (e.g., dry mouth, constipation, trouble urinating).
Store Stiolto Respimat (tiotropium / olodaterol) at room temperature in a dry place away from heat or sunlight. Keep unused inhalers in the original foil pouch.
How to use Stiolto Respimat (tiotropium / olodaterol):
You should receive training from your prescriber or pharmacist on how to use Stiolto Respimat (tiotropium / olodaterol). Make sure to read the instructions or watch this video on how to assemble and use Stiolto Respimat (tiotropium / olodaterol). Let you care team know if you have any questions.
To use the inhaler, remember TOP: Turn the base in the direction of the arrows on the inhaler until you hear a click (half a turn). Open the cap. Then, breathe out slowly and fully before you place your lips around the mouthpiece; don't cover the air vents. Press the dose-release button while you take a slow, deep breath through your mouth. Hold your breath for 10 seconds, or as long as you comfortably can.
If you haven't used your Stiolto Respimat (tiotropium / olodaterol) for more than 3 days, prime the inhaler by releasing 1 visible stream of mist towards the ground before you use it. And if you haven't used your inhaler for more than 3 weeks, prime the inhaler as if it were new.
After you've inserted a new cartridge into a Stiolto Respimat (tiotropium / olodaterol) inhaler, throw the entire inhaler away after 3 months, even if it still contains unused medication. Always place a new cartridge into a new inhaler device.
Be sure to clean the mouthpiece (including the metal part inside) with a damp cloth or tissue at least once a week. It's okay if the mouthpiece gets a little discolored.
Throw away the canister 3 months after you first use it, or when you aren't able to turn the bottom of your inhaler anymore. Once your Stiolto Respimat (tiotropium / olodaterol) inhaler is empty, it locks and can't be used anymore.
Frequently asked questions about Stiolto Respimat (tiotropium / olodaterol)
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What are the risks and warnings for Stiolto Respimat (tiotropium / olodaterol)?
Stiolto Respimat (tiotropium / olodaterol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not for use during worsening COPD symptoms
Stiolto Respimat (tiotropium / olodaterol) isn't a rescue inhaler and won't help to treat a COPD exacerbation (flare up COPD symptoms). If Stiolto Respimat (tiotropium / olodaterol) isn't working well to control your COPD and you're experiencing worsening symptoms, such as coughing and trouble breathing, talk with your provider. They can see if you need to take other medications for your condition.
Don't use Stiolto Respimat with LABAs
Don't use Stiolto Respimat (tiotropium / olodaterol) with other LABAs because this can lead to the risk of serious and life-threatening harm. If you're using inhaled short-acting beta agonists (SABAs) rescue inhalers, such as albuterol (Ventolin), don't use more doses than recommended; doing so can also lead to harm.
Narrowing of your airways (bronchospasm)
Inhaled medications, including Stiolto Respimat (tiotropium / olodaterol), can sometimes cause a muscle spasm in your lungs. This can lead to difficulty breathing, wheezing, cough, and chest discomfort. If you have a hard time breathing after inhaling Stiolto Respimat (tiotropium / olodaterol), use your rescue inhaler and get medical attention right away.
Severe allergic reaction
Risk factors: Allergy to ipratropium, tiotropium, or olodaterol
Severe allergic reactions to Stiolto Respimat (tiotropium / olodaterol) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (closing of the throat). Get medical help right away if you notice hives; rash; swelling of the face, lips, or tongue; or difficulty breathing after you use Stiolto Respimat (tiotropium / olodaterol).
Heart problems
Risk factors: High blood pressure | Heart failure | Heart rate or rhythm problems | Using more Stiolto Respimat (tiotropium / olodaterol) than recommended
Olodaterol in Stiolto Respimat can potentially raise your blood pressure and heart rate, as well as cause changes in heart rhythm. But these side effects are typically unlikely to happen if you're taking the recommended dose of Stiolto Respimat (tiotropium / olodaterol). Your healthcare team might ask you to regularly check your blood pressure and heart rate at home if you have high blood pressure or other heart problems. Don't use Stiolto Respimat (tiotropium / olodaterol) more often than recommended. If you find that you need to use Stiolto Respimat (tiotropium / olodaterol) more often, let your care team know so they can see if you need any changes to your treatment plan. Tell your care team if you have dizziness, fatigue, tremor, rapid heartbeat, or weakness after you use Stiolto Respimat (tiotropium / olodaterol).
Eye problems
Risk factors: History of glaucoma | Accidentally getting Stiolto Respimat (tiotropium / olodaterol) into the eye | Using the nebulizer machine incorrectly
Though not common, using Stiolto Respimat (tiotropium / olodaterol) can raise the pressure in the eyes. Sometimes, this can cause or worsen glaucoma. Let your optometrist or ophthalmologist know that you're taking Stiolto Respimat (tiotropium / olodaterol) if you have glaucoma or other eye problems. Also speak with them if you notice any changes to your vision while you're using the medication. Don't spray Stiolto Respimat (tiotropium / olodaterol) in your eyes because this could cause eye pain, discomfort, blurry vision, and other vision changes.
Trouble urinating
Risk factors: Enlarged prostate | Bladder-neck obstruction (blockage)
Use Stiolto Respimat (tiotropium / olodaterol) with caution in people who have urinary or prostate problems. This medication can cause difficulty urinating, which can worsen urinary problems. Contact your prescriber if you notice difficulty urinating while you're taking this medication.
Low potassium in the blood
Risk factors: Taking too much Stiolto Respimat (tiotropium / olodaterol)
Stiolto Respimat (tiotropium / olodaterol) can sometimes cause the potassium levels in your blood to drop too low. This is more likely to happen if you take too much Stiolto Respimat (tiotropium / olodaterol). Symptoms of low potassium include tiredness, weakness, muscle cramps, and a racing heart. Don't take more Stiolto Respimat (tiotropium / olodaterol) than prescribed. Seek medical help right away if Stiolto Respimat (tiotropium / olodaterol) isn't helping your breathing get better.
Stiolto Respimat (tiotropium / olodaterol) dosage forms
Typical dosing for Stiolto Respimat (tiotropium / olodaterol)
Each inhalation of Stiolto Respimat (tiotropium / olodaterol) delivers 2.5 mcg of tiotropium and 2.5 mcg of olodaterol.
Adults: The typical dose is 2 inhalations by mouth once per day.
How much does Stiolto Respimat (tiotropium / olodaterol) cost?
Stiolto Respimat (tiotropium / olodaterol) contraindications
Use for the treatment of asthma without an inhaled steroid
Allergy to ipratropium, tiotropium, or olodaterol
What are alternatives to Stiolto Respimat (tiotropium / olodaterol)?
Maintenance treatment of COPD
Maintenance treatment of chronic obstructive pulmonary disease (COPD) in adults
Maintenance treatment of COPD
What is the latest news about Stiolto Respimat (tiotropium / olodaterol)?
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References
Best studies we foundAlagha, K., et al. (2014). Long-acting muscarinic receptor antagonists for the treatment of chronic airway diseases. Therapeutic Advances in Chronic Disease.
American Lung Association. (2024). Measuring your peak flow rate.
Anderson, P. (2006). Use of Respimat Soft Mist inhaler in COPD patients. International Journal of Chronic Obstructive Pulmonary Disease.
Boehringer Ingelheim Pharmaceuticals, Inc. (n.d.). How to use Stiolto Respimat.
Boehringer Ingelheim Pharmaceuticals, Inc. (2021). Welcome to your Respimat quick start guide.
Boehringer Ingelheim Pharmaceuticals Inc. (2021). Stiolto Respimat- tiotropium bromide and olodaterol spray, metered [package insert]. DailyMed.
Feldman, G. J., et al. (2017). Comparative efficacy of once-daily umeclidinium/vilanterol and tiotropium/olodaterol therapy in symptomatic chronic obstructive pulmonary disease: A randomized study. Advances in Therapy.
Holt, T. O., et al. (2017). A patient’s guide to aerosol medication delivery. American Association for Respiratory Care.
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