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
Side effects of Stiolto Respimat (tiotropium / olodaterol)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nose and throat infection (12%)
- Cough (4%)
- Back pain (4%)
Less Common Side Effects
- Dizziness
- Trouble sleeping
- Blurry vision
- Dry mouth
- Abnormal heartbeat
- Rash
Stiolto Respimat (tiotropium / olodaterol) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
The following Stiolto Respimat (tiotropium / olodaterol) 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
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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.
Common questions about Stiolto Respimat
Stiolto Respimat can start to improve your breathing as quickly as 5 minutes after a dose, and continues to work for 24 hours. But because Stiolto Respimat is a maintenance inhaler for COPD, it can take several weeks to get the full effects of the medication. If you don't notice improvements to your breathing after using Stiolto Respimat every day, your pulmonologist might make changes to your COPD treatment.
No, Stiolto Respimat isn't a steroid. Instead, it's a combination medication that contains 2 different bronchodilators: a long-acting muscarinic antagonist (LAMA) and long-acting beta agonist (LABA). Sometimes, your pulmonologist might prescribe an inhaled steroid to use in addition to Stiolto Respimat if you need more help controlling COPD symptoms. Both steroids (also known as inhaled corticosteroids, or ICSs) and LAMAs/LABAs can be used to help you breathe better, but they work in different ways. Inhaled corticosteroids lower inflammation in the airways, whereas LAMAs and LABAs relax the muscles in your airways.
Stiolto Respimat isn't FDA-approved for the treatment of asthma; it's only approved as maintenance treatment for COPD. If you have asthma and want to know your maintenance inhaler options, talk with your healthcare team.
No, weight gain isn't a typical side effect of Stiolto Respimat. Contact your primary care provider if you notice unusual weight gain after starting this inhaler. They can help identify what might be causing the weight gain and let you know if you need more medical attention.
Both Anoro Ellipta (umeclidinium / vilanterol) and Stiolto Respimat are combination maintenance inhalers for COPD. They both contain a long-acting muscarinic antagonist (LAMA) and long-acting beta agonist (LABA). One difference between the two is that Anoro Ellipta is a dry powder inhaler, whereas Stiolto Respimat is a soft mist inhaler. Both inhaler types differ in how the dose is delivered and how each should be properly handle and maintained. While more research is needed, a study comparing both medications suggests that people who use Anoro Ellipta might experience greater improvements to their breathing after 2 months of treatment compared to those who use Stiolto Respimat. Talk to your pulmonologist if you have questions about either medications.
No, Spiriva (tiotropium) and Stiolto Respimat shouldn't be taken together. The active ingredient in Spiriva is tiotropium (a long-acting muscarinic antagonist), which is also in Stiolto Respimat. Taking Spiriva and Stiolto Respimat together won't help you breathe better, and will only raise the risk for anticholinergic side effects (e.g., dry mouth, constipation) from too much tiotropium in your body. Ask your pulmonologist if you're not sure which inhalers you should be taking.
Alcohol doesn't interact with Stiolto Respimat or affect how well it works. But alcohol also isn't a safe choice for everyone, depending on your other medications and medical conditions. Talk to your healthcare professional about what's a safe amount of alcohol for you to drink.
No, Stiolto Respimat is only available as a brand-name medication.
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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
Respimat inhaler| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 60 inhalations of 2.5mcg/2.5mcg | 1 respimat inhaler | $473.04 | $473.04 |
| 28 metered inhalations of 2.5mcg/2.5mcg | 1 respimat inhaler | $206.08 | $206.08 |
| 10 metered inhalations of 2.5mcg/2.5mcg | 1 respimat inhaler | $78.25 | $78.25 |
Typical dosage 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?
$78.25
Stiolto Respimat (tiotropium / olodaterol) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Stiolto Respimat (tiotropium / olodaterol) will not be safe for you to take.
- Use for the treatment of asthma without an inhaled steroid
- Allergy to ipratropium, tiotropium, or olodaterol
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