tiotropium
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.
What is Spiriva (tiotropium)?
What is Spiriva (tiotropium) used for?
- Chronic obstructive pulmonary disease (COPD)
- Asthma in people age 6 years and older - Spiriva Respimat only
How Spiriva (tiotropium) works
Spiriva (tiotropium) is an anticholinergic medication. It's also called a long-acting muscarinic antagonist (LAMA). It attaches to proteins called muscarinic receptors to block signals that cause the muscles in your airways to tighten. As a result, the medication relaxes the muscles in your airways to make it easier for you to breathe.
Drug facts
More on Spiriva (tiotropium) essentials
Side effects of Spiriva (tiotropium)
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
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%)
Less Common Side Effects
- Headache
- Dizziness
- Racing heart
- Lower airway inflammation (bronchitis)
- Runny, itchy, or stuffy nose
- Indigestion
- Diarrhea
- Thrush (fungal infection in the mouth)
Spiriva (tiotropium) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reaction: hives, itching, swelling of the face or throat, trouble breathing
- Worsening breathing symptoms
More on Spiriva (tiotropium) side effects
The following Spiriva (tiotropium) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Arm, back, or jaw pain
chest pain or discomfort
chest tightness or heaviness
fast or irregular heartbeat
sweating
trouble breathing
Less common
difficulty with swallowing
dizziness
painful blisters on the trunk of body
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
tightness in the chest
unusual tiredness or weakness
Rare
Fainting
fast, pounding, or irregular heartbeat or pulse
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
belching
bladder pain
bloody or cloudy urine
body aches or pain
chills
congestion
difficult, burning, or painful urination
dryness of the throat
ear congestion
frequent urge to urinate
headache
hoarseness
indigestion
loss of voice
lower back or side pain
pain or tenderness around the eyes and cheekbones
runny or stuffy nose
stomach discomfort, upset, or pain
tender, swollen glands in the neck
voice changes
Less common
Bloody nose
blurred vision
bone pain
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
difficulty having a bowel movement (stool)
discouragement
feeling sad or empty
flushed, dry skin
fruit-like breath odor
increased hunger
increased thirst
increased urination
irritability
lack of appetite
leg pain
loss of interest or pleasure
painful or difficult urination
sore mouth or tongue
sores, ulcers, or white spots on the lips or tongue or inside the mouth
sweating
swelling or inflammation of the mouth
tiredness
trouble concentrating
trouble sleeping
unexplained weight loss
vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Spiriva (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
Pharmacist tips for Spiriva (tiotropium)
- Before using Spiriva (tiotropium), become familiar with the Instructions for Use for Spiriva HandiHaler and its generic or Spiriva Respimat. Ask your pharmacist or provider if you have any questions.
- Spiriva (tiotropium) doesn't work fast enough to treat a sudden COPD or asthma attack. Always have your rescue inhaler (like albuterol (Ventolin)) handy in case you have sudden difficulty breathing.
- Continue to use Spiriva (tiotropium) even if you feel better. Each dose of Spiriva (tiotropium) helps keep your airways open for a full day. Keep in mind that it can take up to 2 months of daily use to see improvement in your breathing.
Additional tips for Spiriva HandiHaler and generic:
- Don't open or swallow the capsule since the medication won't work properly this way. Each capsule has enough powder for one dose, which is 2 puffs.
- Rinse your HandiHaler device with warm water while you press the green button a few times to remove powder buildup. Let it air dry for 24 hours, and don't use a hair dryer to dry it faster. Never use your device when it's still wet because you might not get your full dose of medication.
- Check with your provider whether Spiriva HandiHaler is right for you if you're allergic to milk or lactose. The capsules of Spiriva (tiotropium) contains a little bit of lactose.
Additional tips for Spiriva Respimat:
- Clean your inhaler with a damp cloth or tissue at least once a week.
- Throw away your inhaler after 3 months of inserting the cartridge even if there's still medication left.
Common questions about Spiriva (tiotropium)
No, Spiriva (tiotropium) isn't a steroid. It belongs to a group of medications called anticholinergics, and it helps relax your airway muscles. Spiriva (tiotropium) works differently from steroids, which help to lower inflammation in the lungs.
The Spiriva HandiHaler comes with capsules inside of a blister pack and a device that you'll use to inhale the powder that's in the capsule. To use Spiriva Handihaler, open the dust cap on the HandiHaler device by pressing the green button. Then, open the mouthpiece so that you can see the center chamber. Remove one capsule from the blister pack, and place it into the chamber of the HandiHaler device. Close the mouthpiece firmly until it clicks. With the device upright, press the green button once to make a hole in the capsule so the powder can come out when you inhale. Breathe out completely; then close your lips around the mouthpiece and breathe in fast and deep. Hold your breath for a few seconds and then breathe normally again. You'll need to inhale one more time to get the full dose. Check out this guide for more details on how to use Spiriva HandiHaler.
Remove the clear base of the Spiriva Respimat inhaler and insert a new cartridge. Then, put the clear base back on and turn it in the direction of the arrows until it clicks (half a turn). Open the cap and point the inhaler toward the ground and press the button to release a dose. If you don't see any mist come out, close the cap, turn the clear base again, and spray a dose toward the ground. After you see four sprays, it's ready to use. Each time you're ready to take your dose, remember "TOP" (Turn, Open, Press). Start by keeping the cap closed and turning the clear base until it clicks. Then, open the cap and put you lips around the mouthpiece. Press the button to release your dose while slowly breathing in. Hold your breath for 10 seconds (or as long as possible). Repeat the "TOP" steps to take your second dose. Watch this video to learn more.
You can use Spiriva (tiotropium) at any time of day, so choose a time that's most convenient for you. The most important thing to remember is to take your dose around the same time every day. You can set up a reminder on your phone or pair it with something you do every day (like after brushing your teeth in the morning).
No, Spiriva (tiotropium) isn't considered a rescue inhaler. Rescue inhalers need to work quickly to help treat COPD or asthma attacks. But Spiriva (tiotropium) doesn't work fast enough to do that; the medication works over time to help with your breathing. In fact, it could take up to 4 to 8 weeks to see improvement in your breathing. Talk with your provider about what you should do if your breathing symptoms become worse or if you experience an asthma attack.
Yes. Spiriva (tiotropium) is a bronchodilator, which means it opens up the air passages in your lungs. Keep in mind that there are many different bronchodilators. Some work faster or slower or for a shorter or longer period of time.
While Spiriva (tiotropium) is generally safe to use, there are some precautions. If you have glaucoma or problems with urination, Spiriva (tiotropium) can make these conditions worse. Also, let your provider know if you have kidney problems, since more medication can build up in your body and cause more side effects if you do. Be sure to tell your provider all of your allergies so they can make sure Spiriva (tiotropium) is safe for you. People who've had an allergic reaction to tiotropium or ipratropium in the past shouldn't use this medication. Talk with your provider to see whether Spiriva (tiotropium) is safe for you to use.
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Risks and warnings for Spiriva (tiotropium)
Spiriva (tiotropium) 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 a rescue inhaler
Spiriva (tiotropium) controls your symptoms over time. The medication won't help relieve sudden difficulty breathing. Make sure to always have your rescue inhaler with you to help in these situations.
Allergic reaction
- Risk factors: History of allergic reaction to atropine, tiotropium, or ipratropium
In rare cases, people taking Spiriva (tiotropium) can have very serious, life-threatening allergic reactions. Get medical help right away if you have trouble breathing; feel swelling in your tongue, lips and face; or have severe itching and rash.
Sudden airway tightening (paradoxical bronchospasm)
Like all inhaled medications, Spiriva (tiotropium) can cause your airways to suddenly tighten (bronchospasm) right after you inhale the medication. If this happens, use your rescue inhaler and talk to your provider right away. You might have to switch to a different medication.
Worsening glaucoma
- Risk factors: History of narrow-angle glaucoma
Spiriva (tiotropium) can worsen an eye condition called narrow-angle glaucoma. Be careful using Spiriva (tiotropium) if you have this eye condition. Let your provider know right away if you notice new eye pain, blurry vision, or any other vision changes (like seeing halos or different colors) while you're taking Spiriva (tiotropium).
Urination problems
- Risk factors: History of urinary bladder blockage (urinary obstruction) | History of enlarged prostate
If you have problems with your prostate or with urination, Spiriva (tiotropium) can make your symptoms worse. Tell your provider right away if you notice any difficulty urinating or pain during urination while you're taking Spiriva (tiotropium).
Higher risk for side effects in people with kidney problems
- Risk factors: History of kidney problems
If you have kidney problems, Spiriva (tiotropium) can build up in your body and cause more side effects. These side effects can include dry mouth, blurry vision, fast heart rate, or constipation. Let your provider know if you notice these symptoms while you're taking Spiriva (tiotropium).
Spiriva (tiotropium) dosage
Inhaler| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 30 capsules of 18mcg per capsule | 1 inhaler | $76.57 | $76.57 |
Typical dosage for Spiriva (tiotropium)
Spiriva HandiHaler and generic
- This medication comes as capsules for dry powder inhalation for use with the HandiHaler device. Each capsule contains 18 mcg of tiotropium. The medication is inhaled through the mouth using the HandiHaler device.
- COPD: The typical dose is 2 inhalations of a single capsule (18 mcg total) once daily.
- This medication is available as a 2.5 mcg/puff and 1.25 mcg/puff metered-dose inhaler. The medication is inhaled through the mouth using the Respimat device.
- COPD: The typical dose is 2 inhalations of the 2.5 mcg inhaler (5 mcg total) once daily.
- Asthma in people age 6 years and older: The typical dose is 2 inhalations of the 1.25 mcg inhaler (2.5 mcg total) once daily.
Interactions between Spiriva (tiotropium) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aclidinium
- Amifampridine
- Amitriptyline
- Amoxapine
- Atropine
- Belladonna
- Benztropine
- Biperiden
- Brompheniramine
- Carbinoxamine
- Carisoprodol
- Chlorpheniramine
- Chlorpromazine
- Clemastine
- Clidinium
- Clomipramine
- Clozapine
- Cyclobenzaprine
- Cyclopentolate
- Cyproheptadine
- Darifenacin
- Desipramine
- Dicyclomine
- Dimenhydrinate
- Diphenhydramine
- Donepezil
- Doxepin
- Fesoterodine
- Flavoxate
- Fluphenazine
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Homatropine
- Hydroxyzine
- Hyoscyamine
- Imipramine
- Ipratropium
- Loxapine
- Meclizine
- Mepenzolate
- Methacholine
- Nortriptyline
- Olanzapine
- Orphenadrine
- Oxitropium Bromide
- Oxybutynin
- Paroxetine
- Perphenazine
- Pimozide
- Pipenzolate Bromide
- Pirenzepine
- Prochlorperazine
- Procyclidine
- Promethazine
- Propantheline
- Propiverine
- Protriptyline
- Quetiapine
- Revefenacin
- Scopolamine
- Solifenacin
- Stramonium
- Terodiline
- Thioridazine
- Thiothixene
- Tiotropium
- Tizanidine
- Tolterodine
- Trifluoperazine
- Trihexyphenidyl
- Trimipramine
- Tropicamide
- Trospium
- Umeclidinium
How much does Spiriva (tiotropium) cost?
Spiriva (tiotropium) 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 Spiriva (tiotropium) will not be safe for you to take.
- Allergy to tiotropium or ipratropium
What are alternatives to Spiriva (tiotropium)?
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