Spiriva (tiotropium)

Spiriva (tiotropium)

Basics, Side Effects, Reviews & More

Spiriva (tiotropium) is a good first-choice medication for controlling chronic obstructive pulmonary disease (COPD) and can also help control asthma. It's convenient to use once daily, but it can be expensive and has no generic alternative.


Spiriva, Spiriva Respimat




Not a controlled medication


No lower-cost generic available


Prescription only

Last reviewed by:

Aileen Chu, PharmD, BCPS

Michelle Nguyen, PharmD

Last reviewed on:

June 21, 2020

What is Spiriva (tiotropium) used for?

How Spiriva (tiotropium) works

Spiriva (tiotropium) is an anticholinergic medication that relaxes the airways to make it easier to breathe. People who use it as directed have less COPD or asthma attacks, and don't need to go to the hospital as often.

What is Spiriva (tiotropium) used for?

  • Chronic obstructive pulmonary disease (COPD)
  • Asthma (Spiriva Respimat only)

Typical dosing

Take 2 puffs once daily.

  • For the RESPIMAT version, take 1 puff after each turn of the inhaler.
  • For the HANDIHALER version, take both puffs from the same capsule.

Frequently asked questions about Spiriva (tiotropium)

Pros and cons of Spiriva (tiotropium)


Thumbs UpHelps prevent attacks or flare-ups

Thumbs UpHas few side effects, and doesn't cause a fast heart rate like albuterol (another medication to help you breathe)

Thumbs UpUsed once daily

Thumbs UpThe RESPIMAT version can be used for asthma in children 6 years and older

Thumbs UpThe RESPIMAT version can be easier to use than other inhalers, especially for elderly folks and children


Thumbs DownDoesn't work fast enough to be used as a rescue inhaler for attacks

Thumbs DownOnly available in brand name which might be expensive

Thumbs DownIf using the HANDIHALER version, you have to breathe in forcefully and quickly in order to inhale the entire contents of the capsule

Pharmacist tips for Spiriva (tiotropium)

Capsule IconSpiriva (tiotropium) doesn't work fast enough to treat a sudden COPD or asthma attack. Always have your rescue inhaler (like albuterol) handy in case you have sudden difficulty breathing.

Capsule IconTake 2 puffs every day for best effect. Continue to use Spiriva (tiotropium) even if you feel better.

Capsule IconIf you are allergic to milk or lactose, check with your doctor before using the HANDIHALER version since it contains a little bit of lactose.

Capsule IconIf this is your first time using Spiriva (tiotropium), ask your doctor or pharmacist to show you how to use it properly for full benefits.

Capsule IconIf using the HANDIHALER version, don't open or swallow the capsule since it will not work properly. Each capsule has enough powder for 1 dose, which is 2 puffs.

Prices for Spiriva (tiotropium) start at just $439.73 with a GoodRx coupon. They’re fast, easy-to-use and free!

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What are the side effects of Spiriva (tiotropium)?

With any medication, there are risks and benefits. Even if the medication is working, you may experience some unwanted side effects.

Caution Small The following side effects may get better over time as your body gets used to the medication. Let your doctor know immediately if you continue to experience these symptoms or if they worsen over time.

Common side effects

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

Other side effects

  • Headache
  • Lower airway inflammation (bronchitis)
  • Dizziness
  • Fungal infection in mouth or throat (thrush)
  • Diarrhea
  • Runny nose
  • Urinary tract infection
  • Fever
  • High blood pressure

Source: FDA

The following 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



trouble breathing

Less common


difficulty with swallowing


hives, itching, or skin rash

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



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


bladder pain

bloody or cloudy urine

body aches or pain

chest pain




difficult, burning, or painful urination

dry mouth

dryness of the throat

ear congestion


frequent urge to urinate





loss of voice

lower back or side pain

pain or tenderness around the eyes and cheekbones

runny or stuffy nose


sore throat

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

canker sores

difficulty having a bowel movement (stool)


feeling sad or empty

flushed, dry skin

fruit-like breath odor

increased hunger

increased thirst

increased urination


lack of appetite

leg pain

loss of interest or pleasure

muscle pain


painful or difficult urination

sore mouth or tongue

sores, ulcers, or white spots on the lips or tongue or inside the mouth


swelling or inflammation of the mouth


trouble concentrating

trouble sleeping

unexplained weight loss


Incidence not known


change in vision


red skin

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.

What are the 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


Spiriva (tiotropium) controls your symptoms over time. It won't help if you have sudden difficulty breathing. Make sure to always have your rescue inhaler with you.


In rare cases, people taking Spiriva (tiotropium) can have very serious, life-threatening allergic reactions. If you have trouble breathing, feel swelling in your tongue, lips and face, or have severe itching and rash, go to the emergency room right away.


Like all inhaled medications, Spiriva (tiotropium) can cause suddenly cause tighter airways (bronchospasm) right after inhalation. If this happens, use your rescue inhaler and talk to your doctor right away. You might have to switch to a different medication.


  • Risk factors: History of narrow-angle glaucoma

Spiriva (tiotropium) can worsen narrow-angle glaucoma, so be careful if you already have this condition. If you notice new eye pain, blurry vision, or any other vision changes (like seeing halos or different colors) after taking Spiriva (tiotropium), let your doctor or eye doctor know immediately.


  • Risk factors: History of urinary bladder blockage (urinary obstruction) | History of enlarged prostate

If you have problems with your prostate or urination, Spiriva (tiotropium) can make it worse. Let your doctor know if you notice any difficulty or pain during urination after taking Spiriva (tiotropium).


  • Risk factors: History of kidney disease

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, increased heart rate, or constipation. Let your doctor know if you notice these symptoms after taking Spiriva (tiotropium).

Interactions between Spiriva (tiotropium) and other medications

Spiriva (tiotropium) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Spiriva (tiotropium). Please note that only the generic name of each medication is listed below.

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.

What are people’s reviews of Spiriva (tiotropium)?

We asked 74 people what they think about Spiriva (tiotropium):
  • 64% Worth it
  • 16% Not sure
  • 20% Not worth it
Not sure

I would like to have known about Spiriva mist (Respimat), I think that would be more tolerable than the crushed capsule form. I would also like to have known about alternative brands that might be cheaper.

Worth it

Make sure you have a humidifier. It has a very expensive co-pay!

Not sure

Didn't know it would make me cough but it's gotten quite bad

Worth it

I believe Spiriva Respimat works best.

Worth it

Night and day difference - forgot what it was like to be able to breathe well. Doctor diagnosed COPD, put me on Spiriva, was breathing well in a few days. Was able to do things that would have left me panting for breath just a few days earlier. A fan of Spiriva - hate the cost, but it does what it says it will.

How much does Spiriva (tiotropium) cost?

There is currently no generic for Spiriva (tiotropium), so it can be expensive, even with insurance. GoodRx coupons, copay cards and patient assistance programs may help lower the cost.

Lowest GoodRx Price
Spiriva, Spiriva Respimat (brand)


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Pricing based on most commonly-filled versions: 1 respimat inhalers (60 doses) of Spiriva 2.5mcg per actuation

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