Long-acting antimuscarinic (LAMA)
Long-acting anticholinergic bronchodilator indicated for once-daily maintenance treatment of bronchospasm associated with COPD (including reduction of exacerbations) and maintenance of asthma in patients ≥ 6 years.
Also known as: Spiriva, tiotropium
DailyMed approved label (SPIRIVA RESPIMAT, Boehringer Ingelheim; setID 7b656b14-fcaa-2741-f6f0-e0be48971c02).
DailyMed approved label (SPIRIVA RESPIMAT, Boehringer Ingelheim; setID 7b656b14-fcaa-2741-f6f0-e0be48971c02).
No documented drug–drug interactions for this medicine.
Tiotropium is given by inhalation; food does not affect its pharmacokinetics.
May be administered regardless of meals.
DailyMed approved label (SPIRIVA RESPIMAT, Boehringer Ingelheim; setID 7b656b14-fcaa-2741-f6f0-e0be48971c02).
No relevant pharmacokinetic interaction; usual moderation during treatment.
Moderate alcohol intake.
DailyMed approved label (SPIRIVA RESPIMAT, Boehringer Ingelheim; setID 7b656b14-fcaa-2741-f6f0-e0be48971c02).
Tiotropium elimination is predominantly renal; accumulation may occur.
Use with caution in severe renal impairment.
EMC-UK (MHRA) — approved Tiotropium SmPC: https://www.medicines.org.uk/emc/product/1693/smpc
Long-acting inhaled anticholinergics may precipitate acute glaucoma.
Instruct the patient to avoid eye contact; monitor ocular symptoms.
EMC-UK (MHRA) — approved Tiotropium SmPC: https://www.medicines.org.uk/emc/product/1693/smpc
Data on tiotropium in pregnancy are limited; use only if the benefit outweighs the risk.
Avoid in the 1st trimester unless strictly necessary.
Excretion into breast milk is unknown; use with caution.
No specific additional contraception.
EMC-UK (MHRA) — approved Tiotropium SmPC: https://www.medicines.org.uk/emc/product/1693/smpc
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Long-acting antimuscarinic: blockade of M3 receptors of airway smooth muscle produces sustained bronchodilation (> 24 hours); prevention of methacholine-induced bronchoconstriction is dose-dependent and lasts longer than 24 hours.
Competitive, reversible antagonism of M1–M5 muscarinic receptors, with predominant effect via M3 on bronchial smooth muscle; the effect is predominantly site-specific, at the site of inhalation.
Systemic bioavailability of 2–3% after inhalation (the inhaled fraction acts locally); oral absorption of the swallowed fraction is minimal.
Minimal hepatic metabolism (non-enzymatic ester cleavage); elimination is predominantly renal (unchanged) and fecal.
Effective half-life of 25 hours (COPD) and 44 hours (asthma) after once-daily inhalation.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
