Closely (1)tiotropium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimipramineMonitor Closely (1)tiotropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.trospium chlorideMonitor Closely (1)tiotropium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.umeclidinium bromideMonitor Closely (1)umeclidinium bromide and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agentsumeclidinium bromide/vilanterol inhaledContraindicated (1)tiotropium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Duplicate therapy.vecuroniumMonitor Closely (1)tiotropium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.ziprasidoneMonitor Closely (3)tiotropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tiotropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor. ziprasidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.zotepineMonitor Closely (2)tiotropium decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tiotropium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. >10% Upper respiratory tract infection (41%) Dry mouth (16%) Sinusitis (11%) 1-10% Abdominal pain Allergic reaction Angina pectoris (including aggravated angina pectoris) Cataract Chest pain (nonspecific) Constipation Depression Dyspepsia Dysphonia Edema Epistaxis Gastroesophageal reflux Herpes zoster Hypercholesterolemia Hyperglycemia Infection Laryngitis Leg pain Moniliasis Myalgia Paresthesia Pharyngitis Rash Rhinitis Skeletal pain Stomatitis (including ulcerative stomatitis) Urinary tract infection Vomiting <1% Angioedema Fibrillation Supraventricular tachycardia Urinary retention Postmarketing Reports Bronchospasm Glossitis Dehydration Insomnia Contraindications History of hypersensitivity to ipratropium or tiotropium History of severe hypersensitivity to milk proteins (excipient in powder contained in capsule) Lactose allergy Cautions Not for acute use; not a rescue medication Immediate hypersensitivity reactions (eg, angioedema, itching, rash); stop treatment immediately Capsule not to be swallowed; to be administered only by PO inhalation via HandiHaler device Worsening of narrow-angle glaucoma Worsening of urinary retention Potential for paradoxical bronchospasm Prostatic hyperplasia Bladder-neck obstruction Wash hands after handling capsules Pregnancy The limited human data with therapy during pregnancy are insufficient to inform a drug-associated risk of adverse pregnancy-related outcomes Poorly or moderately controlled asthma in pregnancy increases maternal risk of preeclampsia and infant prematurity, low birth weight, and small for gestational age; level of asthma control should be closely monitored in pregnant women and treatment adjusted as necessary to maintain optimal control Lactation There are no data on presence of tiotropium in human milk, effects on breastfed infant, or effects on milk production; tiotropium is present in milk of lactating rats; however, clinical relevance of these data are not clear. the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal conditionPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Long-acting antimuscarinic agent, often referred to as anticholinergic Inhibits M3-receptors at smooth muscle, leading to bronchodilation Absorption Bioavailability: 19.5% Onset: 30 min Duration: >24 hr Time to peak effect: 1-4 hr Distribution Protein bound: 72% Vd: 32 L/kg Metabolism Metabolized in liver via CYP450-dependent oxidation and subsequent glutathione conjugation Elimination Half-life: 5-6 days Total body clearance: 880 mL/min Excretion: Urine Oral Inhalation Spiriva Respimat: Premeasured dose in slow-moving mist for oral inhalation; delivers medication in a way that does not depend on how fast air is breathed in from the inhaler To receive the full dose of medication, Spiriva Respimat must be administered as 2 inhalations once-daily (ie, 2 inhalations of 2.5 mcg [5 mcg] for COPD; 2 inhalations of 1.25 mcg [2.5 mcg] for asthma) Spiriva Handihaler: Powder for inhalation; device is dependent on the patient's ability to inhale the powder BRAND FORM. UNIT PRICE PILL IMAGE Spiriva Respimat inhalation- 1.25 mcg/actuation inhalationSpiriva Respimat inhalation- 2.5 mcg/actuation inhalationSpiriva with HandiHaler inhalation- 18 mcg capsuleSpiriva with HandiHaler inhalation- 18 mcg capsuleSpiriva with HandiHaler inhalation- 18 mcg capsuleCopyright © 2010 First DataBank, Inc.Print Patient Educationtiotropium bromide inhalation TIOTROPIUM POWDER IN CAPSULE - INHALATION (TYE-oh-TROE-pee-um) COMMON BRAND NAME(S): Spiriva USES: Tiotropium is used to control and prevent symptoms (such as wheezing, shortness of breath) caused by ongoing lung disease (chronic obstructive pulmonary disease-COPD which includes bronchitis and emphysema). It works by relaxing the muscles around the airways so that they open up and you can breathe more easily. Tiotropium belongs to a class of drugs known as anticholinergics. Controlling symptoms of breathing problems can decrease time lost from work or school.This medication must be used regularly to be effective. It does not work right away and should not be used to relieve sudden breathing problems. If wheezing or sudden shortness of breath occurs, use your quick-relief inhaler (such as albuterol, also called salbutamol in some countries) as prescribed. HOW TO USE: Read the Patient Information Leaflet and instruction sheet if available from your pharmacist before you start using tiotropium and each time you get a refill. Learn how to use this inhaler properly. If you have any questions, ask your doctor or pharmacist.Do not swallow these capsules by mouth. Use the special inhaler to inhale the powder in the capsules. Inhale this medication by mouth as directed by your doctor, usually once daily. Inhale 2 times per capsule to make sure you inhale all of the drug. Do not breathe out into the mouthpiece at any time. Avoid getting this medication into your eyes. It may cause eye pain/irritation, temporary blurred vision, and other vision changes.If you are using other inhalers at the same time, wait at least 1 minute between the use of each medication.Use this medication regularly in order to get the most benefit from it. This medication works best if used at evenly spaced intervals. To help you remember, use it at the same time each day. Do not increase your dose, use this medication more often, or stop using it without first consulting your doctor.Rinse your mouth after using the inhaler to prevent dry mouth and throat irritation.Clean the inhaler at least once a month with water. Allow to air-dry fully before using again.Learn which of your inhalers you should use every day and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing, increased sputum, waking up at night with trouble breathing, if you use your quick-relief inhaler more often, or if your quick-relief inhaler does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.Tell your doctor if your symptoms do not improve or if they worsen. SIDE EFFECTS: Dry mouth, constipation, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Rarely, this medication may cause severe sudden worsening of breathing problems right after use. If you have sudden worsening of breathing, use your quick-relief inhaler and get medical help right away.Tell your doctor right away if you have any serious side effects, including: difficult/painful urination, fast heartbeat.Get medical help right away if you have any very serious side effects, including: eye pain/swelling/redness, vision changes (such as seeing rainbows around lights at night, blurred vision).A very serious allergic reaction to this product is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before using tiotropium, tell your doctor or pharmacist if you are allergic to it or to ipratropium; or to atropine or other belladonna-type drugs; or if you have any other allergies. This product may contain inactive ingredients (such as milk proteins), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, personal or family history of glaucoma (angle-closure type), difficulty urinating (for example, due to enlarged prostate).This drug may make you dizzy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially dry mouth and constipation. Older men may also be at greater risk for difficulty urinating while using this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other anticholinergics (such as ipratropium). OVERDOSE: This medication will not work and may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. NOTES: Do not share this medication with others. MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up. STORAGE: Store the capsules at room temperature away from light and moisture. Keep the capsules in the blister package until ready to use. Do not store capsules in the inhaler device. Once the blister package for a capsule is opened, that capsule should be used right away. Discard any capsule that has its blister package opened and not used right away. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada). Information last revised May 2023. Copyright(c) 2023 First Databank, Inc. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific