AdultPediatricDosage Forms & Strengths capsule (Spiriva Handihaler; powder for oral inhalation) 18mcg solution for inhalation (Spiriva Respimat) 1.25mcg/actuation 2.5mcg/actuation Chronic Obstructive Pulmonary Disease Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD); reduction of COPD exacerbations Spiriva Handihaler: 2 PO inhalations of 1 capsule (18 mcg) qDay via HandiHaler inhalation device Spiriva Respimat: 5 mcg (2 actuations; 2.5 mcg/actuation) inhaled PO qDay Asthma Indicated for long-term, once-daily, maintenance treatment of asthma in patients aged ≥12 yr Spiriva Respimat: 2.5 mcg (2 actuations; 1.25 mcg/actuation) inhaled PO qDay Dosage Modifications CrCl <50 mL/min: Use only if benefit outweighs potential risk Cystic Fibrosis (Orphan) Improvement of pulmonary function in conjunction with standard therapy in management of patients with cystic fibrosis Orphan indication sponsor Boehringer Ingelheim Pharmaceuticals, Inc, PO Box 368, 900 Ridgebury Road, Ridgefield, CT 06877 Dosage Forms & Strengths solution for inhalation (Spiriva Respimat) 1.25mcg/actuation Asthma Indicated for long-term, once-daily, maintenance treatment of asthma in patients aged ≥6 yr Spiriva Respimat: 2.5 mcg (2 actuations; 1.25 mcg/actuation) inhaled PO qDayInteraction CheckerEnter a drug name and tiotropiumNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (1)umeclidinium bromide/vilanterol inhaledtiotropium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Duplicate therapy.Serious - Use Alternative (4)glucagonglucagon increases toxicity of tiotropium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .glucagon intranasalglucagon intranasal increases toxicity of tiotropium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .pramlintidepramlintide, tiotropium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.revefenacinrevefenacin and tiotropium both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.Monitor Closely (94)abobotulinumtoxinAabobotulinumtoxinA increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .amantadinetiotropium, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.amitriptylinetiotropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.amoxapinetiotropium and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.anticholinergic/sedative combosanticholinergic/sedative combos and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.aripiprazoletiotropium decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.aripiprazole increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.atracuriumatracurium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.atropineatropine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.atropine IV/IMatropine IV/IM and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.belladonna alkaloidsbelladonna alkaloids and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.belladonna and opiumbelladonna and opium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.benperidoltiotropium decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.benperidol increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.benztropinebenztropine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. bethanecholbethanechol increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.carbacholcarbachol increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.cevimelinecevimeline increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.chlorpromazinetiotropium decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.chlorpromazine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.cisatracuriumcisatracurium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipraminetiotropium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.clozapinetiotropium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.clozapine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.cyclizinecyclizine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.cyclobenzaprinecyclobenzaprine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.darifenacindarifenacin and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.desipraminetiotropium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.dicyclominedicyclomine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.diphenhydraminediphenhydramine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.donepezildonepezil increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.donepezil transdermaldonepezil transdermal, tiotropium. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.dosulepintiotropium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.doxepintiotropium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.droperidoltiotropium decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.droperidol increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.echothiophate iodideechothiophate iodide increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.fesoterodinefesoterodine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.flavoxateflavoxate and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.fluphenazinetiotropium decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.fluphenazine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.galantaminegalantamine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.glycopyrrolateglycopyrrolate and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.glycopyrrolate inhaledglycopyrrolate inhaled and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.glycopyrronium tosylate topicalglycopyrronium tosylate topical, tiotropium. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.haloperidoltiotropium decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.haloperidol increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.henbanehenbane and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.homatropinehomatropine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.huperzine Ahuperzine A increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.hyoscyaminehyoscyamine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.hyoscyamine sprayhyoscyamine spray and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.iloperidonetiotropium decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.iloperidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.imipraminetiotropium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.ipratropiumipratropium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.levodopatiotropium, levodopa. Other (see comment). Use Caution/Monitor. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .lofepraminetiotropium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.loxapinetiotropium decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.loxapine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.loxapine inhaledloxapine inhaled increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tiotropium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.maprotilinetiotropium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.meclizinemeclizine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.methscopolaminemethscopolamine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.neostigmineneostigmine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylinetiotropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.olanzapinetiotropium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.olanzapine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.onabotulinumtoxinAonabotulinumtoxinA and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.orphenadrinetiotropium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutyninoxybutynin and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin topicaloxybutynin topical and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin transdermaloxybutynin transdermal and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.paliperidonetiotropium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.pancuroniumpancuronium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.perphenazinetiotropium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.perphenazine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.physostigminephysostigmine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pilocarpinepilocarpine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pimozidetiotropium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.pimozide increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.pralidoximepralidoxime and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.prochlorperazinetiotropium decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.prochlorperazine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.promethazinetiotropium decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.promethazine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.propanthelinepropantheline and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.protriptylinetiotropium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.pyridostigminepyridostigmine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.quetiapinetiotropium decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.quetiapine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rapacuroniumrapacuronium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.risperidonetiotropium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.risperidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rocuroniumrocuronium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.scopolaminescopolamine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.solifenacinsolifenacin and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.succinylcholinesuccinylcholine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.thioridazinetiotropium decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.thioridazine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.thiothixenetiotropium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.thiothixene increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tolterodinetiotropium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.trazodonetiotropium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.trifluoperazinetiotropium decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.trifluoperazine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.trihexyphenidyltiotropium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimipraminetiotropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.trospium chloridetiotropium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.umeclidinium bromideumeclidinium bromide and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agentsvecuroniumtiotropium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.ziprasidonetiotropium 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.zotepinetiotropium decreases levels of