Although no formal in vivo drug interaction studies have been performed, tiotropium bromide has been used concomitantly with other drugs commonly used in the treatment of COPD, including, methylxanthines, oral and inhaled steroids, without clinical evidence of drug interactions.
Anticholinergic Agents: The co-administration of tiotropium bromide, one component of Spiolto Respimat, with other anticholinergic containing drugs has not been studied and therefore is not recommended.
Adrenergic agents: Concomitant administration of other adrenergic agents (alone or as part of combination therapy) may potentiate the undesirable effects of SPIOLTO RESPIMAT.
Xanthine derivatives, steroids or diuretics: Concomitant treatment with xanthine derivatives, steroids, or non-potassium sparing diuretics may potentiate any hypokalemic effect of adrenergic agonists (see Precautions).
Beta-blockers: Beta-adrenergic blockers may weaken or antagonize the effect of olodaterol. Cardioselective beta-blockers could be considered, although they should be administered with caution.
MAO Inhibitors, Tricyclic Antidepressants, QTc prolonging drugs: Monoamine oxidase inhibitors, or tricyclic antidepressants or other drugs known to prolong the QTc interval may potentiate the action of SPIOLTO RESPIMAT on the cardiovascular system.
Pharmacokinetic Drug-Drug interactions: No relevant effect on systemic exposure to olodaterol has been observed in drug-drug interaction studies with co-administration of fluconazole, used as model inhibitor of CYP2C9.
Co-administration of ketoconazole as potent P-gp and CYP3A4 inhibitor increased systemic exposure to olodaterol by approximately 70%. No dose adjustment of Spiolto Respimat is necessary.
In vitro investigations have shown that olodaterol does not inhibit CYP enzymes or drug transporters at the plasma concentrations achieved in clinical practice.