Tiotropium bromide

Generic Medicine Info
Indications and Dosage
Asthma, Chronic obstructive pulmonary disease
Adult: As inhalation cap: 1 cap (18 mcg) daily via inhaler device, at the same time each day. As inhalation soln: 2 inhalations (5 mcg) daily, at the same time each day.
Renal Impairment
CrCl (mL/min) Dosage
≤50 Use w/ caution.
Hypersensitivity to tiotropium bromide, atropine or its derivatives.
Special Precautions
Patient w/ narrow-angle glaucoma, prostatic hyperplasia/bladder neck obstruction, cystic fibrosis. History of MI (<6 mth), or unstable or life threatening cardiac arrhythmia w/in the past yr. Not intended for use as initial treatment for acute bronchospasm and as monotherapy for asthma. Moderate to severe renal impairment (CrCl ≤50 mL/min). Pregnancy and lactation.
Adverse Reactions
Dry mouth, upper resp tract infection, pharyngitis, sinusitis, rhinitis, epistaxis, non-specific chest pain, UTI, dyspepsia, hypersensitivity reactions (e.g. urticaria, angioedema, rash, itching), dizziness, dysphagia, hoarseness, intestinal obstruction, increased intraocular pressure, palpitations, tachycardia; application site irritation (e.g. glossitis, mouth ulceration, pharyngolaryngeal pain).
Potentially Fatal: Paradoxical bronchospasm, anaphylaxis.
Patient Counseling Information
This drug may cause dizziness and blurred vision, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor pulmonary function.
Drug Interactions
Additive effect w/ other anticholinergic drugs.
Mechanism of Action: Tiotropium bromide antagonises the cholinergic effects of acetylcholine by reversibly and competitively binding to type 3 muscarinic (M3) receptors, resulting in bronchial smooth muscle relaxation.
Absorption: Systemically absorbed from the lungs. Bioavailability: Approx 20% (dry powd inhalation); approx 33% (inhalation soln). Time to peak plasma concentration: 5 min (dry powd inhalation); 5-7 min (inhalation soln).
Distribution: Volume of distribution: 32 L/kg. Plasma protein binding: Approx 72%.
Metabolism: Undergoes minimal hepatic metabolism by non-enzymatic cleavage and by CYP2D6 and CYP3A4 isoenzymes.
Excretion: Via urine as unchanged drug. Half-life: 5-6 days (dry powd inhalation).
Chemical Structure

Chemical Structure Image
Tiotropium bromide

Source: National Center for Biotechnology Information. PubChem Database. Tiotropium bromide, CID=5487426, https://pubchem.ncbi.nlm.nih.gov/compound/Tiotropium-bromide (accessed on Jan. 23, 2020)

Inhalation cap: Store at 25°C. Protect from excessive heat and moisture. Do not store in inhaler device. Inhalation soln: Store at 25°C. Do not freeze.
MIMS Class
Antiasthmatic & COPD Preparations
ATC Classification
R03BB04 - tiotropium bromide ; Belongs to the class of other inhalants used in the treatment of obstructive airway diseases, anticholinergics.
Anon. Tiotropium. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 08/07/2015.

Buckingham R (ed). Tiotropium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/07/2015.

Spiriva Capsule (Boehringer Ingelheim Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 08/07/2015.

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