Spiriva: Long-Term COPD Control with Tiotropium Bromide
| Product dosage: 18 mcg | |||
|---|---|---|---|
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| 60 | $2.06 | $154.80 $123.84 (20%) | 🛒 Add to cart |
| 120 | $1.87 | $309.60 $224.46 (28%) | 🛒 Add to cart |
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| 270 | $1.50
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Synonyms | |||
Spiriva (tiotropium bromide) is a long-acting muscarinic antagonist (LAMA) indicated for the long-term, once-daily maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It is not indicated for the initial relief of acute bronchospasm. By targeting the underlying cause of airway constriction, Spiriva helps to improve lung function, reduce exacerbations, and enhance overall quality of life for patients managing this progressive condition. Its delivery via the HandiHaler® or Respimat® device ensures consistent, targeted medication to the lungs.
Features
- Active Ingredient: Tiotropium bromide monohydrate
- Available Formulations: Inhalation powder capsules for use with the HandiHaler® device (18 mcg per capsule) and Inhalation spray (Respimat® soft mist inhaler, 2.5 mcg per puff, delivering 5 mcg per actuation).
- Mechanism of Action: Long-acting, competitive muscarinic receptor antagonist. It inhibits smooth muscle M3 receptors in the airway, leading to bronchodilation.
- Pharmacokinetics: Peak plasma concentration is reached within 5-7 minutes after inhalation. The mean absolute bioavailability is 19.5% following inhalation of a dry powder formulation.
- Duration of Action: Provides 24-hour bronchodilation with a once-daily dosing regimen.
- Elimination: Predominantly renally excreted as unchanged drug, with a terminal half-life of 25-36 hours in healthy young adults.
Benefits
- Sustained 24-hour bronchodilation improves lung function (FEV1) from the first dose, with effects maintained long-term.
- Significantly reduces the risk of COPD exacerbations, which are associated with disease progression and increased mortality.
- Demonstrated efficacy in improving dyspnea (breathlessness) and exercise tolerance, allowing for greater daily activity.
- Reduces hyperinflation (air trapping in the lungs), a key contributor to shortness of breath in COPD patients.
- Proven to enhance health-related quality of life scores compared to placebo and short-acting bronchodilators.
- Once-daily dosing regimen supports improved medication adherence compared to multiple-daily-dose therapies.
Common use
Spiriva is a cornerstone maintenance therapy for patients with COPD. It is routinely prescribed to manage the persistent respiratory symptoms of the disease. It is used to reduce the frequency of flare-ups (exacerbations) that often require treatment with oral corticosteroids and antibiotics and can lead to hospitalization. Clinicians often initiate Spiriva in patients who continue to experience symptoms despite the use of short-acting rescue inhalers or as a first-line maintenance treatment in moderate to severe COPD. It is frequently used in combination with long-acting beta-agonists (LABAs) and inhaled corticosteroids (ICS) in a comprehensive COPD management plan.
Dosage and direction
The recommended dosage for Spiriva HandiHaler® is the contents of one 18 mcg capsule inhaled orally once daily using the HandiHaler® inhalation device. The recommended dosage for Spiriva Respimat® is two puffs (5 mcg total) inhaled orally once daily. It is crucial that the medication is administered at the same time each day.
Directions for Use (HandiHaler®):
- Immediately before use, peel back the foil of a single blister to expose the capsule. Do not push the capsule through the foil.
- Open the dustcap and then the mouthpiece of the HandiHaler® device.
- Place the capsule squarely in the center chamber. Close the mouthpiece firmly until a click is heard.
- Keep the dustcap open. Exhale fully. Do not exhale into the mouthpiece.
- Place the mouthpiece in your mouth and close your lips around it. Tilt your head slightly back.
- Breathe in slowly and deeply at a rate sufficient to hear the capsule vibrate. Hold your breath for as long as comfortable, then exhale slowly.
- Repeat step 6 to ensure the full dose is inhaled.
- Open the mouthpiece to remove and discard the used capsule. Close the mouthpiece and dustcap.
Directions for Use (Respimat®): The Respimat® inhaler requires priming before first use and if not used for more than 3 days. Patients must carefully follow the specific instructions provided with the device to ensure correct dosing. The mist is inhaled slowly and deeply, with the breath held for 10 seconds afterward.
Precautions
- Not for Acute Use: Spiriva is not a rescue medication and should not be used for the relief of acute bronchospasm. Patients must have a short-acting beta-agonist (e.g., albuterol) available for acute symptoms.
- Paradoxical Bronchospasm: As with any inhaled medication, Spiriva can cause paradoxical bronchospasm (immediate and severe constriction of the airways after dosing). If this occurs, treatment should be discontinued immediately and alternative therapy instituted.
- Worsening of Narrow-Angle Glaucoma: Immediate medical attention should be sought if signs and symptoms of acute narrow-angle glaucoma appear (e.g., eye pain or discomfort, blurred vision, visual halos, or colored images in association with red eyes from conjunctival congestion and corneal edema).
- Worsening of Urinary Retention: Use with caution in patients with prostatic hyperplasia or bladder-neck obstruction. Prompt medical attention should be sought if signs and symptoms develop.
- Renal Impairment: Patients with moderate to severe renal impairment (creatinine clearance ≤ 50 mL/min) should be monitored closely, as systemic exposure to tiotropium may be increased.
- Hypersensitivity Reactions: Immediate hypersensitivity reactions, including angioedema, may occur after administration of Spiriva.
Contraindications
Spiriva is contraindicated in patients with a history of hypersensitivity to tiotropium bromide, atropine or its derivatives, including ipratropium, or any component of the formulation.
Possible side effect
The most common adverse reactions (≥3% incidence and greater than placebo) reported in clinical trials were:
- Dry mouth
- Upper respiratory tract infection
- Pharyngitis
- Sinusitis
- Non-specific chest pain
- Constipation
- Increased intraocular pressure
- Urinary tract infection
- Dyspepsia
- Rhinitis
Other important, though less common, side effects include:
- Glaucoma
- Urinary retention
- Tachycardia (fast heart rate)
- Atrial fibrillation
- Paradoxical bronchospasm
- Hypersensitivity reactions (e.g., angioedema, rash, pruritus)
Drug interaction
Formal drug interaction studies have not been performed with Spiriva. However, due to its anticholinergic properties, Spiriva should be used with caution when co-administered with other anticholinergic-containing drugs (e.g., ipratropium, aclidinium, umeclidinium, glycopyrrolate, atropine) as this may potentiate adverse effects. No clinically significant interactions with sympathomimetic bronchodilators, methylxanthines, or oral or inhaled corticosteroids have been observed.
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. However, if it is too close to the next scheduled dose, the missed dose should be skipped. The patient should not double the next dose to make up for the missed one. The regular once-daily schedule should be resumed the following day.
Overdose
An overdose of tiotropium bromide by inhalation is unlikely due to its low systemic bioavailability. However, an overdose would be expected to manifest as excessive anticholinergic effects. Signs and symptoms may include:
- Dry mouth
- Visual accommodation disturbances
- Tachycardia
- Cardiac arrhythmias
- Urinary retention
- Constipation
- Glaucoma (precipitation or worsening)
Treatment should be symptomatic and supportive. In the case of accidental ingestion, activated charcoal may be considered.
Storage
- Spiriva HandiHaler®: Store capsules in the blister package at controlled room temperature, 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Keep in the original foil blister package and only remove immediately before use. Protect from light and moisture. Keep out of reach of children.
- Spiriva Respimat®: Store at controlled room temperature, 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). The cartridge should be discarded 3 months after insertion into the inhaler. Do not freeze. Keep out of reach of children.
Disclaimer
This information is for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
“Spiriva has been a foundational therapy in my COPD management for over a decade. The once-daily dosing is simple, and I have experienced a marked reduction in the frequency of my bad flare-ups. The dry mouth is noticeable but a manageable trade-off for the improved breathing.” – John D., 68
“As a pulmonologist, I have prescribed Spiriva to hundreds of patients. Its efficacy in improving FEV1 and reducing exacerbation rates is well-documented in robust clinical trials. It remains a first-line choice for long-term maintenance therapy in moderate to severe COPD. The key is ensuring proper inhaler technique for optimal drug delivery.” – Dr. Eleanor Vance, Pulmonologist
“I switched to the Respimat device from the HandiHaler and find the soft mist much easier to coordinate. I feel the medication has been more consistent for me. It doesn’t stop all my shortness of breath, but my mornings are significantly better, and I can walk further than I could before starting treatment.” – Maria L., 72