TIOTROPIUM BROMIDE
| TIOTROPIUM BROMIDE (ti-o-tro'pi-um) Spiriva Classifications: anticholinergic; antimuscarinic; antispasmodic; bronchodilator; Therapeutic:bronchodilator; antispasmodic Prototype: Ipratropium Pregnancy Category: C |
Availability
18 mcg capsules with powder for inhalation
Action
A long-acting, antispasmodic agent. In the bronchial airways, it exhibits inhibition of muscarinic receptors of the smooth muscle resulting in bronchodilation. The drug effect can last up to 24 h.
Therapeutic Effect
Bronchodilation after inhalation of tiotropium is predominantly a site-specific effect.
Uses
Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD).
Contraindications
Hypersensitivity to tiotropium, atropine, or ipratropium; acute bronchospasm; pregnancy (category C); children <18 y.
Cautious Use
Decreased renal function; BPH, urinary bladder neck obstruction; narrow-angle glaucoma; older adults; lactation.
Route & Dosage
| COPD Adult: Inhaled Inhale the contents of one capsule once daily using hand inhaler device provided. |
Administration
Inhalation- Place capsule in HandiHaler® and press button to puncture. Instruct patient to exhale deeply then put the mouthpiece to the lips and breathe in the dose deeply and slowly; remove HandiHaler® and hold breath for at least 10 sec, and then exhale slowly; rinse mouth with water to minimize dry mouth.
- Ensure that drug does not contact the eyes.
- Store at 15°–30° C (59°–86° F).
Adverse Effects (≥1%)
Body as a Whole: Nonspecific chest pain, dependent edema, infection, moniliasis, flu-like syndrome, cough, allergic reactions. CNS: Dysphonia, paresthesia, depression. GI: Abdominal pain, constipation, dry mouth, dyspepsia, vomiting, reflux, stomatitis. Metabolic: Hypercholesterolemia, hyperglycemia. Musculoskeletal: Myalgia, skeletal pain. Respiratory: Epistaxis, pharyngitis, rhinitis, laryngitis, sinusitis, upper respiratory tract infection. Skin: Rash. Special Senses: Cataract. Urogenital: Urinary tract infection.Interactions
Drug: May cause additive anticholinergic effects with other anticholinergic agents.Pharmacokinetics
Absorption: 19.5% absorbed from the lungs. Peak: 5 min. Metabolism: <25% of dose is metabolized in liver by CYP2D6 and 3A4. Elimination: 14% of dose excreted in urine; remaining is excreted in feces as nonabsorbed drug. Half-Life: 5–6 d.Nursing Implications
Assessment & Drug Effects
- Withhold drug and notify physician if S&S of angioedema occurs.
- Monitor for anticholinergic effects (e.g., tachycardia, urinary retention).
Patient & Family Education
- Do not allow powdered medication to contact the eyes, as this may cause blurring of vision and pupil dilation.
- Tiotropium bromide is intended as a once-daily maintenance treatment. It is not useful for treatment of acute episodes of bronchospasm (i.e., rescue therapy).
- Withhold drug and notify physician if swelling around the face, mouth, or neck occurs.
- Report any of the following: constipation, increased heart rate, blurred vision, urinary difficulty.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug