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. Administered via the HandiHaler® dry powder inhaler or the Respimat® Soft Mist™ Inhaler, it works by relaxing the muscles around the airways to help keep them open, making breathing easier. Its 24-hour mechanism of action provides sustained bronchodilation and symptom control, forming a cornerstone of maintenance therapy for appropriate patients.

Features

• Contains the active ingredient tiotropium bromide.
• Available in two delivery systems: Spiriva HandiHaler (18 mcg capsule for inhalation) and Spiriva Respimat (1.25 mcg or 2.5 mcg per actuation).
• Long-acting muscarinic antagonist (LAMA) pharmacology.
• Once-daily dosing regimen for consistent 24-hour control.
• Designed for maintenance therapy, not for rescue use.
• The HandiHaler device requires manual loading of a capsule; the Respimat is a propellant-free, slow-moving mist inhaler.

Benefits

• Provides sustained 24-hour bronchodilation, improving lung function (FEV1) and reducing hyperinflation.
• Significantly reduces the frequency of COPD exacerbations, a major driver of disease progression and mortality.
• Helps alleviate key respiratory symptoms, including breathlessness (dyspnea), wheezing, and chronic cough.
• Enhances exercise tolerance and improves overall health-related quality of life scores.
• Reduces the need for rescue medication (short-acting bronchodilators) over time.
• Offers a convenient once-daily dosing schedule to support long-term adherence to therapy.

Common use

Spiriva is primarily prescribed for the long-term, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD). It is a foundational therapy for patients with moderate to very severe COPD (GOLD groups B through D) to improve lung function, reduce exacerbations, and control daily symptoms. It is routinely used as a monotherapy or in combination with long-acting beta-agonists (LABAs) and inhaled corticosteroids (ICS) as part of a comprehensive COPD management plan. It is not indicated for the treatment of asthma.

Dosage and direction

The dosage is specific to the delivery device and must not be interchanged.

• Spiriva HandiHaler: The recommended dosage is the inhalation of the contents of one 18 mcg capsule, once daily, using the HandiHaler device. Only administer one capsule per day. Do not swallow the capsules.
• Spiriva Respimat: The recommended dosage is two puffs (5 mcg total, from the 2.5 mcg per actuation cartridge) once daily. For new users, the cartridge must be primed before first use.
• Administration: Instructions must be demonstrated by a healthcare professional. Inhale the medication deeply and forcefully through the mouthpiece. Hold your breath for 10 seconds, or as long as is comfortable, after inhalation to allow the medication to deposit in the airways. Rinse your mouth with water after each dose to help reduce the risk of oropharyngeal side effects.

Precautions

• Paradoxical Bronchospasm: Can occur with inhalation, presenting as wheezing and shortness of breath immediately after use. Discontinue immediately and institute alternative therapy if this occurs.
• Immediate Hypersensitivity Reactions: Reactions such as angioedema, urticaria, rash, and anaphylaxis have been reported. Discontinue immediately if such a reaction occurs.
• Worsening of Narrow-Angle Glaucoma: Use with caution in patients with narrow-angle glaucoma. Instruct patients to avoid getting the powder or mist into their eyes, as it may cause 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. May cause urinary retention and catheterization may be required.
• Renal Impairment: Patients with moderate to severe renal impairment (creatinine clearance of ≤50 mL/min) should be monitored closely, as tiotropium is primarily renally excreted.
• Drying of the Mouth: A common side effect. Good oral hygiene is recommended, as dry mouth can increase the risk of dental caries over the long term.

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 product formulation.

Possible side effect

The most common adverse reactions (≥3% incidence and greater than placebo) are:

• Dry mouth
• Upper respiratory tract infection
• Sinusitis
• Pharyngitis
• Non-specific chest pain
• Constipation
• Urinary tract infection
• Dyspepsia Other important side effects include:
• Glaucoma
• Urinary retention
• Tachycardia and palpitations
• Paradoxical bronchospasm
• Immediate hypersensitivity reactions

Drug interaction

Formal drug interaction studies have not been performed with Spiriva. However, due to its anticholinergic properties, concomitant use with other anticholinergic-containing drugs (e.g., ipratropium, aclidinium, glycopyrrolate, oxybutynin, tolterodine) is not recommended as it may potentiate adverse effects. It can be used concomitantly with other drugs used in the treatment of COPD, including sympathomimetic bronchodilators, methylxanthines, and oral or inhaled steroids, without expected pharmacokinetic interactions.

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. Patients should never double the next dose to make up for a missed one. Resume the regular once-daily dosing schedule the following day.

Overdose

An overdose is unlikely due to the low systemic bioavailability via inhalation. However, an overdose of tiotropium bromide may lead to pronounced anticholinergic effects and manifestations. These may include:

• Severe dry mouth
• Visual accommodation disturbances
• Tachycardia
• Cardiac arrhythmias
• Urinary retention
• Constipation
• Glaucoma (precipitation or worsening)
• Anxiety
• Tremor
• Seizures (in severe cases) Treatment is symptomatic and supportive. In case of accidental ingestion, activated charcoal may be considered.

Storage

• Store at room temperature between 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F).
• Spiriva HandiHaler: Store capsules in the blister pack and only remove immediately before use. Protect from light and moisture. Store in a dry place. Keep out of the reach of children.
• Spiriva Respimat: Store the inhaler with the cap on. The cartridge must be used within 3 months of insertion into the inhaler. Keep out of the reach of children.
• Do not puncture or incinerate the container.

Disclaimer

This information is for educational purposes only and 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 game-changer in my COPD management practice. The once-daily dosing is a significant advantage for patient adherence, and I consistently see measurable improvements in FEV1 and a marked reduction in exacerbation rates in my patients on this therapy. The HandiHaler device is generally well-tolerated, though some elderly patients with dexterity issues benefit from a demonstration and ongoing support.” – Dr. Evan Sanderson, Pulmonologist

“For the first time in years, I feel a sense of control over my emphysema. I don’t wake up gasping for air as often, and my morning routine is no longer a struggle. The dry mouth is a minor inconvenience compared to the benefit of being able to walk to the mailbox without stopping to catch my breath.” – James L., patient for 4 years.

“While highly effective, clinicians must remain vigilant for the anticholinergic side effect profile, particularly regarding glaucoma and urinary symptoms in susceptible populations. It remains a first-line cornerstone of maintenance therapy for a reason, but patient selection and education are paramount.” – Clinical Pharmacist Specialist, major hospital network.