Formulary
Tiotropium: Indications, Dosing, Side Effects and Interactions
Tiotropium clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Tiotropium: Indications, Dosing, Side Effects and Interactions
Tiotropium clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Maintenance treatment of chronic obstructive pulmonary disease**
- **Adult** (By Inhalation Of Powder): 1 capsule once daily.
**Maintenance treatment of chronic obstructive pulmonary disease,Severe asthma [add-on to inhaled corticosteroid (at least 800 micrograms budesonide daily or equivalent) and at least 1 controller in patients who have suffered one or more severe exacerbations in the last year]**
- **Adult** (By Inhalation): Maintenance treatment of chronic obstructive pulmonary disease, Severe asthma [add-on to inhaled corticosteroid (at least 800 micrograms budesonide daily or equivalent) and at least 1 controller in patients who have suffered one or more severe exacerbations in the last year] 5 micrograms once daily.
**Severe asthma [add-on to inhaled corticosteroid (over 400 micrograms budesonide daily or equivalent) and 1 controller, or inhaled corticosteroid (200-400 micrograms budesonide daily or equivalent) and 2 controllers, in patients who have suffered one or more severe exacerbations in the last year]**
- **Child** (By Inhalation): 6-11 years 5 micrograms once daily.
**Severe asthma [add-on to inhaled corticosteroid (over 800 micrograms budesonide daily or equivalent) and 1 controller, or inhaled corticosteroid (400-800 micrograms budesonide daily or equivalent) and 2 controllers, in patients who have suffered one or more severe exacerbations in the last year]**
- **Child** (By Inhalation): 12-17 years 5 micrograms once daily.
**Severe asthma [add-on to inhaled corticosteroid (over 400 micrograms budesonide daily or equivalent) and 1 controller, or inhaled corticosteroid (200-400 micrograms budesonide daily or equivalent) and 2 controllers, in patients who have suffered one or more severe exacerbations in the last year] for Spiriva Respimat**
- **Child 6-11 years** (By inhalation): 5 micrograms once daily.
**Severe asthma [add-on to inhaled corticosteroid (over 800 micrograms budesonide daily or equivalent) and 1 controller, or inhaled corticosteroid (400-800 micrograms budesonide daily or equivalent) and 2 controllers, in patients who have suffered one or more severe exacerbations in the last year] for Spiriva Respimat**
- **Child 12-17 years** (By inhalation): 5 micrograms once daily.
Cautions
For all antimuscarinics (inhaled) Bladder outflow obstruction; paradoxical bronchospasm; prostatic hyperplasia; susceptibility to angle-closure glaucoma Cautions, further information Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate with a history of angle-closure glaucoma (may exacerbate glaucoma) or bladder outflow obstruction (may cause urinary retention). Cautions For tiotropium Arrhythmia (unstable, life-threatening or requiring intervention in the previous 12 months); heart failure (hospitalisation for moderate to severe heart failure in the previous 12 months); myocardial infarction in the previous 6 months
Side effects
For all antimuscarinics (inhaled) Common or very common Arrhythmias; constipation; cough; dizziness; dry mouth; headache; nausea Uncommon Dysphonia; glaucoma; palpitations; skin reactions; stomatitis; urinary disorders; vision blurred Side-effects For tiotropium Uncommon Gastrointestinal disorders; increased risk of infection; taste altered Rare or very rare Bronchospasm; dysphagia; epistaxis; insomnia; oral disorders Frequency not known Dehydration; joint swelling; skin ulcer
Interactions
**Other interactions (1):**
- The anticholinergic effect of drugs such as tri- and tetracyclic antidepressants, antihistamines, quinidine, amantadine, antipsychotics (e.g.
Pregnancy
When used for Chronic obstructive pulmonary disease in adults: Avoid (limited data available). M When used for Asthma: Inhaled drugs can be taken as normal during pregnancy.
Breast feeding
Manufacturer advises avoid-no information available.
Renal impairment
Manufacturer advises use only if potential benefit outweighs risk if creatinine clearance less than or equal to 50 mL/minute-plasma-tiotropium concentration raised. See Prescribing in renal impairment .
Medicinal forms
Powder,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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