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Tiotropium bromide (Brand name: Spiriva) is a long-acting anticholinergic bronchodilator used in the management of chronic obstructive pulmonary disease (COPD).
COPD is a long-term lung disease that causes shortness of breath and coughing. The term COPD is associated with the conditions chronic bronchitis and emphysema.
 BRAND NAMES
 MECHANISM OF ACTION
Tiotropium is a long-acting, antimuscarinic agent (parasympatholytic). It has similar affinity to the subtypes of muscarinic receptors, M1 to M5. In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilation
Tiotropium bromide is indicated for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.
Tiotropium bromide is not indicated for the initial treatment of acute episodes of bronchospasm (i.e., rescue therapy).
Two inhalations of the powder contents of a single Tiotropium bromide capsule (18 mcg) once daily
- Hypersensitivity to tiotropium or to ipratropium
 WARNINGS AND PRECAUTIONS
- Immediate hypersensitivity reactions to Tiotropium bromide, including angioedema (swelling of the lips, tongue, or throat), itching, or rash have been reported. If such a reaction occurs, therapy should be stopped and alternative treatments should be considered.
- Paradoxical bronchospasm may occur and should be treated immediately with alternative therapy
- Use with caution in patients with narrow-angle glaucoma (Worsening of narrow-angle glaucoma may occur).
- Worsening of urinary retention may occur. Use with caution in patients with prostatic hyperplasia or bladder-neck obstruction
- Anticholinergics: May interact additively with concomitantly used anticholinergic drugs. Avoid administration of Tiotropium bromide with other anticholinergic-containing drugs.
 PREGNANCY AND LACTATION
- Pregnancy Category C (US). Tiotropium bromide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- Caution should be exercised if administered to nursing women.
 SIDE EFFECTS
Adverse reactions include: dry mouth, upper respiratory tract infection, constipation, sinusitis, pharyngitis, non-specific chest pain, tachycardia, blurred vision, urinary tract infection, dyspepsia, and rhinitis.
Other possible side effects include: Immediate hypersensitivity reactions, paradoxical bronchospasm, worsening of narrow-angle glaucoma and worsening of urinary retention (See precautions and warnings)
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