Tiotropium bromide

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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.




Tiotropium bromide.jpg


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).

[edit] DOSAGE

Two inhalations of the powder contents of a single Tiotropium bromide capsule (18 mcg) once daily


  • Hypersensitivity to tiotropium or to ipratropium


  • 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 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.


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)




Asthma / Chronic obstructive pulmonary disease (COPD)
Adrenergics, inhalants Short acting β2-agonists Fenoterol (Berotec)   Levosalbutamol (Xopenex)   Salbutamol (Ventolin)   Terbutaline (Bricanyl)
Long acting β2-agonists (LABA) Arformoterol (Brovana)   Clenbuterol (Spiropent)   Formoterol (Foradil)   Salmeterol (Serevent)
Ultra long acting β2-agonists Indacaterol   Olodaterol   Vilanterol
Inhaled corticosteroids Beclomethasone (Inhaler)   Budesonide (Inhaler)   Ciclesonide (Inhaler)   Flunisolide (Inhalation suspension)   Fluticasone (Inhaler)   Mometasone (Inhaler)
Anticholinergics (Muscarinic antagonists) Aclidinium bromide   Glycopyrronium bromide   Ipratropium bromide   Oxitropium bromide (Inhalation suspension)   Tiotropium bromide
Mast cell stabilizers Cromoglicate   Nedocromil
Monoclonal anti-IgE antibody Omalizumab
Xanthine derivatives Aminophylline   Bamifylline   Doxofylline   Dyphylline   Theophylline
Eicosanoid inhibition Leukotriene antagonists Montelukast   Pranlukast   Zafirlukast
Thromboxane receptor antagonists Ramatroban   Seratrodast
Non-xanthine PDE4 inhibitors Ibudilast   Roflumilast
Combination products Corticosteroid + Long acting Beta2 agonist Beclomethasone/Formoterol (Inhaler)   Fluticasone/Salmeterol (Inhaler)   Fluticasone/Vilanterol   Mometasone/Formoterol
Corticosteroid + Short acting Beta2 agonist Beclomethasone/Salbutamol   Salbutamol/Flunisolide (Inhalation suspension)   Salbutamol/Flunisolide (Inhaler)
Short acting Beta2 agonist + Muscarinic antagonist Fenoterol/Ipratropium bromide (Inhaler)   Levosalbutamol/Ipratropium   Salbutamol/Ipratropium bromide