TiotropiumTiotropium Bromide

About Tiotropium

Tiotropium blocks muscarinic receptors in the airways so the muscle around them stays relaxed. Spiriva HandiHaler, its generic and Spiriva Respimat are labeled for long-term, once-daily, maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema, and to reduce COPD exacerbations. Spiriva Respimat is also labeled for long-term, once-daily, maintenance treatment of asthma in patients 6 years and older. The COPD dose is the powder from one 18 mcg capsule, inhaled in two breaths through the device, or 2 puffs of the 2.5 mcg Respimat; the asthma dose is 2 puffs of the 1.25 mcg Respimat. No more than one dose is taken in 24 hours.

There is no boxed warning. It is not for acute symptoms, and anyone allergic to tiotropium, ipratropium or any ingredient must not use it. Immediate allergic reactions, including swelling of the lips, tongue or throat, mean stopping it at once; people allergic to atropine or its derivatives are watched closely, and the HandiHaler is used with caution with a severe milk protein allergy, since its capsules contain lactose. It can cause paradoxical bronchospasm and worsen narrow-angle glaucoma (eye pain, blurred vision, halos or colored images with red eyes) or urinary retention, and people with moderate to severe kidney impairment (creatinine clearance under 60 mL/min) are monitored for anticholinergic effects. Common side effects include upper respiratory infection, dry mouth, sinusitis, sore throat, chest pain, urinary tract infection and indigestion with the HandiHaler, and sore throat, cough, dry mouth and sinusitis with Respimat in COPD.

Capsule handling matters: each capsule stays in its blister until just before use, capsules are never stored inside the inhaler, and a capsule exposed to air that cannot be used at once is thrown away. Spiriva capsules are used only with the HandiHaler, and the generic capsules only with the LupinHaler packed with them. The powder is kept out of the eyes, where it can blur vision and widen the pupil. The Respimat cartridge is inserted and primed before first use (spray toward the ground until a cloud is visible, then 3 more times), with 1 spray after more than 3 days unused and full priming after more than 21 days. Tiotropium with olodaterol (Stiolto Respimat) is a separate product.

Taking Tiotropium

How to take it

Once a day at the same time. Place one capsule in the device it came with and inhale its powder in two breaths; never swallow a capsule. Respimat: 2 puffs once a day from a primed inhaler.

If you miss a dose

Inhale the missed dose as soon as you remember, unless it is almost time for the next one; then skip it. Do not inhale a double dose or more than one dose in 24 hours.

Storage

At room temperature, away from excess heat and moisture, out of reach of children. Keep capsules in the blister until just before use and never inside the inhaler; do not freeze the Respimat, and throw it away 3 months after first use or when it locks, whichever comes first.

Interactions to know about

Other anticholinergic medicines, such as ipratropium, add to its effects and are avoided with it. Tell the prescriber about glaucoma, trouble passing urine or kidney disease.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Tiotropium differs from pharmacy to pharmacy

Spiriva HandiHaler has one AB-rated generic, which a pharmacist can dispense where state law allows unless the prescription blocks substitution; it comes with a different inhaler, the LupinHaler. Spiriva Respimat has no rated generic, so a Respimat prescription is filled with the brand, and capsules and Respimat cannot be swapped for each other without the prescriber.

Respimat comes in two strengths for different uses (2.5 mcg for COPD, 1.25 mcg for asthma), so quotes are comparable only for the same strength, and capsules are quoted by the number written.

Ways to pay less for Tiotropium without insurance

• If HandiHaler capsules are prescribed, check that the prescription allows the rated generic.
• For COPD, if Respimat is prescribed, ask the prescriber whether the capsule inhaler would suit you; the capsules are not labeled for asthma.
• For Spiriva Respimat, ask the maker whether its savings or patient assistance program applies to someone paying cash.
• Once your treatment is stable, ask the prescriber whether a prescription covering more than one month suits you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Tiotropium

1. 1.Which device comes with my capsules, and can you show me how to use it?
2. 2.How do I prime my Respimat, and when do I throw it away?
3. 3.Is tiotropium safe with my glaucoma or trouble passing urine?
4. 4.Which inhaler should I use for sudden breathlessness?

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