Tiotropium

SPIRIVA

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Pronunciation: tee-oe-TRO-pee-um (spe-REE-va)

Tiotropium ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Tiotropium ballicule

Tiotropium SPIRIVA mascot mnemonic cartoon — Visual mnemonic: Tiotropium mascot
**“Tio’s tropical Spiral”**
red as a beet” → anticholinergic

What it isLong-acting muscarinic antagonist bronchodilator; COPD maintenance and add-on asthma treatment.

Why this oneIt has the longest clinical track record among LAMAs, and its soft-mist formulation also carries an asthma indication.

What limits itDry mouth, urinary retention, and glaucoma can worsen; it is maintenance only, and powder capsules must be inhaled, not swallowed.

Tiotropium molecular structure (skeletal formula) — Molecular structure: Tiotropium

FDA-approved for

COPD (2004)

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
COPD, maintenance	Adults	Two inhalations of one 18 mcg capsule QD	18 mcg QD

Renal No adjustment needed; monitor closely for anticholinergic effects if CrCl <60 mL/min

Hepatic No adjustment needed (not studied)

Do not exceed one dose (two inhalations) per 24 hours

Instructions

For oral inhalation only; do not swallow capsules
Use capsules only with the HandiHaler device
Not a rescue medication; not for acute bronchospasm
Do not take more than one dose in 24 hours

Available strengths

powder 0.018 mg/inh
cap 18 mcg
spray 1.25, 2.5 mcg/inh

Contraindications

Hypersensitivity to tiotropium, ipratropium, or product components (including angioedema)

Cautions

Not for acute use/rescue
Immediate hypersensitivity reactions including angioedema; caution with severe milk-protein hypersensitivity
Paradoxical bronchospasm
Worsening of narrow-angle glaucoma
Worsening of urinary retention

Adverse reactions

Upper respiratory tract infection
Dry mouth
Sinusitis, pharyngitis
Non-specific chest pain
Urinary tract infection, dyspepsia, rhinitis

Pregnancy Limited human data insufficient to inform risk

Lactation No human data; present in milk of lactating rats

Cost

Tiotropium (SPIRIVA)

Strength		#/mo	generic $/unit	CostPlus
0.018 mg/inh	powder	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Tiotropium is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry2023

NO BOXED WARNINGS

Principal riskAnticholinergic effects; acute urinary retention

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism4 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.

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