Tiotropium
SPIRIVA
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.
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
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
NO BOXED WARNINGS
Principal riskAnticholinergic effects; acute urinary retention
Cost, est. cash$30–$500/month
Generic entry2023
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.
Mechanism of action: Tiotropium ballicule
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Memory aids: mascots and interaction avatars
red as a beet” → anticholinergic