Mechanism of effect
Competitively and reversibly inhibits the actions of acetylcholine and other cholinergic stimuli at M3 receptors in the smooth muscle of the respiratory tract, leading to bronchodilation.
Pharmacodynamic
Inhibits smooth muscle receptors, leading to bronchodilation.
Pharmacokinetics
Bioavailability is approximately 19.5%.Metabolism
CYP2D6 and CYP3A4 are involved. Approximately 14% is eliminated unchanged in the urine; the remainder is not absorbed in the gut and is eliminated in the feces. Terminal elimination half-life is 5 to 6 days.
Dosage
**Usual Pediatric Dose for Asthma – Maintenance
Less than 12 years: The safety and efficacy have not been established.
12 years or older :
-2.5 mcg (2 inhalations of 1.25 mcg) orally once a day
Comments :
-The maximum benefits in lung function may take up to 4 to 8 weeks of dosing.
** Usual Adult Dose for Chronic Obstructive Pulmonary Disease – Maintenance
inhalation powder, hard capsule :
-18 mcg (2 inhalations) orally once a day using the HandiHaler device
Tiotropium, solution for inhalation :
-5 mcg (2 inhalations) orally once a day
Uses: Long-term maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; to reduce exacerbations in COPD patients.
** Usual Pediatric Dose for Asthma – Maintenance
Less than 12 years: The safety and efficacy have not been established.
12 years or older :
-2.5 mcg (2 inhalations of 1.25 mcg) orally
Drug contraindications
hypersensitivity to this drugSide effects
Headache , dry mouth , constipation , Tachycardia , vertigo , Depression , urticaria , palpitations , sinusitis , myalgia , Upper respiratory tract infection , dry skin , pharyngitis , Abdominal pain , Rash , Rhinorrhea , Angina pectorisInteractions
Acetylcholine , Tolterodine , Belladonna , Propantheline , Dicyclomine , Clidinium - C , Doxepin , Digoxin , Hydroxyzine , Solifenacin , Polyethylene glycol , pilocarpine oral , Pramlintide , Huperzine A , Methacholine , umeclidinium bromide/vilanterol inhaled , BlonanserinAlerts
• Closely monitor patients with a history of hypersensitivity reactions to atropine for similar hypersensitivity reactions to tiotropium . Monitor therapy closely in patients with moderate to severe renal impairment.
• Monitor patients for signs and symptoms of narrow-angle glaucoma and urinary retention.
• Immediate hypersensitivity reactions, including angioedema, have been reported. Use with caution in patients with severe hypersensitivity to milk proteins.
• Not indicated for initial treatment of acute episodes of bronchospasm.
Points of recommendation
To make sure this medicine is safe for you, tell your doctor if you have :
• If you have an allergy to this medicine or any other part of it.
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
• Do not stop the medication once symptoms have improved. Continued daily use is necessary to control symptoms.
• Do not change the dose or stop using unless advised by health care provider.
• tiotropium is a maintenance medication and is not to be used for immediate relief of breathing problems. Advise patient to use rescue medication (short-acting bronchodilator) to obtain rapid relief of breathing problems.
• medication does not replace inhaled or oral corticosteroids and to continue to use those drugs as prescribed by health care provider.
• inform health care provider if symptoms do not improve or worsen, if more short-acting bronchodilator than usual is needed, or if the short-acting bronchodilator appears to become less effective.
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