Spiriva (Tiotropium Bromide) Drug Information: Description, User Reviews, Drug Side Effects, Interactions

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May 26, 2012

Spiriva

Emphysema »

Introduction to emphysema

The lungs are a pair of organs in the chest that are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood.

The lung is composed of clusters of small air sacs (alveoli) divided by thin, elastic walls or membranes. Capillaries, the tiniest of blood vessels, run within these walls between the alveoli and allow blood and air to come near each other. The distance between the air in the lungs and the blood in the capillaries is very small, and allows molecules of oxygen and carbon dioxide to transfer across the membranes.

Air reaches the alveoli via the bronchial tree. The trachea splits into the right and left mainstem bronchi, which branch further into bronchioles and finally ends in the alveolar air sacs.

When we breathe in, air enters the lung and the alveoli expand. Oxygen is transferred onto hemoglobin molecules in the red blood cells to be trans...

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SPIRIVA®
HandiHaler® (tiotropium bromide) Inhalation Powder

DRUG DESCRIPTION

SPIRIVA HandiHaler consists of a capsule dosage form containing a dry powder formulation of tiotropium intended for oral inhalation only with the HandiHaler device.

Each light green, hard gelatin SPIRIVA capsule contains 18 mcg tiotropium (equivalent to 22.5 mcg tiotropium bromide monohydrate) blended with lactose monohydrate (which may contain milk proteins) as the carrier.

The dry powder formulation within the SPIRIVA capsule is intended for oral inhalation only.

The active component of SPIRIVA HandiHaler is tiotropium. The drug substance, tiotropium bromide monohydrate, is an anticholinergic with specificity for muscarinic receptors. It is chemically described as (1α, 2β, 4 β, 5α, 7β)-7-[(Hydroxydi-2-thienylacetyl)oxy]-9,9-dimethyl-3-oxa-9-azoniatricyclo[3.3.1.02,4]nonane bromide monohydrate. It is a synthetic, non-chiral, quaternary ammonium compound. Tiotropium bromide is a white or yellowish white powder. It is sparingly soluble in water and soluble in methanol.

The structural formula is:

SPIRIVA® HandiHaler® (tiotropium bromide) Structural Formula Illustration

Tiotropium bromide (monohydrate) has a molecular mass of 490.4 and a molecular formula of C₁₉H₂₂NO₄S₂Br •H₂O.

The HandiHaler device is an inhalation device used to inhale the dry powder contained in the SPIRIVA capsule. The dry powder is delivered from the HandiHaler device at flow rates as low as 20 L/min. Under standardized in vitro testing, the HandiHaler device delivers a mean of 10.4 mcg tiotropium when tested at a flow rate of 39 L/min for 3.1 seconds (2 L total). In a study of 26 adult patients with COPD and severely compromised lung function [mean FEV₁ 1.02 L (range 0.45 to 2.24 L); 37.6% of predicted (range 16% to 65%)], the median peak inspiratory flow (PIF) through the HandiHaler device was 30.0 L/min (range 20.4 to 45.6 L/min). The amount of drug delivered to the lungs will vary depending on patient factors such as inspiratory flow and peak inspiratory flow through the HandiHaler device, which may vary from patient to patient, and may vary with the exposure time of the SPIRIVA capsule outside the blister pack.

What are the possible side effects of tiotropium inhalation (Spiriva)?

Stop using tiotropium inhalation and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

tongue swelling or redness;
sores or white patches of your mouth, lips, or tongue; or
urinating less than usual or not at all.

Less serious side effects may include:

dry mouth, cough,...

Read All Potential Side Effects and See Pictures of Spiriva »

What are the precautions when taking tiotropium bromide (Spiriva)?

Before using tiotropium, tell your doctor or pharmacist if you are allergic to it or to ipratropium; or to atropine or other belladonna-type drugs; or if you have any other allergies. This product may contain inactive ingredients (such as milk proteins), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, glaucoma (narrow-angle), difficulty urinating (for example, due to enlarged prostate).

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this...

Read All Potential Precautions of Spiriva »

Last reviewed on RxList: 9/7/2011
This monograph has been modified to include the generic and brand name in many instances.