Tiotropium

Indications

Tiotropium is used for: Asthma, COPD

Adult Dose

Inhalation Asthma; Chronic obstructive pulmonary disease Adult: As Inhaler: 2 puffs (18mcg) once daily. As inhalation cap: 1 cap (18 mcg) daily via inhaler device, at the same time each day.

Child Dose

Inhalation Asthma Child> 12 years: As Inhaler: 2 puffs (18mcg) once daily. Child> 18 years: As inhalation cap: 1 cap (18 mcg) daily via inhaler device, at the same time each day.

Renal Dose

Renal impairment: CrCl (ml/min) Dosage Recommendation <50 Use w/ caution.

Administration

Contra Indications

Hypersensitivity to atropine and its derivatives (e.g. ipratropium).

Precautions

Patient w/ narrow-angle glaucoma, prostatic hyperplasia/bladder neck obstruction, cystic fibrosis. History of MI (<6 mth), or unstable or life threatening cardiac arrhythmia w/in the past yr. Not intended for use as initial treatment for acute bronchospasm and as monotherapy for asthma. Moderate to severe renal impairment (CrCl ≤50 mL/min). Pregnancy and lactation. Patient Counselling This drug may cause dizziness and blurred vision, if affected, do not drive or operate machinery. Monitoring Parameters Monitor pulmonary function.

Pregnancy-Lactation

Interactions

Other anticholinergic agents.

Adverse Effects

Side effects of Tiotropium : >10% Upper respiratory tract infection (41%),Dry mouth (16%),Sinusitis (11%) 1-10% Abdominal pain,Allergic reaction,Angina pectoris (including aggravated angina pectoris),Cataract,Chest pain (nonspecific),Constipation,Depression,Dyspepsia,Dysphonia,Edema,Epistaxis,Gastroesophageal reflux,Herpes zoster,Hypercholesterolemia,Hyperglycemia,Infection,Laryngitis,Leg pain,Moniliasis,Myalgia,Paresthesia,Pharyngitis,Rash,Rhinitis,Skeletal pain,Stomatitis (including ulcerative stomatitis),Urinary tract infection,Vomiting <1% Angioedema,Fibrillation,Supraventricular tachycardia,Urinary retention

Mechanism of Action

Tiotropium bromide, a long-acting quaternary ammonium antimuscarinic, is structurally related to ipratropium. It is a nonselective competitive antagonist of muscarinic (M1-M5) receptors and causes bronchodilation by inhibiting the actions of acetylcholine and other cholinergic stimuli at M3 receptors in the smooth muscle of the respiratory tract.