Tiotropium

Sounds like 'tee-oh-tro-pee-um'

Easy-to-read medicine information about tiotropium – what it is, how to take it safely and possible side effects.

Type of medicine Also called
  • Bronchodilator (opens the airways)
  • Spiriva®
  • Spiriva Respimat®

What is tiotropium?

Tiotropium is used to treat the symptoms of COPD such wheezing, coughing and shortness of breath. It reduces your symptoms over the long term. Tiotropium opens air passages in your lungs, making breathing easier. Tiotropium must be used every day. It is a long-acting bronchodilator, which means that it works throughout the day.

In New Zealand, tiotropium is available as different inhaler devices:

  • Spiriva Respimat which is a mist inhaler
  • Spiriva inhalation capsules to be used with the handihaler device. 

Spiriva contains tiotropium in a capsule form, which is for inhalation with a handihaler only. The powder from the capsule is breathed into the lungs using the handihaler device provided. Do not swallow the capsules – they must be used by inhaling the contents of the capsule with the handihaler. Using an inhaler device enables the medicine to go straight into your airways when you breathe in. This means that your airways and lungs are treated, but very little of the medicine gets into the rest of your body.

Tiotropium does not give immediate relief from wheezing, tight chest and shortness of breath
If you need quick relief from these symptoms, use your ‘reliever’ medicine such as salbutamol or terbutaline.

Dose

  • The dose of tiotropium is different depending on which inhaler device you are using.
  • Spiriva Respimat: 2 puffs inhaled once a day.
  • Spiriva Handihaler: 1 tiotropium capsule inhaled once a day.
  • Follow your doctor's instructions carefully. The pharmacy label on your medicine will tell you how much to use, how often to use it and any special instructions.

Tips

  • Keep using your inhaler every day. Do not stop using it, even if you feel better. Since COPD is a long-term condition, prevention with tiotropium is ongoing and it will need to be used every day.
  • Try to use your inhaler at the same time each day, to help you to remember to use it regularly.
  • If you miss a dose, you can take it as soon as you remember. But if it is nearly time for your next dose, just take your next dose at the right time.

How to use your Respimat device

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist or nurse to show you how to use your Respimat device. Here is some guidance:

Source: Health Navigator & Auckland District Health Board, NZ, 2018

If using your Respimat device for the first time:

  • Insert the cartridge: Keep the cap closed. Remove clear base – press the safety catch while firmly pulling the base with other hand. Insert the narrow end of the cartridge into the inhaler. Press down on a hard surface (such as a table) to secure the cartridge into the device and close the base.
  • Prime the inhaler: To ensure the device releases the medicine properly, you will need to prime it. Do this by turning the clear base in the direction of the arrows on the label until it clicks (half a turn). Open the cap, push the release button on the front, until you see the mist come out of the mouth piece. You may need to do this a few times.

Inserting the cartridge and priming the Respimat device can be tricky. Ask your pharmacist to load the cartridge for you.

To use your Respimat device:

  • Load the dose: Hold the inhaler upright with the cap closed. Turn the base in the direction of arrows until until you hear a click.
  • Breathe out: Breathe out, away from the device. Do not blow directly into your device.
  • Inhale your dose: Open the cap and press your lips around the mouthpiece without covering the air vents on either side. Breathe in slowly and deeply through your mouth. Press the dose release button and continue to breathe in. Hold your breath for up to 10 seconds. Breathe out slowly.

When to start a new device: There is a counting device on the side of your inhaler that tells you how many doses are left. When it gets into the red section, it is time to get a new inhaler.

How to use your Handihaler device

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist or nurse to show you how to use your handihaler device. Here is some guidance:

 Source: Health Navigator & Auckland District Health Board, NZ, 2018

Using your HandiHaler

  • Open: Press the green button on the side of the handihaler to open the lid. Lift the lid to see the mouthpiece. Pull on the mouthpiece to reveal the capsule chamber.
  • Load the capsule: Spiriva capsules come packaged in blister strips. Peel back the foil from one blister strip to release one capsule. Place the capsule into the capsule chamber. Close the mouthpiece firmly until you hear a click.
  • Pierce the capsule: Press the green button on the side to pierce the capsule.
  • Breathe out: Sit upright, tilt head back (into 'sniff' position) and breathe out gently. Do not breathe into the device.
  • Inhale your dose: Put the mouthpiece into your mouth and seal lips firmly around it. Breathe in rapidly and deeply through your mouth. You will hear the sound of the capsule vibrating in the chamber. Remove the Handihaler from your mouth and hold your breath for up to 10 seconds.
  • Take two breaths from one capsule: To get your full daily dose, you must use your inhaler twice from the same Spiriva capsule. You will not need to pierce the capsule again.
  • Discard the used capsule: After inhaling your dose, open the mouthpiece and discard the used capsule. Close the mouthpiece and the lid of the inhaler.

Precautions – before using tiotropium

  • Do you have problems with your prostate, or have had difficulty passing urine?
  • Do you have glaucoma?
  • Do you have heart problems such as an unusual heart rhythm?
  • Do you have problems with your kidneys?
  • Do you have lactose intolerance?
  • Are you pregnant or breastfeeding?

If so, it’s important that you tell your doctor or pharmacist before you start using tiotropium. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines tiotropium can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.

Side effects What should I do?
  • Dry mouth
  • A change in voice (hoarse voice)
  • A different taste in your mouth
  • After using your handihaler or inhaler device, rinse your mouth to prevent dry mouth and throat irritation.
  • Tell your doctor if troublesome.
  • Difficulty urinating (peeing)
  • Constipation or diarrhoea
  • Bleeding nose
  • Tell your doctor.
  • Dizziness or blurred vision
  • Tell your doctor.
  • Do not drive or use machinery.
  • Do not drink alcohol.
  • Changes in your heartbeat (fast or irregular)
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
  • Difficulty breathing or worsening of your breathing problem
  • Tell your doctor immediately or ring Healthline on 0800 611 116.

Learn more

Tiotropium New Zealand Formulary
Spiriva; Spiriva Respimat Medsafe Consumer Information Sheets

References

  1. Tiotropium New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 22 Jun 2019