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

Easy-to-read medicine information about tiotropium – what it is, how to take tiotropium 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 and prevent them from recurring. Tiotropium must be used every day. It is a long-acting bronchodilator, which means that it works throughout the day. It prevents symptoms such as  such wheezing, coughing, and shortness of breath and reduces your symptoms over the long term. Tiotropium opens air passages in the lungs to make breathing easier.

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 the active tiotropium in a capsule form, which is for inhalation 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.

Totropium 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.


  • 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.


  • 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 for months or years.
  • 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:

(Health Navigator NZ & Auckland District Health Board, 2018)

If using your Respimat device for the first time

  • Insert the cartridge or canister into the base of the inhaler device.
  • Press down on a hard surface to secure the cartridge into the device and close the base.
  • Prime the inhaler the first time you use it or if you have not used it for days or weeks. Do this by pressing the dose-release button until you see a mist.

To use your Respimat device 

  • Hold the inhaler upright with the cap closed. Turn the base in the direction of arrows until it clicks.
  • Breathe out fully, away from the inhaler.
  • Open the cap and press your lips around the mouthpiece without covering the air vents. Begin to breathe in slowly and deeply through the mouth.
  • Press the dose release button and continue to breathe in for as long as possible.
  • Hold your breath for at least six seconds. Breathe out slowly. 

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:

 (Health Navigator NZ & Auckland District Health Board, 2018)

Using your HandiHaler

  • Spiriva capsules come packaged in blister strips.
  • Peel back the foil from one blister strip for one capsule.
  • Open the HandiHaler cover and mouthpiece. Place the Spiriva capsule in the centre chamber.
  • Close the mouthpiece firmly until a click is heard, leaving the cover open.
  • Holding the Handihaler upright, pierce the capsule by pressing the green button completely.
  • Sit upright, tilt head back (into 'sniff' position) and breathe out gently. Do not breathe into the device. Put the mouthpiece into your mouth and seal lips firmly around it.
  • Breathe in slowly and deeply. The sound of the capsule vibrating in the chamber will be heard. Remove the Handihaler from your mouth and hold your breath for 10 seconds or as long as possible. Breathe out gently through your nose.
  • Check to see if any powder is still in the capsule. If so, repeat the process from 'sit upright'.
  • Open the mouthpiece. Tip out and dispose of the used capsule. Close the mouthpiece and cover to stop dust or dirt getting on the mouthpiece and being inhaled.

Cleaning your HandiHaler

  • Clean your Handihaler once a month.
  • Open the cap, mouthpiece and base.
  • Rinse the whole device with warm water and air-dry thoroughly for 24 hours.
  • Clean the outside of the mouthpiece with a damp tissue when needed.

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?
  • 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)
  • Tell your doctor
  • 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


  1. Tiotropium New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Carolyn Woolerton, Pharmacist, MedWise, August 2016