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Bronchodilator Pregnancy: Very limited data in pregnancy; as a precautionary measure preferable to avoid use during pregnancy. Not recommended during breast-feeding (long-acting compound); weigh benefit of breast-feeding against therapy.

Tiotropium

Brand names: Spiriva, Spiriva Respimat

Tiotropium is a long-acting muscarinic antagonist (LAMA) inhaler used for maintenance bronchodilation in COPD and as add-on therapy in some asthma.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 18 micrograms (contents of one capsule) once daily
Route: Inhalation (via NeumoHaler device)
Frequency: Once daily, at the same time of day
Max: One capsule (18 micrograms) once daily — recommended dose should not be exceeded; not to be used more than once daily
Long-acting maintenance bronchodilator (COPD); not for initial treatment of acute bronchospasm/rescue. Capsules are for inhalation only via the NeumoHaler and must not be swallowed. Geriatric, renally impaired and hepatically impaired patients can use the recommended dose; in moderate-to-severe renal impairment (creatinine clearance <=50 ml/min) use only if expected benefit outweighs potential risk. Paediatric: no relevant use below 18 years in COPD; safety and efficacy in cystic fibrosis in children/adolescents not established (no data).

Dose adjustments

Renal

Can be used at the recommended dose in renal impairment; in moderate-to-severe impairment (creatinine clearance <=50 ml/min) plasma concentration rises — use only if expected benefit outweighs potential risk (no long-term experience in severe impairment).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any excipient
  • Hypersensitivity to atropine or its derivatives (e.g. ipratropium or oxitropium)

Side effects

  • Dry mouth (common)
  • Constipation; gastro-oesophageal reflux; oropharyngeal candidiasis
  • Dizziness; headache; taste disorder
  • Blurred vision; glaucoma; raised intraocular pressure
  • Urinary retention; dysuria; atrial fibrillation

Interactions

  • Co-administration with other anticholinergic-containing drugs has not been studied and is not recommended
  • No clinical evidence of interaction with sympathomimetic bronchodilators, methylxanthines, or oral/inhaled steroids commonly used in COPD; LABA or ICS did not alter tiotropium exposure

Clinical monograph

How it works

It blocks airway muscarinic receptors to give sustained bronchodilation; it is a maintenance treatment, not a reliever.

Prescribing in practice

  • It is for regular daily use, not for acute symptom relief.
  • Use caution in narrow-angle glaucoma and bladder-outflow obstruction (antimuscarinic effects); avoid the mist/powder getting into the eyes.
  • Inhaler technique and device differ between products — train the patient.

Monitoring

Review symptoms, exacerbation frequency and inhaler technique.

Counselling the patient

  • Use it every day for maintenance — keep your reliever for sudden breathlessness.
  • Dry mouth can occur; keep it out of your eyes.
  • Report eye pain or visual changes, or difficulty passing urine.

Evidence & guidelines

LAMAs are central to COPD maintenance and an add-on option in asthma per NICE NG115/NG80.

Reference: GOLD COPD Guidelines 2024; UPLIFT Trial NEJM 2008; NICE; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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