Tiotropium

Tiotropium (IPA: ) is a long-acting, 24 hour, anticholinergic bronchodilator used in the management of chronic obstructive pulmonary disease (COPD). Tiotropium bromide (INN) capsules for inhalation are co-marketed by Boehringer-Ingelheim and Pfizer under the trade name Spiriva.

Mode of delivery
The patient removes from the blister pack one Spiriva capsule and places it into the piercing chamber of the proprietary HandiHaler device and closes the mouthpiece.

The capsule is manually pierced, and the medication is then inhaled through the mouthpiece. It is recommended to be repeat the inhalations, 2 to 3 times, to make sure all medication is drawn from the capsule. When properly done, the capsule will make a distinctive flutter or rattle, to be heard and sensed by the patient.

The manufacturer warns users to only remove the capsule when ready to immediately take. Any advance removal of capsule, or exposing an additional capsule, is to be discarded. This is because any advanced removal will exposed capsule to the air, of which will render the medication ineffective.

Do not take the capsule orally

Mode of action
Tiotropium is a muscarinic receptor antagonist, often referred to as an antimuscarinic or anticholinergic agent. Although it does not display selectivity for specific muscarinic receptors, on topical application it acts mainly on M3 muscarinic receptors located in the airways to produce smooth muscle relaxation, thus producing a bronchodilatory effect.

Indications
Tiotropium is indicated as a daily, 24 hour, maintenance treatment of chronic obstructive pulmonary disease (COPD).

Adverse effects
Adverse effects are mainly related to its antimuscarinic effects. Common adverse drug reactions (≥1% of patients) associated with tiotropium therapy include: dry mouth and/or throat irritation. Rarely (<0.1% of patients) treatment is associated with: urinary retention, constipation, acute angle closure glaucoma, palpitations, and/or allergy (rash, angioedema, anaphylaxis) (Rossi, 2006).

Image collection
Tiotropiumbromid