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Pharmacologic class: Antimuscarinic, anticholinergic
Therapeutic class: Bronchodilator
Pregnancy risk category C
Inhibits smooth-muscle muscarinic M3-receptors, leading to bronchodilation
Capsules for inhalation: 18 mcg
Indications and dosages
➣ Long-term, once-daily maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease
Adults: Contents of one capsule inhaled orally once daily using supplied HandiHaler
• Hypersensitivity to atropine or its derivatives (including ipratropium) or drug components
Use cautiously in:
• angle-closure glaucoma, prostatic hyperplasia, bladder neck obstruction, moderate to severe renal impairment, severe hypersensitivity to milk proteins
• concurrent use of other anticholinergics
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• Give contents of one capsule once daily using HandiHaler.
• Don't let patient swallow capsule.
CNS: depression, paresthesia
CV: angina, increased heart rate
EENT: eye pain or discomfort, blurred vision, visual halos, cataract, colored images in association with red eyes (with inadvertent eye exposure), epistaxis, rhinitis, sinusitis, laryngitis, pharyngitis, dysphonia
GI: vomiting, constipation, dyspepsia, abdominal pain, gastroesophageal reflux, stomatitis, dry mouth
GU: urinary tract infection, urinary retention, urinary difficulty
Musculoskeletal: myalgia, skeletal pain, arthritis, leg pain
Respiratory: upper respiratory tract infection, coughing, paradoxical bronchospasm
Other: nonspecific chest pain, edema, infection, candidiasis, flulike symptoms, herpes zoster, hypersensitivity reaction (including angioedema)
Drug-diagnostic tests. Blood glucose, cholesterol: increased
Closely monitor patient for allergic reaction and paradoxical bronchospasm; if these occur, discontinue drug and consider alternative therapy.
• Closely monitor patients with moderate to severe renal impairment.
• Give patient information portion of package insert on HandiHaler use.
• Inform patient that drug is once-daily maintenance medicine that opens narrowed airways and helps keep them open for 24 hours. Stress that it's not for immediate (rescue) relief of breathing problems.
• Tell patient that capsules are intended for oral inhalation only and should be used only with HandiHaler device. Emphasize that HandiHaler must not be used to take any other drug.
Caution patient not to let powder get into eyes.
• Teach patient to take prescribed dose in these steps: Immediately before use, open one sealed blister foil and HandiHaler device, insert capsule, press HandiHaler button once to pierce capsule, and exhale completely before placing mouthpiece into mouth with head upright. Then breathe in slowly and deeply at a rate fast enough to hear capsule vibrate, until lungs are full. Holding breath as long as comfortable, take HandiHaler device out of mouth. Then place device back in mouth and inhale again to get full dose.
• Tell patient not to exhale into HandiHaler mouthpiece at any time.
• Caution patient not to swallow capsules.
• Tell patient not to store capsules in HandiHaler device.
• Instruct patient to clean device as shown in patient information sheet.
• Instruct patient to discard any capsules inadvertently exposed to air while preparing dose.
Tell patient to contact prescriber immediately if eye pain or discomfort, blurred vision, visual halos, or colored images occur.
2Instruct patient to immediately stop drug and report signs and symptoms of hypersensitivity reaction (including itching, rash, swelling of the lips, tongue, or throat) or difficulty breathing.
Tell patient to immediately report signs and symptoms of prostatic hyperplasia or bladder-neck obstruction (such as difficulty passing urine or painful urination).
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.
Time/action profile (bronchodilation)
|inhaln||rapid||5 min||24 hr|
Adverse Reactions/Side Effects
Ear, Eye, Nose, Throat
- paradoxical bronchospasm
- dry mouth (most frequent)
- urinary difficulty
- urinary retention
- hypersensitivity reactions including angioedema (life-threatening)
Drug-Drug interactionShould not be used concurrently with ipratropium due to risk of additive anticholinergic effects.
- Inhalation: Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult health care professional about alternative medication if severe bronchospasm is present; onset of action is too slow for patients in acute distress. If paradoxical bronchospasm (wheezing) occurs, withhold medication and notify health care professional immediately.
Potential Nursing DiagnosesIneffective airway clearance (Indications)
Risk for activity intolerance (Indications)
- Do not confuse Spiriva (tiotropium) with Inspra (eplerenone).
- Inhalation: See for administration of inhalation medications.
- Instruct patient to take medication as directed. Capsules are for inhalation only and must not be swallowed. Take missed doses as soon as remembered unless almost time for the next dose; space remaining doses evenly during day. Do not double doses.
- Advise patient that tiotropium is not to be used for acute bronchospasm attacks, but may be continued during an acute exacerbation.
- Instruct patient in proper use and cleaning of the Handihaler inhaler. Review the Patient's Instructions for Use guide with patient. Capsules should be stored in sealed blisters; remove immediately before use or effectiveness of capsules is reduced. Tear blister strip carefully to expose only one capsule at a time. Discard capsules that are inadvertently exposed to air. Spiriva should be administered only via the Handihaler and the Handihaler should not be used with other medications. When disposing of capsule, tiny amount of powder left in capsule is normal.
- Advise patient to notify health care professional immediately if signs and symptoms of angioedema (swelling of the lips, tongue, or throat, itching, rash) or signs of glaucoma (eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) occur.
- Caution patient to avoid spraying medication in eyes; may cause blurring of vision and pupil dilation.
- Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth; usually resolves with continued treatment.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, including eye drops.
- Advise patient to inform health care professional if pregnancy is planned or suspected or if breast feeding.
- Decreased dyspnea.
- Improved breath sounds.
- Fewer exacerbations in patients with COPD.
SpirivaA long-acting once-daily antimuscarinic bronchodilator indicated for long-term management of bronchospasm in chronic obstructive pulmonary disease (COPD) (e.g., chronic bronchitis, emphysema).
Dry mouth, constipation, vomiting, dyspepsia.