tiotropium


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tiotropium

Spriva (UK), Spiriva HandiHaler

Pharmacologic class: Antimuscarinic, anticholinergic

Therapeutic class: Bronchodilator

Pregnancy risk category C

Action

Inhibits smooth-muscle muscarinic M3-receptors, leading to bronchodilation

Availability

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

Contraindications

• Hypersensitivity to atropine or its derivatives (including ipratropium) or drug components

Precautions

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).

Administration

• Give contents of one capsule once daily using HandiHaler.
• Don't let patient swallow capsule.

Adverse reactions

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

Skin: rash

Other: nonspecific chest pain, edema, infection, candidiasis, flulike symptoms, herpes zoster, hypersensitivity reaction (including angioedema)

Interactions

Drug-diagnostic tests. Blood glucose, cholesterol: increased

Patient monitoring

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.

Patient teaching

• 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.

tiotropium

(tye-o-trope-ee-yum) ,

Spiriva

(trade name)

Classification

Therapeutic: bronchodilators
Pharmacologic: anticholinergics
Pregnancy Category: C

Indications

Long-term maintenance treatment of bronchospasm due to COPD.Reducing exacerbations in patients with COPD.

Action

Acts as anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways.

Therapeutic effects

Decreased incidence and severity of bronchospasm.

Pharmacokinetics

Absorption: 19% absorbed following inhalation.
Distribution: Extensive tissue distribution; due to route of administration ↑ concentrations occur in lung.
Metabolism and Excretion: 74% excreted unchanged in urine; 25% of absorbed drug is metabolized.
Half-life: 5–6 days.

Time/action profile (bronchodilation)

ROUTEONSETPEAKDURATION
inhalnrapid5 min24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to tiotropium or ipratropium;Concurrent ipratropium.
Use Cautiously in: Hypersensitivity to atropine or milk proteins;Narrow-angle glaucoma, prostatic hyperplasia, bladder neck obstruction (may worsen condition);CCr ≤50 mL/min (monitor closely); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children (safety not established).

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • glaucoma

Respiratory

  • paradoxical bronchospasm

Cardiovascular

  • tachycardia

Gastrointestinal

  • dry mouth (most frequent)
  • constipation

Genitourinary

  • urinary difficulty
  • urinary retention

Dermatologic

  • rash

Miscellaneous

  • hypersensitivity reactions including angioedema (life-threatening)

Interactions

Drug-Drug interaction

Should not be used concurrently with ipratropium due to risk of additive anticholinergic effects.

Route/Dosage

Inhalation (Adults) 18 mcg once daily.

Availability

Dry powder capsules for inhalation: 18 mcg Cost: $317.33 / 30 capsules

Nursing implications

Nursing assessment

  • 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 Diagnoses

Ineffective airway clearance (Indications)
Risk for activity intolerance (Indications)

Implementation

  • Do not confuse Spiriva (tiotropium) with Inspra (eplerenone).
  • Inhalation: See for administration of inhalation medications.

Patient/Family Teaching

  • 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.

Evaluation/Desired Outcomes

  • Decreased dyspnea.
    • Improved breath sounds.
  • Fewer exacerbations in patients with COPD.

tiotropium

an anticholinergic and bronchodilator.
indications This drug is used for long-term treatment of chronic obstructive pulmonary disease (COPD) and for once-daily maintenance of bronchospasm associated with COPD, including chronic bronchitis and emphysema.
adverse effects Adverse effects of this drug include depression, chest pain, increased heart rate, dry mouth, blurred vision, glaucoma, abdominal pain, constipation, dyspepsia, rash, urinary difficulty, urinary retention, sinusitis, upper respiratory tract infection, epistaxis, and pharyngitis. Common side effects include vomiting, cough, and a worsening of symptoms.

Spiriva

A long-acting once-daily antimuscarinic bronchodilator indicated for long-term management of bronchospasm in chronic obstructive pulmonary disease (COPD) (e.g., chronic bronchitis, emphysema).

Adverse effects
Dry mouth, constipation, vomiting, dyspepsia.
References in periodicals archive ?
The children were randomly assigned to the fluticasone propionate aerosol group or the fluticasone propionate aerosol plus tiotropium group for 12 weeks.
37 per person-year in the 532 patients of the tiotropium plus ICS group (rate ratio, 0.
Over 4 years, tiotropium has been shown to increase time to first exacerbation by approximately 4 months.
The first thing to do is to check if you are using an inhaler which has Salmeterol, Formoterol or Tiotropium bromide as the only active ingredient.
The present study was done to evaluate the effectiveness of three different regimens consisting of tiotropium and formoterol combinations in moderate COPD patients so that to observe the 12 hour as well as 24 hour protection by the LABA along with 24 hour acting LAMA.
Impact of tiotropium on the course of moderate-to-very severe chronic obstructive pulmonary disease: The UPLIFT trial.
Finally, a newer oral NSAID, roflumilast, has been shown to reduce exacerbations in patients with moderate to severe COPD when added to salmeterol or tiotropium (Lancet 2009;374:695-703).
The drugs include the short-acting anticholinergic ipratropium (Atrovent, Combivent) and long-acting tiotropium (Spiriva).
In severe disease and in patients with previous hospitalizations, a combination of inhaled corticosteroids, tiotropium and long-acting beta-2 agonists may be required to reduce morbidity.
The drugs studied, which include tiotropium (Spiriva) and ipratropium bromide (Atrovent), are the most commonly prescribed medications for COPD, a progressive lung disease.
The purpose of which was to evaluate the RCC recommendations of tiotropium bromide inhalation powder (TB).