Tiotropium

Tiotropium

Clinical data
Pregnancy category	AU: B1
Routes of administration	inhalation (topical)
ATC code	R03BB04 (WHO)
Legal status
Legal status	AU: S4 (Prescription only) UK: POM (Prescription only)
Pharmacokinetic data
Bioavailability	19.5% (inhalation)
Metabolism	hepatic 25% (CYP2D6, CYP3A4)
Elimination half-life	5–6 days
Excretion	renal
Identifiers
IUPAC name (1α,2β,4β,7β)- 7-[(hydroxidi-2-thienylacetyl)oxy]-9,9-dimethyl- 3-oxa-9-azoniatricyclo[3.3.1.02,4]nonane
CAS Number	186691-13-4
PubChem CID	131950
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}
Chemical and physical data
Formula	C19H22NO4S2+
Molar mass	490.4

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch. Tiotropium (IPA: Template: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.

Clinical use

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).

References

• Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006.

See also

• Chronic obstructive pulmonary disease

External links

• Official SPIRIVA Site
• Thomson CenterWatch

Image collection

Front view

A previously pierced Spiriva capsule

Open (cleaning) view

Template:Asthma and copd rx