Tiotropium

LAMA·Respiratory - Asthma & COPD

Maintenance treatment of COPD, add-on maintenance for severe asthma

Authority requiredPBSLAMASpiriva HandiHaler, Spiriva RespimatDry powder capsules for inha…+2

Max Dose

18 mcg/day

Half-life

5-6 Days

Freq

ONCE DAILY

Dry Mouth

COMMON

Rapid Summary

Overview

Long-Acting Muscarinic Antagonist (LAMA). The gold-standard baseline maintenance bronchodilator for COPD.

Maximum Dose

Max 18 mcg/day (HandiHaler) or 5 mcg/day (Respimat).

Clinical Focus

Never use for acute bronchospasm. Prevent patients from accidentally swallowing the HandiHaler capsules.

Bottom Line

Tiotropium is the gold-standard long-acting anticholinergic for COPD maintenance and severe asthma add-on, but provides no acute relief and must not be used as a rescue inhaler.

Formulation & Access

Brand Names

Spiriva HandiHaler, Spiriva Respimat

Oral Routes

Dry powder capsules for inhalation (18 mcg). Soft mist inhaler (2.5 mcg/puff).

Prescribing & PBS

Authority Required (PBS) for COPD.

Indications & Use

Primary

PBSTGA

Maintenance treatment of COPD, add-on maintenance for severe asthma.

Clinical Place

First-line monotherapy for symptomatic COPD. Significantly reduces COPD exacerbations and hospitalisations.

Quick reference

Class & Role

LAMA — Long-Acting Muscarinic Antagonist (LAMA).

Route / Formulation

Dry powder capsules for inhalation (18 mcg). Soft mist inhaler (2.5 mcg/puff). (Spiriva HandiHaler, Spiriva Respimat)

Usual Dose & Max

Inhaled 18 mcg OD (inhale contents of 1 capsule via HandiHaler) OR 2 puffs (2.5 mcg/puff) OD via Respimat. Max 18 mcg/day (HandiHaler) or 5 mcg/day (Respimat).

Key Indication Doses

COPD Maintenance: Inhaled 18 mcg OD (inhale contents of 1 capsule via HandiHaler) OR 2 puffs (2.5 mcg/puff) OD via Respimat. Asthma Maintenance: Inhaled 2 puffs (2.5 mcg/puff) OD via Respimat (add-on to ICS/LABA).

Best Uses

Tiotropium is the gold-standard long-acting anticholinergic for COPD maintenance and severe asthma add-on, but provides no acute relief and must not be used as a rescue inhaler.

Avoid / Cautions

Do not use for acute bronchospasm relief. Pregnancy Category B1.

Key Risks

Gastrointestinal: Dry mouth (usually mild but persistent), constipation. Genitourinary: Urinary retention in susceptible patients (BPH). Cardiovascular: Mild tachycardia, rare arrhythmias.

Key Interactions

Additive effects with other anticholinergics (e.g., Oxybutynin, Amitriptyline). Avoid concurrent use with Ipratropium.

Monitoring

Check inhaler technique regularly. Monitor for severe dry mouth leading to dental caries. No specific routine laboratory tests required.

Clinical Pearl

Ward patients routinely mistake the HandiHaler capsules for oral medications and swallow them. They must be pierced and inhaled. This is a massive cause of treatment failure.

Access

Authority requiredSpiriva HandiHaler, Spiriva RespimatDry powder capsules for inha…

Brand: Spiriva HandiHaler, Spiriva Respimat
PBS status: Authority required
Formulation: Dry powder capsules for inhalation (18 mcg)

Tiotropium

LAMA·Respiratory - Asthma & COPD

Maintenance treatment of COPD, add-on maintenance for severe asthma

Authority requiredPBSLAMASpiriva HandiHaler, Spiriva RespimatDry powder capsules for inha…+2

Max Dose

18 mcg/day

Half-life

5-6 Days

Freq

ONCE DAILY

Dry Mouth

COMMON

Rapid Summary

Overview

Long-Acting Muscarinic Antagonist (LAMA). The gold-standard baseline maintenance bronchodilator for COPD.

Maximum Dose

Max 18 mcg/day (HandiHaler) or 5 mcg/day (Respimat).

Clinical Focus

Never use for acute bronchospasm. Prevent patients from accidentally swallowing the HandiHaler capsules.

Bottom Line

Tiotropium is the gold-standard long-acting anticholinergic for COPD maintenance and severe asthma add-on, but provides no acute relief and must not be used as a rescue inhaler.

Formulation & Access

Brand Names

Spiriva HandiHaler, Spiriva Respimat

Oral Routes

Dry powder capsules for inhalation (18 mcg). Soft mist inhaler (2.5 mcg/puff).

Prescribing & PBS

Authority Required (PBS) for COPD.

Indications & Use

Primary

PBSTGA

Maintenance treatment of COPD, add-on maintenance for severe asthma.

Clinical Place

First-line monotherapy for symptomatic COPD. Significantly reduces COPD exacerbations and hospitalisations.

Quick reference

Class & Role

LAMA — Long-Acting Muscarinic Antagonist (LAMA).

Route / Formulation

Dry powder capsules for inhalation (18 mcg). Soft mist inhaler (2.5 mcg/puff). (Spiriva HandiHaler, Spiriva Respimat)

Usual Dose & Max

Inhaled 18 mcg OD (inhale contents of 1 capsule via HandiHaler) OR 2 puffs (2.5 mcg/puff) OD via Respimat. Max 18 mcg/day (HandiHaler) or 5 mcg/day (Respimat).

Key Indication Doses

Best Uses

Tiotropium is the gold-standard long-acting anticholinergic for COPD maintenance and severe asthma add-on, but provides no acute relief and must not be used as a rescue inhaler.

Avoid / Cautions

Do not use for acute bronchospasm relief. Pregnancy Category B1.

Key Risks

Gastrointestinal: Dry mouth (usually mild but persistent), constipation. Genitourinary: Urinary retention in susceptible patients (BPH). Cardiovascular: Mild tachycardia, rare arrhythmias.

Key Interactions

Additive effects with other anticholinergics (e.g., Oxybutynin, Amitriptyline). Avoid concurrent use with Ipratropium.

Monitoring

Check inhaler technique regularly. Monitor for severe dry mouth leading to dental caries. No specific routine laboratory tests required.

Clinical Pearl

Ward patients routinely mistake the HandiHaler capsules for oral medications and swallow them. They must be pierced and inhaled. This is a massive cause of treatment failure.

Access

Authority requiredSpiriva HandiHaler, Spiriva RespimatDry powder capsules for inha…

Brand: Spiriva HandiHaler, Spiriva Respimat
PBS status: Authority required
Formulation: Dry powder capsules for inhalation (18 mcg)