Tiotropium

Key facts

• Tiotropium (found in inhalers such as Spiriva) is a long-acting muscarinic antagonist, a bronchodilator that keeps the airways open by blocking the nerve signals that tighten airway muscle.
• It is taken once daily as a maintenance inhaler for chronic obstructive pulmonary disease (COPD); some formulations are also used as an add-on for asthma. Full benefit builds over days to weeks.
• It is not a rescue medicine. It will not stop a sudden attack of breathlessness or wheeze, so you still need a fast-acting inhaler for emergencies.
• Seek urgent care for sudden eye pain with blurred vision and halos around lights, or for chest pain, a fast or irregular heartbeat, or a marked drop in how much you urinate.

What tiotropium treats

Tiotropium is a maintenance treatment for chronic obstructive pulmonary disease, used to reduce daily breathlessness and cut the frequency of flare-ups. Certain inhaler formulations are also approved as an add-on treatment for asthma that is not controlled by a corticosteroid inhaler alone. It does not treat an acute asthma or COPD attack in progress.

How tiotropium works

Airway muscle tightens when a nerve chemical called acetylcholine binds to muscarinic receptors on the muscle. Tiotropium blocks those receptors, so the airway muscle relaxes and stays open. Because the drug binds tightly and releases slowly, one inhalation keeps the airways open for around 24 hours.

Before you take it

• Do not use tiotropium if you have had a severe allergic reaction to it, to atropine-related drugs, or to any of the inhaler's ingredients.
• Tell your prescriber if you have narrow-angle glaucoma, an enlarged prostate, or bladder outflow problems. Tiotropium's anticholinergic action can raise eye pressure or make urination harder.
• Take care that the inhaler mist or powder does not enter your eyes; contact can trigger acute glaucoma with eye pain, blurred vision, and halos around lights.
• Tell your prescriber about any heart rhythm problems, since anticholinergic bronchodilators can occasionally affect heart rate.

Side effects

The most common effect is a dry mouth, which usually eases with time. Constipation, mild throat irritation, and cough after inhaling are also reported.

Stop and seek urgent medical care for any of these:

• Sudden eye pain, blurred vision, or halos around lights (possible acute angle-closure glaucoma).
• Difficulty or inability to pass urine.
• A fast, irregular heartbeat, chest pain, or new swelling.
• Signs of a severe allergic reaction: facial or throat swelling, hives, or trouble breathing.

Safety essentials

• Keep the inhaler mist away from your eyes. Anyone with narrow-angle glaucoma who develops sudden eye pain or visual halos after using tiotropium needs same-day eye care.
• This is a maintenance inhaler, not a rescue treatment. Using it more often than prescribed will not relieve a sudden attack and will not replace your rescue inhaler.
• Tell your prescriber if you have prostate enlargement or trouble emptying your bladder, since anticholinergic effects can worsen urinary retention.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.