tiotropium

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.