Spiriva (Tiotropium Bromide)
Also sold as: Spiriva, Tiova, Tiotropium Respimat, Braltus, Tiospir
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
DPI (HandiHaler) capsule 18 mcg +1
Indications
- COPD — maintenance bronchodilation (first-line LAMA)
- COPD — reducing exacerbations
- Asthma (add-on, step 4-5 if uncontrolled on ICS+LABA)
Adult Dosing
COPD
HandiHaler: 18 mcg (1 capsule) inhaled once daily. Respimat: 5 mcg (2 actuations) inhaled once daily
Lifelong maintenance
Asthma (add-on)
Respimat: 5 mcg once daily
Only as add-on to ICS + LABA; not as monotherapy in asthma
Pediatric Dosing
Not indicated for COPD in children. Asthma use: specialist only
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 50 mL/min | No adjustment |
| CrCl < 50 mL/min | Use with caution; adverse effects more likely (urinary retention, constipation) |
Hepatic Adjustment
No dose adjustment required
Pregnancy & Lactation
Pregnancy: Category C
Limited data; use only if COPD/asthma benefits outweigh risks. Inhaled route minimises systemic exposure.
Lactation: Caution
Unknown if excreted in breast milk; use with caution.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Other anticholinergics (ipratropium, aclidinium, glycopyrronium) | Additive anticholinergic adverse effects — avoid concurrent long-acting anticholinergics | Major |
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Side Effects
Common
- Dry mouth (most common)
- Constipation
- Urinary retention (especially elderly males with BPH)
- Blurred vision
- Palpitations
Serious / Discontinue If
- Acute angle-closure glaucoma (if powder contacts eyes)
- Urinary retention (BPH)
- Paradoxical bronchospasm (rare)
Contraindications
- Hypersensitivity to tiotropium, atropine, or its derivatives
- Acute angle-closure glaucoma (relative)
- Urinary retention
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Spiriva HandiHaler 18 mcg | Boehringer Ingelheim | 10 cap ₹595 |
| Tiova HandiHaler 18 mcg | Cipla | 10 cap ₹380 |
| Braltus Zonda DPI | Intas | 10 cap ₹320 |
Monitoring Required
- FEV1 / spirometry at baseline and annually
- Symptoms: COPD Assessment Test (CAT) or mMRC dyspnoea scale
- Urinary symptoms in elderly males
- Eye symptoms (glaucoma risk)
Patient Counseling Points
- Use ONLY with HandiHaler device — DO NOT swallow capsules
- Inhale deeply and forcefully to activate DPI capsule
- Rinse mouth after inhalation
- If powder enters eye — rinse immediately and seek help (glaucoma risk)
- For BPH patients: report difficulty passing urine
- This is a MAINTENANCE inhaler — NOT for acute breathlessness; use SABA (salbutamol) for rescue
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Clinically reviewed by: Dr. Kavitha Rao, MD (Pulmonology), Consultant
Last reviewed: 2026-04-01
References
- BNF — Tiotropium
- GOLD COPD Guidelines 2025
- UPLIFT Trial
- TIOSPIR Trial