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Overview: Tiotropium is used to treat long-term breathing problems, such as chronic obstructive pulmonary disease (COPD) or asthma. It helps relax the muscles around your airways, making it easier to breathe. Common side effects include sore throat, cough, dry mouth, and headache. Tell your healthcare provider right away if you have any changes in your vision or trouble emptying your bladder.

Uses

What is tiotropium used for?

Tiotropium is commonly used for the following conditions.

Tiotropium may also be used for other conditions as determined by your healthcare provider.

How does tiotropium work (mechanism of action)?

Tiotropium helps relax the muscles around the airways, making it easier for you to breathe. Once the muscles can relax, air can flow more easily throughout the lungs. Tiotropium is long-acting, which means the medicine continues to work over a long period of time. 

How is tiotropium supplied (dosage forms)?

Brand and other names

  • Spiriva HandiHaler
  • Spiriva Respimat

Dosage forms and strengths

  • 18 mcg inhalation powder capsules
  • 1.25 mcg per actuation inhalation spray
  • 2.5 mcg per actuation inhalation spray

How should I store tiotropium?

Tiotropium should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place away from direct heat or sunlight. Do not freeze.

Inhalation Capsules. If you are prescribed tiotropium capsules for inhalation, keep the capsules in their blister packaging until you are ready to use them. Throw out any unused capsules after the expiration date has passed.

Inhaled Spray. If you are prescribed tiotropium inhalation spray (Spiriva Respimat), throw out and replace the cartridge for the inhaler once three months have passed from the first time you use it, or when there are no more doses left, whichever is sooner. 

Side Effects

What are the most common side effects of tiotropium?

The most common side effects of tiotropium are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Infection in the nose, throat, or sinuses, sore throat, runny nose, or common cold symptoms
  • Dry mouth
  • Cough
  • Chest pain
  • Kidney or bladder infection
  • Indigestion
  • Headache 
  • Inflammation of the sinuses
  • Bronchitis

There may be other side effects of tiotropium that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of tiotropium?

While less common, the most serious side effects of tiotropium are described below, along with what to do if they happen.

Severe Allergic Reactions. Tiotropium may cause allergic reactions, which can be serious. Stop using tiotropium and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Breathing Problems. Tiotropium may cause the muscles around the airways to tighten (bronchospasm) instead of relaxing, which can be serious. Stop using tiotropium and contact your healthcare provider right away if you have trouble breathing.

Glaucoma. Using tiotropium for a long time may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. Tell your healthcare provider right away if you have any of the following symptoms of glaucoma.

  • Loss of vision
  • Eye pain or redness
  • Severe headache or vomiting
  • Seeing bright, colorful circles around lights (vision halos)

Inability to Empty Bladder (Urinary Retention). Tiotropium might make it harder to empty your bladder, especially if you already have a blockage or trouble peeing. Stop using tiotropium and call your healthcare provider right away if you have a hard time peeing or have a weak stream, if peeing is painful, or if you are peeing frequently.

Warnings & Precautions

Who should not use tiotropium?

Allergies to Ingredients. People who are allergic to any of the following should not use tiotropium.

  • Tiotropium
  • Ipratropium
  • Spiriva
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific tiotropium products they stock.

What should I know about tiotropium before using it?

Do not use tiotropium unless it has been prescribed to you by a healthcare provider. Use it as prescribed. 

Your pharmacist or other healthcare provider will show you how to correctly use and clean tiotropium. Follow the “Instructions for Use” that comes with the product when using it for the first time or when you have not used it for a while. If you have any questions about how to use your inhaler, talk to your pharmacist or other healthcare provider.

Tiotropium is not a rescue inhaler. It should not be used to treat sudden breathing problems. It is used daily as a maintenance medicine. Tiotropium should not be used in asthma or COPD that is getting worse quickly over time. If you are using your rescue inhaler (such as an albuterol inhaler) more often than usual, contact your healthcare provider to discuss your asthma or COPD medicines.

Do not share tiotropium with other people, even if they have the same condition as you. It may harm them.

Keep tiotropium out of the reach of children.

Tiotropium can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how tiotropium affects you.

If you are prescribed tiotropium inhalation capsules, do not swallow the capsules. Tiotropium capsules should only be used with the inhalation device. 

What should I tell my healthcare provider before using tiotropium?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if tiotropium is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Eye problems, such as glaucoma 
  • A blockage in your bladder, trouble peeing, or prostate problems
  • Kidney problems

Milk Allergy. Tell your pharmacist and other healthcare providers if you have a milk allergy. People with a severe milk allergy may have an allergic reaction to tiotropium inhalation capsules because the capsules contain a powder that may have milk proteins in it. 

Other Medicines and Supplements. Tiotropium may interact with other medicines and supplements. Before using tiotropium, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how tiotropium could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.

Breastfeeding. It is not known if tiotropium passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should use tiotropium while breastfeeding.

Interactions

Does tiotropium interact with foods or drinks?

There are no known interactions between tiotropium and foods or drinks.

It is unknown if drinking alcohol will affect tiotropium. The risk of dizziness may be increased if you drink alcohol while using tiotropium. 

Does tiotropium interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC)medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using tiotropium.

  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
  • A long-acting muscarinic antagonist (LAMA) medicine like tiotropium, such as aclidinium (Tudorza), revefenacin (Yupelri), or umeclidinium (Incruse)

This may not be a complete list of medicines that can interact with tiotropium. Always check with your healthcare provider.

 

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much tiotropium?

If you or someone else has used too much tiotropium, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of tiotropium?

If you miss a dose, use it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only use the next dose. Do not use double or extra doses.