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Spiriva HandiHaler
tiotropium inhaled
Adult Dosing .
Dosage forms: DPI: 18 mcg per cap
COPD, maintenance tx
- [2 puffs (1 cap) inhaled qd]
- Max: 1 cap/24h; Info: caps for use with HandiHaler device only
renal dosing
- [see below]
- renal impairment: no adjustment; Info: monitor for anticholinergic side effects if CrCl <60
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- bronchospasm, acute
- caution: hypersensitivity to milk protein
- caution: CrCl <60
- caution: glaucoma, angle-closure
- caution: urinary retention
- caution: prostatic hypertrophy
- caution: bladder neck obstruction
Drug Interactions .
Overview
tiotropium inhaled
anticholinergic inhaled
- anticholinergic effects
- tachycardia
Contraindicated
Avoid/Use Alternative
Monitor/Modify Tx
Caution Advised
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- bronchospasm, paradoxical
- glaucoma, angle-closure
Common Reactions
- URI symptoms
- xerostomia
- chest pain
- UTI
- dyspepsia
- abdominal pain
- headache
- edema
- depression
- insomnia
- constipation
- arthralgia
- myalgia
- vomiting
- epistaxis
- rash
- infection
- candidiasis
- urinary hesitancy
- urinary retention
Safety/Monitoring .
Monitoring Parameters
anticholinergic symptoms if CrCl <60
Look/Sound-Alike Drug Names
Spiriva confused with: Apidra; Inspra; Serevent
tiotropium confused with: ipratropium
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; no known risk of teratogenicity, though possible risk of decr. birth wt and embryo-fetal toxicity based on animal data at 40x MRHD
Lactation
Clinical Summary
may use while breastfeeding; no human data available, though risk of infant harm not expected based on minimal drug excretion into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for tiotropium: liver minimally; CYP450: 2D6, 3A4 substrate; Info: 19.5% systemic absorption
Excretion: for tiotropium: urine 7%, feces; Half-life: 25h
Subclass: Muscarinic Antagonists, Inhaled Long-Acting (LAMAs)
Mechanism of Action
for tiotropium: antagonizes acetylcholine receptors, producing bronchodilation
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Boehringer Ingelheim Pharmaceuticals, Inc.
DEA/FDA: Rx
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
inhalation capsule:
- 18 mcg/capsule (1 handihaler, 90 capsules): $1,440.00
inhalation capsule:
- 18 mcg/capsule (1 handihaler, 30 capsules): $497.00
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