Spiriva Respimat

How does it work?

• Spiriva inhalers (HandiHaler or Respimat) contain the active ingredient tiotropium, which is a type of medicine known as an antimuscarinic or anticholinergic bronchodilator. It works by opening the airways to make it easier to breathe.
• Tiotropium works in the lungs, where it blocks receptors called muscarinic receptors that are found on the muscle surrounding the airways. A natural chemical called acetylcholine normally acts on these receptors, causing the muscle in the airways to contract and the airways to narrow.
• In chronic obstructive lung diseases (COPD), such as chronic bronchitis or emphysema, the airways are narrowed, and this makes breathing in and out difficult.
• Tiotropium blocks the muscarinic receptors in the lungs and therefore stops the action of acetylcholine on them. This allows the muscle around the airways to relax and the airways to open. This makes it easier for people with COPD to breathe.
• Tiotropium is taken using an inhaler device; either Spiriva HandiHaler or Spiriva Respimat. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.
• Tiotropium should not be used to relieve an attack of breathing difficulty. Instead, it should be used regularly each day to keep the airways open and help prevent breathing difficulties. The medicine works over 24 hours so it is best to always take it at the same time of day.

How do I use it?

• Spiriva comes as two different types of inhaler - the HandiHaler, which is a dry powder inhaler, and the Respimat inhaler, which is used to inhale a liquid form of the medicine from a cartridge.
• Spiriva HandiHaler comes with capsules that contain the medicine in powder form. One capsule is put in the chamber in the inhaler. You then use the inhaler to pierce the capsule and breathe in the powder. Do not swallow the capsules. It is important to follow the instructions provided with the HandiHaler carefully. These explain in detail how to use this inhaler. Talk to your doctor, pharmacist or nurse if you are unsure how to use the device, or have any problems using it.
• The usual dose of Spiriva HandiHaler is one capsule to be inhaled once daily. The daily dose should be taken at the same time each day. The effect of the medicine lasts for 24 hours.
• Spiriva Respimat inhaler comes with a cartridge that you insert into the inhaler. This contains approximately 30 doses (60 puffs) of the medicine in liquid form. Follow the instructions provided with the Spiriva Respimat inhaler carefully. These describe in detail how to use the inhaler correctly. Talk to your doctor, pharmacist or nurse if you are unsure how to use the device, or have any problems using it.
• The usual dose of Spiriva Respimat is two puffs to be inhaled once daily. The daily dose should be taken at the same time each day. The effect of the medicine lasts for 24 hours.
• If you forget to take your dose of Spiriva at your usual time, then take it as soon as you remember that day. Then take your next dose at your usual time the following day. If you forget to take a dose for a whole day then just leave out the missed dose. Do not take more than one dose in a day to make up for a missed dose.
• Do not exceed the recommended dose of this medicine.

Use with caution in

• People with closed angle glaucoma.
• People who have difficulty passing urine, for example men with an men with enlarged prostate gland (prostatic hypertrophy) or people with an obstruction of the bladder.
• People with moderate to severely decreased kidney function.
• People with an abnormal heart rhythm.

Not to be used in

• People who are allergic to atropine or similar medicines, eg ipratropium or oxitropium.
• Children and adolescents under 18 years of age.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

• Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
• The safety of this medicine in pregnancy has not been established. It should only be used during pregnancy if the potential benefits to the mother outweigh any risks to the developing baby. Seek medical advice from your doctor.
• It is not known if this medicine passes into breast milk after inhalation. You should seek medical advice from your doctor before breastfeeding while using this medicine.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common

• Dry mouth.

Uncommon

• Dizziness.
• Headache.
• Cough.
• Taste disturbance with HandiHaler.
• Inflammation of the throat (pharyngitis).
• Hoarseness.
• Oral thrush.
• Constipation.
• Acid reflux (uncommon with HandiHaler, rare with Respimat).
• Difficulty or pain when swallowing (uncommon with Respimat, rare with HandiHaler).
• Rash.
• Difficulty or pain passing urine (dysuria).
• Inability to completely empty the bladder (urinary retention).
• Blurred vision (uncommon with HandiHaler, rare with Respimat).
• Irregular heartbeat (atrial fibrillation).
• Awareness of your heartbeat (palpitations) or faster than normal heartbeat (tachycardia). These side effects are uncommon with the Respimat inhaler and rare with the HandiHaler.
• Nosebleeds (uncommon with Respimat, rare with HandiHaler).

Rare 

• Feeling sick.
• Difficulty sleeping (insomnia).
• Increased pressure in the eyeball or glaucoma.
• Breathing difficulties due to a sudden narrowing of the airways (bronchospasm - see warning section above).
• Inflammation of the mouth (stomatitis).
• Inflammation of the tongue (glossitis).
• Inflammation of the gums (gingivitis).
• Tooth decay (see warning section above).
• Inflammation of the sinuses (sinusitis).
• Infection of the urinary tract.
• Dryness, infections or ulceration of the skin.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to make sure that the combination is safe.

The manufacturer of this medicine has not performed any studies to confirm whether it can affect other medicines. However, it has been used safely with the following medicines for COPD:

• aminophylline
• corticosteroids taken by mouth, eg prednisolone, or by inhaler, eg beclometasone, budesonide.
• sympathomimetic bronchodilators, such as salbutamol and terbutaline
• theophylline.

This medicine has not been studied in combination with other anticholinergic medicines such as those below, and these are therefore not recommended while you are taking this medicine:

• aclidinium
• glycopyrronium
• ipratropium
• oxitropium.

If you experience a dry mouth as a side effect of this medicine you may find that medicines that are designed to dissolve and be absorbed from under the tongue, eg sublingual glyceryl trinitrate (GTN) tablets for angina, become less effective. This is because the tablets do not dissolve properly in a dry mouth. To resolve this, drink a mouthful of water before taking sublingual tablets.

If you have any more questions please ask your Pharmacist.

Remember to keep all medicines out of reach of children
Please Note: We have made every effort to ensure that the content of this information sheet is correct at time of publish, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.

References:

http://www.netdoctor.co.uk/medicines/lungs/a8400/spiriva-tiotropium/

https://www.medicines.org.uk/emc/medicine/20134l

https://www.spiriva.com

https://www.drugs.com/cdi/spiriva-respimat-spray.html

http://www.rxlist.com/spiriva-respimat-drug.htm

http://patient.info/medicine/tiotropium-a-bronchodilator-spiriva