Drug reference

Tiotropium

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 284, 285

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Maintenance treatment of chronic obstructive pulmonary disease ▶BY INHALATION OF POWDER ▶Adult: 1 capsule once daily DOSE EQUIVALENCE AND CONVERSION ▶For Spiriva ® inhalation powder, 1 capsule contains a metered dose of 18 micrograms tiotropium; for Braltus ® inhalation powder, 1 capsule contains a metered dose of 13 micrograms tiotropium. ▶The delivered dose of Spiriva ® and Braltus ® inhalation powder products are the same (10 micrograms); no dose adjustment is necessary when switching between brands. SPIRIVA RESPIMAT ® Maintenance treatment of chronic obstructive pulmonary disease | Severe asthma [add-on to inhaled corticosteroid (at least 800 micrograms budesonide daily or equivalent) and at least 1 controller in patients who have suffered one or more severe exacerbations in the last year] ▶BY INHALATION ▶Adult: 5 micrograms once daily Severe asthma [add-on to inhaled corticosteroid (over 400 micrograms budesonide daily or equivalent) and 1 controller, or inhaled corticosteroid (200–400 micrograms budesonide daily or equivalent) and 2 controllers, in patients who have suffered one or more severe exacerbations in the last year] ▶BY INHALATION ▶Child 6–11 years: 5 micrograms once daily Severe asthma [add-on to inhaled corticosteroid (over 800 micrograms budesonide daily or equivalent) and 1 controller, or inhaled corticosteroid (400–800 micrograms budesonide daily or equivalent) and 2 controllers, in patients who have suffered one or more severe exacerbations in the last year] ▶BY INHALATION ▶Child 12–17 years: 5 micrograms once daily DOSE EQUIVALENCE AND CONVERSION ▶For Spiriva Respimat ®: 2 puffs of inhalation solution is equivalent to 5 micrograms tiotropium.

PDF page 284

Cautions

Arrhythmia (unstable, life-threatening or requiring intervention in the previous 12 months). heart failure (hospitalisation for moderate to severe heart failure in the previous 12 months). myocardial infarction in the previous 6 months

PDF page 284

National Funding Access Decisions

Scottish Medicines Consortium (SMC) decisions SMC No. 1028/15 The Scottish Medicines Consortium has advised (August 2015) that tiotropium (Spiriva Respimat ®) is accepted for use within NHS Scotland as add-on maintenance bronchodilator treatment in adults with asthma who are currently treated with the maintenance combination of inhaled corticosteroids (800 micrograms budesonide/day or equivalent) and long-acting beta2- agonists and who experienced one or more severe exacerbations in the previous year. SMC No. 411/07 The Scottish Medicines Consortium has advised (December 2017) that tiotropium (Spiriva Respimat ®) is accepted for use within NHS Scotland as a maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease. SMC No. SMC2118 The Scottish Medicines Consortium has advised (January 2019) that tiotropium (Spiriva Respimat ®) is accepted for use within NHS Scotland as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year. All Wales Medicines Strategy Group (AWMSG) decisions AWMSG No. 1882 The All Wales Medicines Strategy Group has advised (December 2018) that tiotropium (Spiriva Respimat ®) is recommended as an option for use within NHS Wales as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year.

PDF page 284

Safety

Important Safety Information

MHRA/CHM ADVICE: BRALTUS ® (TIOTROPIUM): RISK OF INHALATION OF CAPSULE IF PLACED IN THE MOUTHPIECE OF THE INHALER (MAY 2018) The MHRA have received reports of patients who have inhaled a Braltus ® capsule from the mouthpiece into the back of the throat, resulting in coughing and risking aspiration or airway obstruction. Patients should be trained in the correct use of their inhaler and told to store capsules in the screw-top bottle provided (never in the inhaler) and to always check the mouthpiece is clear before inhaling. Pharmacists dispensing Braltus ® capsules should remind patients always to read the instructions for use in the package leaﬂet and that they must never place a capsule directly into the mouthpiece. MHRA/CHM ADVICE: PRESSURISED METERED DOSE INHALERS (PMDI): RISK OF AIRWAY OBSTRUCTION FROM ASPIRATION OF LOOSE OBJECTS (JULY 2018) See Respiratory system, drug delivery p. 249.

PDF page 284

Interactions

→Appendix 1: tiotropium

PDF page 284

Side Effects

▶Uncommon Gastrointestinal disorders. increased risk of infection. taste altered ▶Rare or very rare Bronchospasm. dysphagia. epistaxis. insomnia. oral disorders ▶Frequency not known Dehydration. joint swelling. skin ulcer

PDF page 284

Pregnancy

Manufacturer advises avoid—limited data available.

PDF page 284

Breast Feeding

Manufacturer advises avoid—no information available.

PDF page 284

Renal Impairment

Manufacturer advises use only if potential beneﬁt outweighs risk if creatinine clearance less than or equal to 50 mL/minute—plasma-tiotropium concentration raised.

PDF page 284

Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Inhalation powder ▶Braltus (Teva UK Ltd) Tiotropium (as Tiotropium bromide) 10 microgram Braltus 10microgram inhalation powder capsules with Zonda inhaler | 30 capsule P £25.80 DT = £25.80 ▶Spiriva (Boehringer Ingelheim Ltd) Tiotropium (as Tiotropium bromide) 18 microgram Spiriva 18microgram inhalation powder capsules with HandiHaler | 30 capsule P £34.87 DT = £34.87 Spiriva 18microgram inhalation powder capsules | 30 capsule P £33.50 DT = £33.50 | 60 capsule P £67.00 Inhalation solution ▶Spiriva Respimat (Boehringer Ingelheim Ltd) Tiotropium (as Tiotropium bromide) 2.5 microgram per 1 dose Spiriva Respimat 2.5micrograms/dose inhalation solution cartridge with device | 60 dose P £23.00 DT = £23.00 Spiriva Respimat 2.5micrograms/dose inhalation solution refill cartridge | 60 dose P £23.00

PDF page 285

Clinical care

Patient And Carer Advice

Patients or carers should be given advice on appropriate inhaler technique and reminded that the powder inhalation capsules are not for oral administration; for Braltus ®, see also Important safety Information.

PDF page 284

Dose text by age group

Adult

1 capsule once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 284

Adult

5 micrograms once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 284

Child 6–11 years

5 micrograms once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 284

Child 12–17 years

5 micrograms once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 284

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Tiotropium

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 284, 285

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 284

Cautions

PDF page 284

National Funding Access Decisions

PDF page 284

Safety

Important Safety Information

PDF page 284

Interactions

→Appendix 1: tiotropium

PDF page 284

Side Effects

PDF page 284

Pregnancy

Manufacturer advises avoid—limited data available.

PDF page 284

Breast Feeding

Manufacturer advises avoid—no information available.

PDF page 284

Renal Impairment

Manufacturer advises use only if potential beneﬁt outweighs risk if creatinine clearance less than or equal to 50 mL/minute—plasma-tiotropium concentration raised.

PDF page 284

Dose and formulations

Medicinal Forms

PDF page 285

Clinical care

Patient And Carer Advice

PDF page 284

Dose text by age group

Adult

1 capsule once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 284

Adult

5 micrograms once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 284

Child 6–11 years

5 micrograms once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 284

Child 12–17 years

5 micrograms once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 284

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.