Names and pronunciation
(ty-oh′tro-pee-um) Spiriva HandiHaler, Spiriva Respimat
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Drug reference
(ty-oh′tro-pee-um) Spiriva HandiHaler, Spiriva Respimat
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Func. class.: Anticholinergic, bron- chodilator
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Chem. class.: Synthetic quaternary ammonium compound
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Do not confuse: Spiriva/Apidra/Inspra
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ACTION: Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, thereby resulting in decreased cGMP and bronchodilation
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USES: COPD; for the long-term treatment and once-daily maintenance of bronchospasm associated with COPD, including chronic bronchitis and emphysema
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CONTRAINDICATIONS: Hyper- sensitivity to this product, atropine, or its derivatives Precautions: Pregnancy, breastfeed- ing, children, geriatric patients, closed- angle glaucoma, prostatic hypertrophy, bladder neck obstruction, renal disease
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SIDE EFFECTS CNS: Depression, paresthesia CV: Chest pain, increased heart rate, angina, atrial fibrillation, supraventricular tachycardia EENT: Dry mouth, blurred vision, glaucoma GI: Vomiting, abdominal pain, constipa- tion, dyspepsia, paralytic ileus GU: Urinary difficulty, urinary retention, UTI INTEG: Rash, angioedema MISC: Candidiasis, flulike syndrome, herpes zoster, infections, angina pectoris MS: Arthritis, myalgic leg/skeletal pain RESP: Cough, sinusitis, upper respi- ratory tract infection, epistaxis, pharyngitis
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INTERACTIONS • Other anticholinergics: avoid use with other anticholinergics Drug/Lab Test Increase: cholesterol, glucose
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DOSAGE AND ROUTES • Adult: INH content of 1 cap/day (18 mcg) using HandiHaler inhalation de- vice or 2 INH (spray) (2.5 mcg each) daily
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Available forms: Powder for INH 18 mcg in blister packs containing 6 caps with inhaler; 30 caps with inhaler; spray inhaler (Respimat) 2.5 mcg/ spray
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Administer: Inhalation route (caps) • Not for acute bronchospasm or acute symptoms • Caps are for INH only; do not swallow • Check package insert for directions on how to use • Rinse mouth after use Inhalation route (spray) • Insert cartridge into inhaler, prime inhaler, must reprime once if not used for >3 days, if not used for >21 days, prime until aerosol is visible, and 3 more times
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Assess: • Respiratory status: oral thrush, dys- pnea, rate, breath sounds before and during treatment; pulmonary function tests at baseline and periodically; upper respiratory infections, cough, sinusitis • Tolerance over long-term therapy; dose may have to be increased or changed • Patient’s ability to use HandiHaler • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, cautious use in breastfeeding, unlikely to cause harm in the infant
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Evaluate: • Therapeutic response: ability to breathe easier
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Signs of closed-angle glaucoma (eye pain, blurred vision, visual halos) • That product is used for long-term T maintenance, not for immediate relief of breathing problems; that effect takes 20 min, lasts 24 hr • To avoid getting the powder in the eyes; may cause blurred vision and pupil dilation • To breathe out completely; not to breathe into mouthpiece at any time • To hold HandiHaler with mouthpiece upward; to press button in once, com- pletely, and release; this allows for medi- cation to be released • To raise device to mouth and close lips tightly around mouthpiece • With head upright, to breathe in slowly and deeply, but allow the cap to vibrate; to breathe until the lungs fill; to hold breath and remove mouthpiece; to re- sume normal breathing • To rinse mouth after use; to use hard candy or regular oral hygiene to reduce dry mouth • To report immediately blurred vision, eye pain, halos • To keep caps in sealed blisters before use; to store at room temperature
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PHARMACOKINETICS Half-life 5-6 days in animals, does not cross blood-brain barrier, very little metabolized in the liver, excreted in urine, 72% protein binding
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• Adult: INH content of 1 cap/day (18 mcg) using HandiHaler inhalation de- vice or 2 INH (spray) (2.5 mcg each) daily
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