Spiriva is a long-acting anticholinergic agent. Generally, anticholinergic agents block special proteins throughout the body known as receptors. Specifically, they target nicotinic or muscarinic receptors. A chemical in your body called acetylcholine can activate the receptors and cause constriction of your bronchioles. If you have asthma or COPD, your symptoms may be caused by the constriction or closing of airways (bronchioles) in your lungs. When Spiriva blocks a specific muscarinic receptor located in the bronchioles, the muscles around the bronchioles relax and widen. This provides relief of symptoms in lung disorders like asthma or COPD.
In the United States, Spiriva is only available with a proper prescription. You cannot get it over-the-counter (OTC).
What Is Spiriva Used For?
The Food and Drug Administration (FDA) has approved Spiriva for:
Brand Name: Spiriva, Spiriva Respimat
Drug Availability: Prescription
Therapeutic Classification: Bronchodilator
Available Generically: No
Controlled Substance: N/A
Administration Route: Inhalation
Active Ingredient: Tiotropium bromide
Dosage Form: Spray, capsule
Long-term maintenance of COPD Long-term maintenance of asthma for people aged 12 years and older
How to Take Spiriva
Spiriva is a medication that should only be taken if a healthcare provider has prescribed it to you. There are two types of Spiriva that you may be prescribed: Spiriva Respimat (soft-mist inhaler) and Spiriva HandiHaler (dry powder inhaler).
The inhaler used with Spiriva Respimat may need “priming” before the first time you use it and again if you don’t use it for more than 21 days. If you don’t use the inhaler for more than three days, make sure to activate the inhaler once to prepare it before use.
To prime Spiriva Respimat:
Activate the inhaler towards the ground until an aerosol cloud is visible. Repeat the process three more times. Activate your inhaler towards the ground a total of four times.
Priming is not necessary if you are prescribed Spiriva HandiHaler. Spiriva HandiHaler comes as a powder in a capsule that is placed in the inhaler for use. Each capsule contains a small amount of powder that equals one dose. Do not swallow the capsule or remove the capsules from the blister until right before use.
To use Spiriva HandiHaler:
Place the capsule in the center chamber of the HandiHaler inhaler. Leaving the dust cap open, close the mouthpiece firmly until a click is heard. Press and release the green piercing button on the side of the device. This pierces the capsule. Exhale fully. To inhale, tilt your head back and inhale rapidly, steadily, and deeply. Once inhaled, hold your breath, then repeat using the same capsule to ensure you receive the full dose. A tip is to close your lips tightly around the mouthpiece. Do not exhale into the inhaler.
Do not use any capsules that have been exposed to air or not immediately used. Keep the capsules and inhaler dry.
Generally, Spiriva and other drugs with anticholinergic effects cause side effects like dry mouth or sometimes constipation. Because of this, you should avoid other medications that have anticholinergic effects. There are many anticholinergic medications; the most common ones you may take are allergy medicines, such as Zyrtec or Benadryl.
Storage
Store this medication in a cool, dry place. Keeping both the assembled medication and the cartridge away from children or pets is important to avoid accidental ingestion. Spiriva is not a controlled substance, so there are not as many limitations on how often you can refill your prescription.
Off-Label Uses
Unlike other medications, there are not many non-approved uses of Spiriva. Ongoing clinical trials are researching other inhaled anticholinergic medications, but they mainly involve medications that are not approved by the FDA.
What Are the Side Effects of Spiriva
This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.
Common Side Effects
The most commonly experienced side effects of Spiriva are related to its anticholinergic nature:
Cough Dry mouth Headaches Sore throat Inflamed sinuses
Severe Side Effects
Severe side effects are also related to the anticholinergic nature of Spiriva, but these require more urgent care and are not as common. Examples of severe side effects include:
Allergic reactions like rash, hives, swelling of the face, lips, or tongueDifficulty breathingChanges in visionChest painIncreased heart rate or palpitationsFlu-like symptomsDifficulty urinating
Call your healthcare provider right away if you experience severe side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.
Long-Term Side Effects
Spiriva is a medication intended to be taken long-term to manage asthma and COPD. Some long-term side effects include:
Lung infectionHeart palpitationsCoronary artery disease
Although a few side effects can occur when taken long-term, these are rare and often happen with larger doses. It is still important to take Spiriva regularly and as directed.
Dosage: How Much Spiriva Should I Take?
Modifications
Spiriva is available in two dosage forms: an inhalable aerosol solution (Spiriva Respimat) and an inhaled powder in capsule form (Spiriva HandiHaler). The drug and its effects are the same regardless of the form you are prescribed. Generally, the dose will be lower in children.
If you experience a serious side effect, you or your healthcare provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For asthma: For oral inhalation dosage form (spray): Adults and children 6 years of age and older—2 puffs once a day. Each puff contains 1. 25 microgram (mcg) of tiotropium. Do not take more than 2 puffs in 24 hours. Children younger than 6 years of age—Use and dose must be determined by your doctor. For bronchospasm caused by COPD: For oral inhalation dosage form (capsules): Adults—2 puffs of the powder from one Spiriva® capsule (18 micrograms [mcg]) inhaled through the HandiHaler® device once a day. Children—Use and dose must be determined by your doctor. For oral inhalation dosage form (spray): Adults—2 puffs once a day. Each puff contains 2. 5 microgram (mcg) of tiotropium. Children—Use and dose must be determined by your doctor.
Missed Dose
If you miss a dose of Spiriva, take the missed dose as soon as you remember if it is the same day. If you don’t remember that you missed a dose until the next, skip the missed dose and go back to the normal routine. Do not double the dose of this medication.
Overdose: What Happens If I Take Too Much Spiriva?
High and excessive doses of Spiriva will likely lead to an increased occurrence of the side effects, including:
Excessive dryness of the mouth, throat, nasal passagesIncreased heart rateDifficulty urinating
A common cause of overdosing on Spiriva is mistaking it for a rescue inhaler. Spiriva is not intended to be a rescue medication; it is supposed to be for the long-term management of these conditions.
If you experience these symptoms or see someone experiencing these symptoms after consuming Spiriva, someone must contact a poison control center immediately.
Precautions
What Are Reasons I Shouldn’t Take Spiriva?
Spiriva is generally a very safe medication.
This medicine will not stop bronchospasm that has already started. Your doctor will give you another medicine to use in case of an acute attack.
Tiotropium may cause allergic reactions, including anaphylaxis and angioedema. Check with your doctor right away if you develop a skin rash, itching, trouble breathing, or large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs after using this medicine.
This medicine may cause paradoxical bronchospasm, which means your breathing or wheezing will get worse. Paradoxical bronchospasm may be life-threatening. Check with your doctor right away if you have coughing, difficulty breathing, shortness of breath, or wheezing after using this medicine.
Check with your doctor right away if you have any changes to your eyes, such as eye pain, eye discomfort, blurred vision, visual halos, or colored images with red eyes while you are using this medicine. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
Check with your doctor right away if you have decrease in urine volume, decrease in the frequency of urination, difficulty in passing urine, or painful urination.
This medicine may cause dizziness or blurred vision. Avoid driving, using machines, or doing anything else that could be dangerous if you are dizzy or not able to see well.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.
The only reason you shouldn’t take Spiriva is if you have known allergies to the medication or any of its ingredients. If you have an allergy to Spiriva, you may experience a rash or allergic reaction after taking it.
What Other Medications Interact With Spiriva?
Caution should be used if Spiriva is taken with other anticholinergic medications. Some examples of medications that can have anticholinergic effects include:
Certain allergy medications like Zyrtec (cetirizine) or Benadryl (diphenhydramine) Some antidepressant medications like Elavil (amitriptyline) Muscle relaxants like Robaxin (methocarbamol) Medications for irritable bowel syndrome, or overactive bladder like Levsin (hyoscyamine)
If you have to take Spiriva with a medication that also has anticholinergic effects, it is more likely that you will experience side effects like dry mouth, headache, or sore throat.
What Medications Are Similar?
Spiriva is an inhaler in the long-anticholinergic drug class. It is primarily used to treat asthma and COPD. Although Spiriva is the only available drug in the long-acting anticholinergic drug class, a short-acting anticholinergic drug class exists.
Spiriva should NOT be taken together with these short-acting anticholinergic drugs:
Atrovent (ipratropium bromide) Ipratropium and albuterol
The medications are very similar and will lead to a much higher likelihood of side effects occurring.
Other inhaler medications that may be used to treat asthma and COPD include:
Advair Diskus (fluticasone propionate and salmeterol) Symbicort (budesonide and formoterol) Qvar (beclometasone) Pulmicort (budesonide) Flovent (fluticasone)
These medications may sometimes be prescribed together depending on your asthma or COPD severity. If you have been prescribed these medications, you should take them regularly. The purpose of these medications is to prevent long-term breathing problems. They will not work well to treat a current asthma attack.
You may also be prescribed rescue inhalers to help treat the sudden onset of breathing problems. Typically, they are used as needed, and hopefully, you won’t need to use them every day. Some examples of rescue inhalers include:
Albuterol: Common brand names include ProAir Digihaler, ProAir HFA, Ventolin HFA, ProAir RespiClick, among others Xopenex (levosalbutamol)
How Can I Stay Healthy While Taking Spiriva?
To stay healthy while taking Spiriva, it is important to take it as directed by your healthcare provider or pharmacist. It may be difficult to remember to take your medications regularly, but it is important to adequately manage asthma and COPD.
Along with taking this medication regularly, another way to manage your symptoms is by doing breathing exercises to strengthen your lungs. The main way to do lung exercises is to take a breath in through your nose and then exhale slowly through your mouth. Like any other muscle, exercising your lungs is a way to strengthen them. As you can tolerate it, light aerobic exercises have also been shown to improve endurance. Generally, it is also important to always get lots of rest, stay well hydrated, and eat a healthy diet.
