Spiriva (Tiotropium) - Inhalation

What Is Spiriva?

Spiriva (tiotropium) is an inhalable drug in the class known as anticholinergics. It is most commonly prescribed to manage and treat lung disorders, such as asthma or chronic obstructive pulmonary disease (COPD).

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).

Drug Facts

Generic Name: Tiotropium

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

What Is Spiriva Used For?

The Food and Drug Administration (FDA) has approved Spiriva for:

  • 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.

How Long Does Spiriva Take to Work?

Spiriva will generally take around 30 minutes for it to take effect once it has been inhaled. Although it will take effect quickly, the symptoms of your asthma or COPD may take longer to be reduced.

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 tongue
  • Difficulty breathing
  • Changes in vision
  • Chest pain
  • Increased heart rate or palpitations
  • Flu-like symptoms
  • Difficulty 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 infection
  • Heart palpitations
  • Coronary 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.

Report Side Effects

Spiriva may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

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).

Dosage: How Much Spiriva Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

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.

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.

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 passages
  • Increased heart rate
  • Difficulty 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.

What Happens If I Overdose on Spiriva?

If you think you or someone else may have overdosed on Spiriva, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking Spiriva, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress closely while you are using this medicine to see if it is working properly and to help reduce any unwanted effects.

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.

What Are Reasons I Shouldn’t Take Spiriva?

Spiriva is generally a very safe medication.

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:

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)

Frequently Asked Questions

  • Can I travel with Spiriva?

    Spiriva can be taken on a plane in a checked bag in all cases and in a carry-on bag with special instructions. According to the Transportation Security Administration (TSA), you would have to declare any medically necessary liquids, gels, and aerosols to TSA officers at the checkpoints. They also recommend that your medications be labeled appropriately to facilitate the process.

  • How can I manage the side effects of Spiriva?

    The side effects of Spiriva can be managed in a variety of ways. For example, you can increase your water intake or chew sugarless gum if you experience the associated dry mouth. Similarly, headaches can be managed appropriately with over-the-counter medications, such as acetaminophen or ibuprofen.

  • How much does Spiriva cost? Is there a way I can get help paying for it?

    If Spiriva is not covered by insurance, it can cost between $400 to $600 depending on the pharmacy. It is a steep price, but it’s an important medication. Savings cards are available. There is no generic drug available yet for Spiriva.

  • When should I take Spiriva if I have multiple inhalers?

    Take Spiriva regularly and as directed. Rescue inhalers like Proventil HFA should only be taken if you have difficulty breathing. Long-term inhalers, like Advair and Spiriva, should not be used to treat an asthma attack. Generally, if you have trouble breathing, you should use your rescue inhaler first.

  • Should I rinse my mouth after taking Spiriva?

    No, you do not have to rinse your mouth after taking Spiriva. Generally, you should rinse your mouth after taking medications that contain drugs in the class inhaled corticosteroids. Inhaled corticosteroids can increase the chance you get something called oral thrush. Inhaled corticosteroids decrease the amount of cells that fight off the fungi that cause oral thrush. Anticholinergics like Spiriva don’t affect those cells as inhaled corticosteroids do, so it is not necessary to rinse your mouth afterward. 

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.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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