SPIRIVA ® - Tiotropium

SPIRIVA ® is a drug based on Tiotropium bromide

THERAPEUTIC GROUP: Anticholinergic

IndicationsAction mechanismStudies and clinical effectiveness Usage and dosage instructionsWarnings Pregnancy and lactationInteractionsContraindicationsUndesirable effects

Indications SPIRIVA ® - Tiotropium

SPIRIVA ® is indicated, as a bronchodilator, in the long-term therapy of chronic obstructive pulmonary disease.

Mechanism of action SPIRIVA ® - Tiotropium

SPIRIVA ® is a drug based on Tiotropium bromide, a quaternary ammonium compound with a strong anticolinergic activity directed towards all muscarinic receptors and in particular of the M3 receptor expressed in degrees by the bronchial smooth muscle.

Taken topically by inhalation, the aforementioned active principle concentrates mainly at the level of the upper respiratory tract where it blocks the bronchoconstrictor effect of acetylcholine on muscarinic receptors, causing a bronchodilation that lasts for several hours, given the slow kinetics of dissociation of the Tiotropium from the receptor itself.

Despite the topical use of the product is characterized by an excellent bioavailability, part of the drug is absorbed systemically, going first to a non-enzymatic metabolism that generates two pharmacologically inactive catabolites and then from a hepatic oxidative metabolism necessary for renal excretion of the drug .

Studies carried out and clinical efficacy


Respir Care. 2013 Oct 29. [Epub ahead of print]

Clinical trial demonstrating how the addition of Tiotropium bromide to standard asthma therapy leads to a marked improvement in lung function, reducing complications and overall mortality related to this disease


Pulm Pharmacol Ther. 2013 Sep 30. pii: S1094-5539 (13) 00173-9. doi: 10.1016 / j.pupt.2013.09.004

Experimental study that shows that, despite the fact that Tiotropium bromide is not yet approved for the treatment of asthma, in asthmatic models it can determine not only a bronchodilation but also a suppressive action against inflammation and mucus secretion.


N Engl J Med. 2013 Oct 17; 369 (16): 1491-501. doi: 10.1056 / NEJMoa1303342. Epub 2013 Aug 30.

Study that tests the bioavailability and clinical efficacy of Tiotropium bromide taken through different medical devices, observing however the same efficacy of action in the treatment of patients suffering from chronic obstructive pulmonary disease and the relative safety of use

Method of use and dosage


Hard capsule, powder for inhalation, of 22.5 mcg of Tiotropium bromide, equal to 18 mcg of Tiotropium.

SPIRIVA ® therapy should be defined by the physician based on the patient's pathophysiological conditions and the severity of his clinical picture.

In general, we recommend inhaling a tablet once a day, using a HandiHaler medical device, necessary to optimize the availability of the active ingredient.

SPIRIVA ® warnings - Tiotropium

Given the particular mechanism of action of Tiotropium bromide and its characteristic kinetic action, it is necessary to consider the inadequacy of this drug for the treatment of acute episodes of bronchospasm.

The same pharmacokinetic characteristics, impose the maximum caution in the use of the drug, in patients suffering from renal insufficiency and therefore characterized by a reduced clearance of the same.

The patient receiving SPIRIVA ® should avoid contact of the powder with the eyes, avoid ingesting the drug, and consult their doctor immediately following the appearance of side effects such as dry mouth, bronchospasm, glaucoma or urinary retention.

SPIRIVA ® contains lactose, therefore its intake is not indicated in patients with glucose-galactose malabsorption syndrome, lactase enzyme deficiencies and allergies to milk proteins.

The use of SPIRIVA ®, without clinical necessity, is prohibited in and out of the race.

It is recommended to keep the medicine out of the reach of children.


The aforementioned contraindications to the use of SPIRIVA ® are generally extended also to the pregnancy and to the subsequent period of breastfeeding, given the absence of studies able to fully characterize the safety profile of the drug for the health of the fetus and infant .


The reduced number of pharmacokinetic studies useful to characterize the possible pharmacokinetic interactions of Tiotropium bromide, impose the utmost caution in the contextual use of SPIRIVA ® and other active ingredients in particular to other anticholinergics rather than active ingredients taken by inhalation.

Contraindications SPIRIVA ® - Tiotropium

The use of SPIRIVA ® is contraindicated in patients with hypersensitivity to the active ingredient or to one of its excipients or to structurally and chemically related molecules.

Undesirable effects - Side effects

Treatment with SPIRIVA ®, especially in predisposed patients, could determine the appearance of side effects such as dry mouth, dizziness, headache, dysuria and urinary retention.

Clinically more serious side effects are decidedly less frequent.


SPIRIVA ® is a prescription drug prescribed by a doctor.