Tiotropium is a bronchodilator belonging to the muscarinic receptor (or anticholinergic) class of antagonists.
Tiotropium - Chemical Structure
Tiotropium is mainly used for the treatment of symptoms related to chronic obstructive pulmonary disease (or COPD). In fact, it is available in pharmaceutical formulations suitable for inhalation administration.
Generally, in medicinal products, tiotropium is found in the form of tiotropium bromide.
Examples of medicinal specialties containing Tiotropium
- Spiriva ®
- Spiriva Respimat ®
- Rapid Respimat ® (in combination with olodaterol).
- Yanimo Respimat ® (in association with olodaterol).
Indications
For what it uses
The use of tiotropium is indicated for the treatment of bronchospasm in patients with chronic obstructive pulmonary disease.
Indeed, tiotropium is a long-acting bronchodilator drug that - through bronchial dilation - is able to promote breathing in patients with COPD.
Warnings
Because tiotropium is used in COPD maintenance therapy, it should never be used to treat acute shortness of breath or wheezing (typical symptoms of chronic obstructive pulmonary disease).
Before starting tiotropium therapy, you must inform your doctor if you are in one of the following conditions:
- If you suffer from closed-angle glaucoma;
- If you suffer from urination difficulties and / or prostate problems;
- If you have recently suffered from myocardial infarction, cardiac arrhythmias and / or heart failure.
Should any allergic reaction occur after taking the tiotropium, it is necessary to inform the doctor immediately.
The use of tiotropium can cause dry mouth which, in the long term, could favor the onset of dental caries. Therefore, it is good to maintain an accurate dental hygiene.
The tiotropium should never come into contact with the eyes because, if this happens, serious side effects may occur.
The use of tiotropium in children and adolescents under 18 years of age is not recommended.
Tiotropium can cause side effects that can alter the ability to drive vehicles and / or use machinery, so great care must be taken.
Interactions
Before starting treatment with tiotropium, you must tell your doctor if you are taking - or if you have recently been - other anticholinergic drugs, such as, for example, ipratropium bromide or oxytropium .
In any case, it is still advisable to inform your doctor if you are taking - or have recently taken - medicines of any kind, including non-prescription drugs and herbal and homeopathic products.
Side effects
Tiotropium can cause side effects of various kinds, but not all patients manifest them. This depends on the sensitivity that each person has towards the drug. Therefore, not all unwanted effects are manifested with the same intensity in each individual.
The following are the main adverse effects that may occur during treatment with the drug.
Allergic reactions
Tiotropium can trigger allergic reactions in sensitive individuals that can manifest themselves in the form of:
- Skin eruptions;
- Angioedema;
- Breathing difficulties;
- Dizziness;
- Decreased blood pressure;
- Anaphylaxis.
Nervous system disorders
Treatment with tiotropium can cause headaches and dizziness.
Psychiatric disorders
Tiotropium therapy may promote insomnia.
Oral cavity disorders
During treatment with tiotropium, the following may occur:
- Dry mouth;
- Gingivitis;
- Glossitis (inflammation of the tongue);
- Stomatitis;
- Dental caries;
- Oropharyngeal candidiasis.
Cardiac disorders
Tiotropium therapy may cause palpitations, tachycardia and atrial fibrillation.
Respiratory tract disorders
Treatment with tiotropium may favor the onset of:
- Cough;
- Pharyngitis;
- Laryngitis;
- Paradoxical bronchospasm;
- Sinusitis.
Kidney and urinary tract disorders
Tiotropium-based therapy can cause urinary tract infections, urinary retention and pain when urinating.
Gastrointestinal disorders
Nausea, constipation and heartburn may occur during treatment with tiotropium. Furthermore, the drug can promote the onset of intestinal obstruction, including the paralytic ileus.
Skin and subcutaneous tissue disorders
Tiotropium-based therapy can cause:
- Dryness of the skin;
- Skin eruptions;
- Itch;
- Urticaria;
- Skin infections and ulcerations.
Eye disorders
Treatment with tiotropium may cause:
- Glaucoma;
- Increased measured eye pressure;
- Blurred vision.
Other side effects
Other side effects that may occur during tiotropium therapy are:
- Dysphonia;
- Dysphagia;
- Joint swelling;
- Bleeding of the nose (epistaxis).
Overdose
If you take excessive doses of tiotropium, there is an increased risk of developing side effects, such as:
- Dry mouth;
- Urination difficulties;
- Blurred vision;
- Increased heart rate;
- Constipation.
If you suspect a tiotropium overdose, you must immediately inform your doctor or contact the nearest hospital.
Action mechanism
As mentioned, tiotropium is a muscarinic receptor antagonist.
At the level of bronchial smooth muscle, muscarinic M3 receptors are present which - once activated by their endogenous substrate (acetylcholine) - are responsible for bronchoconstriction.
The tiotropium, once inhaled, exerts an antagonistic activity towards the above mentioned M3 muscarinic receptors, thus inducing a bronchodilation.
Method of use and dosage
Tiotropium is administered by inhalation and is available both in the form of a solution for inhalation and in the form of capsules containing inhalation powder which must be administered using the appropriate device.
The capsules containing the powder for inhalation must NOT be taken by mouth.
Tiotropium has a duration of action of approximately 24 hours, therefore, a single administration per day is sufficient.
As for the amount of drug to be taken - as well as for the duration of treatment - it is necessary to strictly adhere to the information provided by the doctor, in order to avoid the occurrence of serious side effects.
In any case, doses of tiotropium greater than those recommended should never be taken.
Pregnancy and breastfeeding
Pregnant women and breastfeeding mothers should not take tiotropium before seeking medical advice.
Contraindications
The use of tiotropium is contraindicated in the following cases:
- In patients with known hypersensitivity to the same tiotropium;
- In patients with known hypersensitivity to atropine or other anticholinergic drugs, such as, for example, hypratropium bromide or oxitropium.
