Inhaled bronchodilators · Respiratory
Tiotropium
LAMA · Spiriva®(brand names vary by market)
A once-daily anticholinergic that keeps COPD patients out of hospital.
Mechanism
Long-acting muscarinic antagonist that dissociates very slowly from M3 receptors in airway smooth muscle: bronchodilation and reduced secretions for a full day from one dose.
Indications
- COPD maintenance
- Severe asthma as add-on therapy
Formulations
Dosing concepts
Maintenance only
Once daily, and never used as a reliever. Its onset is far too slow for an acute episode.
Not with a short-acting anticholinergic
Combining it with regular ipratropium adds side effects without adding bronchodilation.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- Low systemically from the inhaled route
- Half-life
- ~25 h
- Elimination
- renal: Largely renal; caution as clearance falls
- Protein binding
- ~72%
Adverse effects
- Dry mouthcommonThe characteristic anticholinergic effect and the commonest complaint.
- Constipationcommon
- Urinary retentionseriousParticularly in men with prostatic enlargement.
- Acute angle-closure glaucomaseriousUsually from drug reaching the eye; a spacer and correct technique reduce it.
Contraindications & precautions
Contraindications
- Hypersensitivity to atropine derivatives
Precautions
- Narrow-angle glaucoma
- Prostatic hypertrophy and bladder outlet obstruction
- Renal impairment
Interactions
No curated interaction entries yet for this agent.
Monitoring
Exacerbation frequency and symptom scores
The endpoints that matter in COPD
Inhaler technique
Device-specific and frequently wrong
Urinary symptoms in older men
A predictable anticholinergic harm
Counselling points
- Once a day, at the same time. This is not a rescue inhaler.
- Do not swallow the capsules used with some devices; they are for inhalation only.
- Dry mouth is common; sips of water and sugar-free gum help.
- Tell us if you have difficulty passing urine or get eye pain and blurred vision.
Clinical pearls
- The capsule-based devices are swallowed by patients often enough that it is worth demonstrating rather than describing.
- In COPD, long-acting bronchodilators reduce exacerbations and improve quality of life, while inhaled steroids carry a pneumonia risk. Getting the order of therapy right matters more here than in asthma.
References & review
- Tiotropium product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.