Tiotropium Bromide

Indications
 Inhalation
Maintenance therapy in chronic obstructive pulmonary disease
Adult: >18 yr: 1 cap (18 mcg of tiotropium) inhaled daily, with the inhalation device, at the same time of day.
CrCl (ml/min)Dosage Recommendation
≤50Use with caution and monitor closely.
Contraindications
 Hypersensitivity to atropine and its derivatives (e.g. ipratropium).
Warnings / Precautions
 Narrow-angle glaucoma; prostatic hypertrophy or bladder-neck obstruction; renal impairment. Pregnancy and lactation. Discontinue if immediate hypersensitivity (e.g. angioedema) or paradoxical bronchospasm occurs. Discontinue if eye pain, red eye, visual halos, and other signs of acute narrow-angle glaucoma.
Adverse Reactions
 Dry mouth, constipation, cough and local irritation, tachycardia, urinary retention, UTI, upper respiratory tract infection, hypersensitivity reactions, pupil dilation, blurred vision, myalgia, dyspepsia, rash. Pharyngitis, sinusitis, rhinitis and epistaxis reported with the use of inhalation powder.
Mechanism of Actions
 Tiotropium bromide, a long-acting quaternary ammonium antimuscarinic, is structurally related to ipratropium. It is a nonselective competitive antagonist of muscarinic (M1-M5) receptors and causes bronchodilation by inhibiting the actions of acetylcholine and other cholinergic stimuli at M<290>3<>190> receptors in the smooth muscle of the respiratory tract.
Absorption: Bioavailability 20% (lungs).
Distribution: Protein-binding: 72%.
Metabolism: Undergoes some metabolism by non-enzymatic cleavage and by cytochrome P450 isoenzymes CYP2D6 and CYP3A4.
Excretion: Excreted largely unchanged in urine. Terminal half-life: 5-6 days.
Storage Conditions
 Inhalation: Store at 15-30°C (59-86°F). Do not store in the inhalation device.
ATC Classification
 R03BB04 - tiotropium bromide ; Belongs to the class of other inhalants used in the treatment of obstructive airway diseases, anticholinergics.
Storage
 Inhalation: Store at 15-30°C (59-86°F). Do not store in the inhalation device.
Available As
  • Tiotropium Bromide 12 mcg
  • Tiotropium Bromide 18 mcg
  • Tiotropium Bromide 6 mcg
  • Tiotropium Bromide 9 mcg

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