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RESPIRATORY SYSTEM › DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES › OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES, INHALANTS › Anticholinergics
tiotropium bromide, combinations
R03BB54
Forms & Strengths
- Inhalation Powder: Tiotropium 9 mcg / Olodaterol 2.5 mcg per actuation (Respimat Soft Mist Inhaler)
- Inhalation Powder: Tiotropium 18 mcg / Formoterol fumarate dihydrate 12 mcg per capsule (Inhaler device)
Adult Dosing
- COPD (Tiotropium/Olodaterol): Two inhalations of Respimat 2.5 mcg/2.5 mcg once daily at the same time of day
- COPD (Tiotropium/Formoterol): One inhalation of capsule containing tiotropium 18 mcg / formoterol 12 mcg twice daily
Pediatric Dosing
- Not indicated for pediatric patients; safety and efficacy have not been established in patients under 18 years of age
Indications
- Long-term, once-daily or twice-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD)
- Reduction of exacerbations in COPD patients
Mechanism of Action
- Combines a long-acting muscarinic antagonist (LAMA - tiotropium) providing bronchodilation by inhibiting M3 receptors on airway smooth muscle
- Combines a long-acting beta-2 adrenergic agonist (LABA - olodaterol or formoterol) causing relaxation of airway smooth muscle via stimulation of intracellular adenylate cyclase
Contraindications
- History of hypersensitivity to tiotropium, olodaterol, formoterol, atropine, or its derivatives
- Primary treatment of acute episodes of bronchospasm (rescue therapy)
- Severe hypersensitivity to milk proteins (applies to specific powder formulations containing lactose)
Adverse Reactions
- Nasopharyngitis
- Upper respiratory tract infection
- Dizziness
- Dry mouth
- Cough
- Tachycardia or palpitations
- Paradoxical bronchospasm
- Urinary retention
Drug Interactions
- Other anticholinergic agents: May potentiate anticholinergic adverse effects; avoid co-administration
- Adrenergic drugs: May potentiate sympathetic effects on the cardiovascular system
- Beta-blockers: May weaken or antagonize the effect of the LABA component
- QT-prolonging drugs (MAOIs, tricyclic antidepressants): May increase risk of ventricular arrhythmias associated with the LABA component
- Hypokalemia-inducing agents (non-potassium-sparing diuretics, systemic corticosteroids): May potentiate potential ECG changes and/or hypokalemia
Curated Content: Needs Vetting Before Put to Clinical Use