Tiotropium bromide, sold under the brand nameSpiriva among others, is a long-actingbronchodilator (LAMA: long acting muscarinic antagonist) used in the management ofchronic obstructive pulmonary disease (COPD) andasthma.[10][11] Specifically it is used during periods of breathing difficulty to prevent them from getting worse, rather than to prevent them from happening.[10] It is used by inhalation through the mouth.[10] Onset typically begins within half an hour and lasts for 24 hours.[10]
Common side effects include a dry mouth, runny nose, upper respiratory tract infection, shortness of breath and headache.[10] Severe side effects may includeangioedema, worseningbronchospasm, andQT prolongation.[10] Tentative evidence has not found harm duringpregnancy, however, such use has not been well studied.[1] It is ananticholinergic medication and works by blockingacetylcholine action onsmooth muscle.[10]
Tiotropium is also used in a combination inhaler witholodaterol, along-acting beta-agonist, for the treatment of COPD, under the brand namesStiolto andSpiolto among others.[20][21][22]
Data regarding some serious side effects is mixed as of 2020.[10] In September 2008 a review found that tiotropium and another member of its classipratropium may be linked to increased risk of heart attacks, stroke and cardiovascular death.[25] The US FDA reviewed the concern and concluded in 2010 that this association was not supported.[16][26] A 2011 review of the tiotropium mist inhaler (Respimat), however, still found it associated with an increase in all cause mortality in people with COPD.[27][28]
Tiotropium is amuscarinic receptorantagonist, often referred to as anantimuscarinic oranticholinergic agent. Although it does not display selectivity for specific muscarinic receptors, when topically applied it acts mainly onM3 muscarinic receptors[29] located on smooth muscle cells and submucosal glands. This leads to a reduction insmooth muscle contraction and mucus secretion and thus produces abronchodilatory effect.[citation needed]
Tiotroprium is available in two inhaler formats: a soft mist inhaler (Respimat) and a dry powder inhaler (HandiHaler).[30] The safety and efficacy profiles of both devices are comparable and people's preference should play a role in determining inhaler choice.[30] There is no significant difference in all-causemortality between tiotropium soft mist inhalers compared to dry powder inhalers, however caution needs to be taken in people with severe heart or kidney problems.[31]
^ab"AusPAR: Tiotropium bromide".Therapeutic Goods Administration (TGA). 29 November 2016.Archived from the original on 1 October 2021. Retrieved30 September 2021.
^World Health Organization (2023).The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization.hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
^abTashkin DP, Celli B, Senn S, Burkhart D, Kesten S, Menjoge S, Decramer M (October 2008). "A 4-year trial of tiotropium in chronic obstructive pulmonary disease".The New England Journal of Medicine.359 (15):1543–1554.doi:10.1056/nejmoa0805800.hdl:2437/111564.PMID18836213.
^Rodrigo GJ, Castro-Rodríguez JA (February 2015). "What is the role of tiotropium in asthma?: a systematic review with meta-analysis".Chest.147 (2):388–396.doi:10.1378/chest.14-1698.PMID25322075.
^Kesten S, Jara M, Wentworth C, Lanes S (December 2006). "Pooled clinical trial analysis of tiotropium safety".Chest.130 (6):1695–1703.doi:10.1378/chest.130.6.1695.PMID17166984.
^Singh S, Loke YK, Furberg CD (September 2008). "Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis".JAMA.300 (12):1439–1450.doi:10.1001/jama.300.12.1439.PMID18812535.
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