Dilriva

Indications

Tiotropium is an inhaled medicine used every day to keep the airways open in chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It reduces breathlessness and flare-ups. The soft mist inhaler form is also used as an add-on treatment for some adults with asthma who are already using an inhaled corticosteroid. It is a maintenance treatment and does not relieve a sudden attack.

How It Works

Tiotropium is a long-acting bronchodilator. It blocks the action of acetylcholine on the muscles around the airways, so the muscles relax and the airways stay wider for 24 hours.

Dosage and Administration

Adults:

• Inhalation capsules (dry powder): inhale the contents of one 18 mcg capsule once a day using the inhaler device supplied. The capsules are for inhalation only and must not be swallowed.
• Soft mist inhaler: two puffs (2.5 mcg each, 5 mcg in total) once a day.

Use it at the same time each day, even when you feel well. Do not use more than once a day. Keep a quick-relief inhaler, such as Salbutamol, for sudden breathlessness. Ask the pharmacist to show you how to use your device correctly.

Interactions

• Do not use with other anticholinergic inhalers such as Ipratropium, Glycopyrronium or Umeclidinium.
• Other medicines with anticholinergic effects (some antihistamines, tricyclic antidepressants such as Amitriptyline, and some bladder medicines) may add to side effects such as dry mouth, constipation and difficulty passing urine.

Contraindications

• Allergy to Tiotropium, Atropine or related medicines such as Ipratropium
• For the powder capsules: allergy to lactose or milk protein

Side Effects

Common: dry mouth, constipation, cough, sore throat, hoarse voice, headache and dizziness.

Get urgent medical help if you notice:

• Sudden wheezing or worse breathlessness right after inhaling (stop using it)
• Eye pain, blurred vision, seeing halos around lights or red eyes (possible acute glaucoma)
• Difficulty or pain passing urine, or being unable to pass urine
• Fast or irregular heartbeat
• Swelling of the face, lips or throat, or a severe rash

Pregnancy and Lactation

There is limited information on use in pregnancy and breastfeeding. Use only if the doctor advises that the benefit outweighs any possible risk.

Precautions and Warnings

• Tell the doctor if you have narrow-angle glaucoma, an enlarged prostate or bladder blockage, kidney disease, a recent heart attack or heart rhythm problems.
• Keep the powder or mist away from the eyes.
• It is not a reliever for sudden attacks.
• See the doctor if breathing gets worse or you need your reliever more often.

Overdose

Too much may cause dry mouth, blurred vision, fast heartbeat, constipation or difficulty passing urine. Accidentally swallowing a capsule is unlikely to cause serious harm. Seek medical advice if symptoms appear.

Therapeutic Class

Long-acting muscarinic antagonist (LAMA); inhaled bronchodilator.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep capsules in the blister until just before use. Do not freeze.