Spiriva Handihaler

Uses

Spiriva Handihaler is used for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

Spiriva Handihaler is also used to associated treatment for these conditions: Asthma, Bronchitis, Bronchoconstriction, Chronic Bronchitis, Chronic Obstructive Airways Disease Exacerbated, Chronic Obstructive Pulmonary Disease (COPD), Chronic Obstructive Respiratory Diseases, Emphysema

How Spiriva Handihaler works

Spiriva Handihaler is an antagonist of muscarinic receptors M₁ to M₅. Inhibition of the M₃ receptor in the smooth muscle of the lungs leads to relaxation of smooth muscle and bronchodilation.

Dosage

Spiriva Handihaler dosage

Adults and adolescents 12 years and older: The recommended dosage of Spiriva Handihaler bromide is the inhalation of 2 puffsonce daily.

Side Effects

The most commonly reported adverse drug reaction was dry mouth. Dry mouth was usually mild and often resolved during continued treatment. Other reactions reported in individual patients and consistent with possible anticholinergic effects included constipation, increased heart rate, blurred vision, glaucoma, urinary difficulty, and urinary retention.

Toxicity

Symptoms of overdose include altered mental status, tremors, abdominal pain, and severe constipation. However, doses of up to 282µg did not lead to systemic anticholinergic effects in a trial of 6 patients. In case of overdose, stop tiotropium and being symptomatic and supportive therapy.

Precaution

As an anticholinergic drug, Spiriva Handihaler may potentially worsen symptoms and signs associated with narrow angle glaucoma, prostatic hyperplasia or bladder-neck obstruction and should be used with caution in patients with any of these conditions. As a predominantly renally excreted drug, patients with moderate to severe renal impairment treated with Spiriva Handihaler should be monitored closely.

Eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema may be signs of acute narrow angle glaucoma. Should any of these signs and symptoms develop, consult a physician immediately. Miotic eye drops alone are not considered to be effective treatment.

Interaction

Spiriva Handihaler has been used concomitantly with other drugs commonly used in COPD without increases in adverse drug reactions. These include sympathomimetic bronchodilators, methylxanthines, and oral and inhaled steroids. However, the co-administration of Spiriva Handihaler with other anticholinergic-containing drugs (e.g., ipratropium) has not been studied and is therefore not recommended.

Food Interaction

• Take with or without food. Food is not expected to interfere with absorption.

Spiriva Handihaler Drug Interaction

Moderate: albuterol / ipratropium, albuterol / ipratropiumUnknown: fluticasone / salmeterol, aspirin, aspirin, omega-3 polyunsaturated fatty acids, fluticasone nasal, furosemide, metoprolol, metoprolol, polyethylene glycol 3350, nitroglycerin, acetaminophen, albuterol, budesonide / formoterol, albuterol, albuterol, cyanocobalamin, ascorbic acid, cholecalciferol

Spiriva Handihaler Disease Interaction

Moderate: angioedema, anticholinergic effects, tachycardia, liver, renal dysfunction

Volume of Distribution

The volume of distribution of tiotropium is 32L/kg.

Elimination Route

33% of an inhaled solution reaches systemic circulation, while oral solutions have a bioavailability of 2-3%. A dry powder for inhalation is 19.5% bioavailable. Spiriva Handihaler metered spray for inhalation reaches a maximum concentration in 5-7 minutes.

Half Life

The terminal half life of tiotropium is 24 hours in patients with COPD and 44 hours in patients with asthma.

Clearance

The total clearance of tiotropium is 880mL/min in healthy subjects receiving 5µg daily. The renal clearance of tiotropium was 669mL/min. Patients 2 This decreased clearance is not associated with increased AUC or C_max.

Elimination Route

74% of intravenous tiotropium was excreted unchanged in urine. 14% of a dry powder inhalation dose was excreted unchanged in the urine. 24 hour urinary excretion after 21 days of 5µg once daily inhalation in patients with COPD is 18.6% and in patients with asthma is 12.8%.

Pregnancy & Breastfeeding use

Pregnancy Category C. Spiriva Handihaler should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Use in Labor and Delivery: The safety and effectiveness of Spiriva Handihaler has not been studied during labor and delivery.

Nursing Mothers: Clinical data from nursing women exposed to Spiriva Handihaler are not available. caution should be exercised if administered to a nursing woman.

Contraindication

Spiriva Handihaler is contraindicated in patients with a history of hypersensitivity to atropine or its derivatives, including ipratropium, or to any component of this product.

Special Warning

Pediatric Use: The safety and effectiveness of Spiriva Handihaler in pediatric patients have not been established.

Geriatric use: No adjustment of Spiriva Handihaler dosage in geriatric patients is warranted.

Acute Overdose

High doses of Spiriva Handihaler may lead to anticholinergic signs and symptoms. Acute intoxication by inadvertent oral ingestion of Spiriva Handihaler Bromide unlikely since it is not well-absorbed systemically.

Storage Condition

The inhaler should be stored in a dry, cool place away from direct sunlight and heat. The canister should not be broken, punctured or burnt, even when apparently empty. Keep away from eyes. Keep out of reach of children.

Innovators Monograph

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