TIOTROPIUM ADCO

Indications

• Maintenance treatment of chronic obstructive pulmonary disease (COPD)
• Severe asthma as an add-on therapy to inhaled corticosteroids and other controllers

Dosage

Children: For children aged 6-11 years: 5 micrograms once daily. For children aged 12-17 years, refer to BNF for Children for specific dosing guidance.

Adults: 1 capsule (18 micrograms) once daily by inhalation.

Mechanism of action

Tiotropium exerts its effects by selectively blocking the M3 muscarinic acetylcholine receptors in the bronchial smooth muscle. This blockade leads to relaxation of the bronchial muscles and dilation of the airways. The inhibition of these receptors prevents bronchoconstriction and facilitates easier breathing in patients with obstructive pulmonary diseases.

Pharmacodynamics

Tiotropium has a long duration of action due to its slow dissociation from the M3 receptors, allowing for sustained bronchodilation over a 24-hour period. The onset of action typically begins within 30 minutes of administration, with peak effects occurring around 3 hours post-dose. It significantly improves lung function, reduces exacerbation rates, and enhances exercise tolerance in patients with COPD.

Pharmacokinetics

Tiotropium is primarily absorbed through the lungs when inhaled, with approximately 20% of the delivered dose reaching systemic circulation. The drug undergoes minimal hepatic metabolism, primarily via cytochrome P450 enzymes, and is mainly excreted unchanged in the urine. The elimination half-life is approximately 5 to 6 days, which supports its once-daily dosing regimen.

Contra-indications

• Hypersensitivity to tiotropium, atropine or its derivatives
• Patients with narrow-angle glaucoma
• Patients with urinary retention

Adverse effects

• Cough
• Dizziness
• Dry mouth
• Headache
• Nausea
• Constipation
• Dysphonia
• Palpitations
• Skin reactions
• Stomatitis
• Urinary disorders
• Vision blurred

Interactions

• Clozapine: Unknown (additive effect)
• Second-generation antipsychotics: Unknown (additive effect)

Precautions

• Counsel patients on appropriate administration technique
• Warn against accidental contact with the eye due to risk of ocular complications
• Increased risk of dizziness affecting driving and skilled tasks

Pregnancy

Manufacturer advises only use if potential benefit outweighs risk.

Breast-feeding

No information available-manufacturer advises only use if potential benefit outweighs risk.

Storage

Store in a cool, dry place, away from direct sunlight.

Formulations

• {'name': 'Spiriva® Inhalation Powder', 'dose': '18 micrograms per capsule', 'route': 'inhalation'}
• {'name': 'Braltus® Inhalation Powder', 'dose': '13 micrograms per capsule', 'route': 'inhalation'}
• {'name': 'Nebuliser liquid', 'dose': 'Variable, refer to specific product information', 'route': 'nebulisation'}