Tiotropium Bromide and Liver

• Generic Name: tiotropium
• Dosage Forms: n.a.
• Other Brand Names: Spiriva, Spiriva Respimat, Spiriva Handihaler, Spiriva Respimat 30 Dose, Spiriva Respimat 14 Dose, Spiriva Respimat 28 ACT, Spiriva Respimat 60 ACT, Spiriva Respimat 10 ACT

Tiotropium alone (as oral inhalation powder or solution) or tiotropium/olodaterol fixed-combination therapy (as oral inhalation solution): Long-term maintenance treatment of reversible bronchospasm associated with COPD, including chronic bronchitis and emphysema.

Tiotropium alone (as oral inhalation powder or solution): Reduction of COPD exacerbations in patients with a history of exacerbations.

A long-acting bronchodilator (e.g., orally inhaled salmeterol, formoterol, tiotropium) or an inhaled corticosteroid recommended for maintenance monotherapy in patients with moderate to severe COPD (e.g., FEV1 30 to <80% of predicted or, alternatively, <60% of predicted) who have persistent symptoms not relieved by as-needed therapy with a selective, short-acting inhaled β2-adrenergic agonist. Maintenance therapy with long-acting bronchodilators in such patients more effective and more convenient than regular therapy with short-acting bronchodilators. Insufficient data to favor one maintenance monotherapy over another in patients with moderate to severe COPD. In selected patients with inadequate response, may use a combination of several long-acting bronchodilators, such as tiotropium, and a long-acting β2-adrenergic agonist.

In patients with severe to very severe COPD (e.g., FEV1 <30 to <50% of predicted), some clinicians recommend addition of an inhaled corticosteroid to one or more long-acting bronchodilators, given separately or in fixed combination; however, benefits of combination therapy over monotherapy not consistently established. If inadequate response or limiting adverse effects occur, may consider the addition or substitution of extended-release oral theophylline.

Tiotropium alone (as oral inhalation powder or solution) or tiotropium/olodaterol fixed-combination therapy (as oral inhalation solution): Not indicated for initial treatment of acute episodes of bronchospasm or acute deterioration of COPD; a drug with a more rapid onset of action (e.g., a short-acting β-adrenergic agonist) preferred.

Tiotropium alone (as oral inhalation solution): Long-term maintenance treatment of reversible bronchospasm associated with asthma.

Tiotropium oral inhalation solution: Not indicated for treatment of acute episodes of bronchospasm.

Tiotropium/olodaterol fixed-combination therapy: Not indicated for treatment of asthma.