TM Owner Boehringer Ingelheim
Spiriva HandiHaler 18mcg Inhaler
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Indications & Clinical Uses
- Spiriva HandiHaler (tiotropium bromide) 18 mcg per capsule is a long-acting anticholinergic (antimuscarinic) bronchodilator supplied as a dry-powder capsule for use only with the HandiHaler inhalation device - the capsules must never be swallowed.
- It is approved for the long-term, once-daily maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, and to reduce COPD exacerbations, in adults.
- It is not approved for asthma and is not a rescue inhaler for sudden breathlessness - a fast-acting reliever inhaler is still needed for acute symptoms.
- Spiriva HandiHaler (dry-powder capsule) must not be confused with the separately dosed Spiriva Respimat (metered spray, 2.5 mcg per actuation): the two deliver different amounts of tiotropium from different devices, so a HandiHaler capsule must never be opened into a Respimat inhaler, or vice versa.
Side Effects
- The most common side effect is dry mouth, affecting up to 16% of patients in year-long trials; other reported effects include upper respiratory tract infection, sinusitis, sore throat (pharyngitis), and urinary tract infection.
- No boxed warning appears on the current label.
- More serious but less common effects include immediate hypersensitivity reactions such as angioedema, itching or rash, and rarely anaphylaxis - stop the medicine and seek urgent care for swelling of the face, lips or throat, or difficulty breathing.
- Paradoxical bronchospasm, a sudden worsening of wheeze right after inhaling, can occur; if it does, stop Spiriva HandiHaler, use your reliever inhaler, and contact your provider.
- Tell your provider about eye pain, blurred vision or halos around lights, or new difficulty passing urine.
Precautions & Warnings
- Spiriva HandiHaler is contraindicated in people with known hypersensitivity to tiotropium, atropine or its derivatives.
- Use it cautiously if you have narrow-angle glaucoma, since anticholinergics can worsen eye pressure, or urinary retention or bladder outlet obstruction, since it can make emptying the bladder harder.
- It is not a rescue treatment for sudden breathlessness.
- Moderate-to-severe kidney impairment increases drug exposure, so your provider may monitor you more closely.
- Pregnancy and breastfeeding data are limited - discuss with your provider.
- Only ever load one capsule into the HandiHaler device immediately before use, and never swallow the capsules.
- Stop and seek advice if you notice blurred vision or dizziness before driving.
Avoid Interactions
- Avoid combining Spiriva HandiHaler with other anticholinergic (antimuscarinic) medicines, such as ipratropium, since the effects can add up and increase the risk of dry mouth, urinary retention and eye problems.
- No clinically significant interactions have been found with commonly co-prescribed sympathomimetics such as salbutamol, theophylline, or inhaled or oral corticosteroids, so Spiriva HandiHaler can normally be combined with these standard COPD treatments.
- Tell your healthcare provider about every medicine, herbal product and supplement you take, particularly any other inhalers, to avoid unintentionally doubling up on anticholinergic treatment.
References
Frequently Asked Questions
Spiriva HandiHaler (tiotropium) is a once-daily inhaled medicine for long-term maintenance treatment of COPD, including chronic bronchitis and emphysema, and to reduce flare-ups. It's not approved for asthma and isn't a rescue inhaler for sudden breathlessness, so you still need a fast-acting reliever for that.
Load one Spiriva HandiHaler capsule into the HandiHaler device just before use, pierce it, and inhale the powder deeply through the mouthpiece once daily. Never swallow the capsules; they only work when inhaled. Rinse your mouth afterward if dry mouth bothers you.
The most common Spiriva HandiHaler side effect is dry mouth, along with respiratory and urinary tract infections and sore throat. Get urgent help for swelling of the face or throat, breathing difficulty, or sudden worsening wheeze right after inhaling, as these signal a rare but serious reaction.
Avoid using other anticholinergic medicines, such as ipratropium, alongside Spiriva HandiHaler, since the effects can add up. It's generally safe alongside salbutamol, theophylline, and inhaled or oral steroids. Tell your provider about all your inhalers and medicines to prevent doubling up.
No. Spiriva HandiHaler is a dry-powder capsule delivering 18 mcg tiotropium via its own device, while Spiriva Respimat is a metered spray delivering 2.5 mcg per puff from a different inhaler. They are not interchangeable, and capsules must never be put into a Respimat device.
Yes, rarely. Spiriva HandiHaler can worsen narrow-angle glaucoma, causing eye pain, blurred vision or halos around lights, and can make urinary retention worse in men with an enlarged prostate. Tell your provider straight away if you notice these symptoms so your treatment can be reviewed.
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