Home : DrugWatch : Spiriva : Wikipedia : Tiotropium

Wikipedia - Tiotropium

Tiotropium
Systematic (IUPAC) name
(1a,2ß,4ß,7ß)-
7-[(hydroxidi-2-thienylacetyl)oxy]-9,9-dimethyl-
3-oxa-9-azoniatricyclo[3.3.1.02,4]nonane
Identifiers
CAS number 186691-13-4
ATC code R03BB04
PubChem CID 131950
DrugBank DB01409
Chemical data
Formula C19H22NO4S2+
Mol. mass 472.42
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability 19.5% (inhalation)
Metabolism hepatic 25%
(CYP2D6, CYP3A4)
Half-life 5–6 days
Excretion renal
Therapeutic considerations
Pregnancy cat. B1(AU)
Legal status Prescription Only (S4) (AU) POM (UK) ?-only (US)
Routes inhalation (oral)

Tiotropium (Spiriva) is a long-acting, 24 hour, anticholinergic bronchodilator used in the management of chronic obstructive pulmonary disease (COPD). Tiotropium bromide (INN) capsules for inhalation are co-marketed by Boehringer-Ingelheim and Pfizer under the trade name Spiriva.

Contents

[edit] Mode of delivery

The patient removes one tiotropium capsule from the blister pack, places it into the piercing chamber of the inhalation device and closes the mouthpiece.

The capsule is manually pierced, and the medication is inhaled through the mouthpiece. It is recommended that inhalations are repeated 2 to 3 times to ensure all medication is drawn from the capsule. When properly done, the capsule will make a distinctive flutter or rattle, audible to the patient.

Once the powder capsules are removed from the blister pack, it should be taken immediately via the inhalation device. If a capsule is exposed to the air, it will rapidly degrade to the point the dose will become ineffective. Any previously exposed capsules should be discarded.

The capsules cannot be taken orally - they will not be effective as respiratory medication if absorbed through the gastrointestinal tract and may have side effects if absorbed via this route.

[edit] Mode of action

Tiotropium is a muscarinic receptor antagonist, often referred to as an antimuscarinic or anticholinergic agent. Although it does not display selectivity for specific muscarinic receptors, on topical application it acts mainly on M3 muscarinic receptors[1] located in the airways to produce smooth muscle relaxation, thus producing a bronchodilatory effect.

[edit] Clinical use

[edit] Indications

Tiotropium is indicated as a daily, 24 hour, maintenance treatment of chronic obstructive pulmonary disease (COPD).

[edit] Adverse effects

Adverse effects are mainly related to its antimuscarinic effects. Common adverse drug reactions (=1% of patients) associated with tiotropium therapy include: dry mouth and/or throat irritation. Rarely (<0.1% of patients) treatment is associated with: urinary retention, constipation, acute angle closure glaucoma, palpitations, and/or allergy (rash, angioedema, anaphylaxis).[2]

A study of more than 15,000 patients published in the Journal of the American Medical Association in 2008 linked tiotropium and another member of its class ipratropium to increased risk of heart attacks, stroke and cardiovascular death.[3]

In 2010 the FDA announced it had completed its analysis of the Understanding the Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) trial. UPLIFT was a large, 4-year clinical trial that compared Spiriva HandiHaler to placebo in 5,992 patients.

In the UPLIFT trial, there was no significant increase in the risk of stroke, heart attack, or cardiovascular death between Spiriva HandiHaler and placebo.

In November 2009, the FDA Pulmonary - Allergy Drugs Advisory Committee also reviewed data from the UPLIFT trial and voted that the UPLIFT findings adequately resolve the potential safety concerns for stroke, heart attack and cardiovascular death.[4]

[edit] Image collection

Front view
A previously pierced Spiriva capsule
Open (cleaning) view

[edit] See also

[edit] References

  1. ^ Kato M, Komamura K, Kitakaze M (December 2006). "Tiotropium, a novel muscarinic M3 receptor antagonist, improved symptoms of chronic obstructive pulmonary disease complicated by chronic heart failure" ([dead link]). Circ. J. 70 (12): 1658–60. PMID 17127817. http://joi.jlc.jst.go.jp/JST.JSTAGE/circj/70.1658?from=PubMed. 
  2. ^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006
  3. ^ Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and the risk of major adverse cardiovascular events. JAMA 2008;300(12)1439-1450.
  4. ^ FDA. Follow-Up to the October 2008 Updated Early Communication about an Ongoing Safety Review of Tiotropium (marketed as Spiriva HandiHaler). FDA 2010

[edit] External links


v • d • e
Drugs for obstructive airway diseases: asthma/COPD (R03)
Adrenergics, inhalants
other
Glucocorticoids
Anticholinergics/
muscarinic antagonist
Ipratropium • Tiotropium
Mast cell stabilizers
Xanthines
Eicosanoid inhibition
Combination products

M: RES

anat(n,x,l,c)/phys/devp

proc, drug(R1/2/3/5/6/7)
Retrieved from "http://en.wikipedia.org/wiki/Tiotropium"

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Tiotropium".

Need A Spiriva Attorney?

First Name Last Name Email Address State
Has Your Health Been Negatively Affected?

Please Describe the Injury

Your Friend's Email Address

Your Email Address

Type a Message (optional)


Do you need a Spiriva lawyer in Washington, DC? Contact one of our Spiriva lawyers in Washington, DC now.

 

Close (x)

Looking for an Attorney?


Please type your question:

Close (x)

logo Find Legal Help for Your Spiriva Case - Submit Your Information Below

Do you need legal assistance with your Spiriva case?
LegalView may be able to help.


Submit your information below for a free, no-cost evaluation.

We'll submit your information to one of our partner firms.
LegalView's partners represent clients throughout the United States, for a very wide range of legal issues. Submit your information now, to see if one of LegalView's partners can help!

* Indicates Required Fields

First name *
Last name *
Email Address *
Phone Number *
()  -

State *
Legal Issue * DrugWatch: Spiriva Change
Was There an Injury?
Please Describe The Injury

DISCLAIMER and STATEMENT OF NON-CONFIDENTIALITY

By submitting this form, you agree that completing the above is not intended to create an attorney-client relationship.

Disclosure

Legal WebTV Network LLC, LegalView.com, and LegalWebMedia.com are group advertising sponsored by the attorneys identified here. It is not a lawyer referral service. If you submit information on this website [more...]

Legal WebTV Network LLC, LegalView.com, and LegalWebMedia.com are group advertising sponsored by the attorneys identified here. It is not a lawyer referral service. If you submit information on this website, LegalWebMedia.com will submit your information to the law firms that pay for this group advertising and to respond to your requests for information concerning legal services in their assigned local areas. If there is no sponsoring firm in your state, your inquiry will be submitted to one of the sponsoring law firms on a predetermined, rotating basis. If the sponsoring law firm accepts your case, it will associate with licensed attorneys practicing in your state, if required; the sponsoring law firm may also contact other law firms to see if they may be able to assist.

The information provided by the LegalView.com and LegalWebMedia.com websites is for advertising and informational purposes and should not be considered as legal advice from the sponsoring attorneys. The websites contain general information and may not reflect current legal developments, verdicts, or settlements. LegalView.com contains information created by others or supplied through open forums; the sponsoring law firms are not responsible for the accuracy of this information. Any person viewing or receiving information from these websites should not act or refrain from acting on the basis of any such information without first seeking appropriate legal advice from an attorney in your area. Legal WebTV Network, LLC expressly disclaims any liability with respect to actions taken or not taken by the recipient based on any or all of the information or contents contained in these websites.

Any information sent to Legal WebTV Network LLC through this website is done using standard Web encryption techology. LegalView.com will exercise all reasonable care, within technological limits, to protect the confidentiality of any information submitted via Internet e-mail or through this website. By accessing this website, you may be seeking an attorney to represent you or legal advice. However, none of the sponsoring attorneys represent you yet.

The choice of a lawyer is an important decision and should not be based solely upon advertisements.

Any transmission of information, whether via Internet e-mail or through the website, is solely for evaluation purposes by the sponsoring law firms and their associates. The transmission of any information to any attorney sponsoring advertising on LegalView.com or LegalWebMedia.com does not create an attorney-client relationship between the sender and any recipient. An attorney-client relationship can only be created by a written, signed-fee agreement entered into with an attorney. The sponsoring attorneys will treat your information as a confidential communication for the purpose of obtaining legal services or legal advice.

For more information about the sponsoring law firms, please click here.
This form is secure and encrypted. More information about secure forms and your privacy here.