Tiotropium
3070446
216817129
2008-06-03T10:48:40Z
Carlo Banez
5493017
{{drugbox |
| image = Tiotropium.png
| width = 150
| image2 = Tiotropium-3D-balls.png
|IUPAC_name = (1α,2β,4β,7β)-<br />7-[(hydroxidi-2-thienylacetyl)oxy]-9,9-dimethyl-<br />3-oxa-9-azoniatricyclo[3.3.1.0<sup>2,4</sup>]nonane
| CAS_number = 186691-13-4
| ATC_prefix = R03
| ATC_suffix = BB04
| PubChem = 131950
| DrugBank = <!-- nil -->
| C=19 | H=22 | N=1 | O=4 | S=2 |charge=+
| molecular_weight = 490.4
| smiles = [Br-].O=C(OC1C[C@H]2[C@@H]3O[C@@H]3[C@@H](C1)[N+]2(C)C)C(O)(c1cccs1)c1cccs1
| bioavailability = 19.5% (inhalation)
| metabolism = [[hepatic]] 25%<br />([[CYP2D6]], [[CYP3A4]])
| elimination_half-life = 5–6 days
| excretion = [[renal]]
| pregnancy_AU = B1
| pregnancy_US =
| pregnancy_category =
| legal_AU = S4
| legal_CA =
| legal_UK = POM
| legal_US = Rx-only
| legal_status =
| routes_of_administration = inhalation (oral)
}}
'''Tiotropium''' ({{pronEng|ˌtaɪəˈtroʊpiəm}}) (administered as tiotropium bromide) is a long-acting, 24 hour, [[anticholinergic]] [[bronchodilator]] used in the management of [[chronic obstructive pulmonary disease]] (COPD). Tiotropium bromide ([[International Nonproprietary Name|INN]]) capsules for inhalation are co-marketed by [[Boehringer-Ingelheim]] and [[Pfizer Inc.|Pfizer]] under the trade name "Spiriva".
== 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 immediately taken, via through 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.
==Mode of action==
Tiotropium is a [[muscarinic receptor]] [[receptor antagonist|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 M<sub>3</sub> muscarinic receptors located in the airways to produce [[smooth muscle]] relaxation, thus producing a [[bronchodilator]]y effect.
==Clinical use==
===Indications===
Tiotropium is indicated as a daily, 24 hour, maintenance treatment of [[chronic obstructive pulmonary disease]] (COPD).
===Adverse effects===
Adverse effects are mainly related to its antimuscarinic effects. Common [[adverse drug reaction]]s (≥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]]) (Rossi, 2006).
==References==
*Rossi S, editor. [[Australian Medicines Handbook]] 2006. Adelaide: Australian Medicines Handbook; 2006.
==See also==
*[[Chronic obstructive pulmonary disease]]
==External links==
*[http://spiriva.com/ Official SPIRIVA Site]
*[http://www.centerwatch.com/patient/drugs/dru848.html Thomson CenterWatch]
==Image collection==
{| border="0" cellpadding="0" cellspacing="0" align="left"
|+
|-
|[[Image:Spiriva3.png|thumb|Front view]]
|[[Image:Tiocap.png|thumb|160px|A previously pierced Spiriva capsule]]
|[[Image:SP2.png|thumb|Open (cleaning) view]]
|}
{{Asthma_and_copd_rx}}
[[Category:Bronchodilators]]
[[Category:Muscarinic antagonists]]
[[Category:Thiophenes]]
[[Category:Epoxides]]
[[de:Tiotropiumbromid]]
[[pl:Tiotropium]]