Tiotropium bromide

By Medically reviewed by hellodoktor

Generic Name: Tiotropium bromide Brand Name(s): Tiotropium bromide.


What is Tiotropium bromide used for?

Tiotropium bromide is used to treat lung diseases such as asthma and COPD (bronchitis, emphysema). It must be used regularly to prevent wheezing and shortness of breath. It works by relaxing the muscles around the airways so that they open up and you can breathe more easily. Tiotropium belongs to a class of drugs known as anticholinergics. Controlling symptoms of breathing problems can decrease time lost from work or school.

This medication must be used regularly to be effective. It does not work right away and should not be used to relieve sudden breathing problems. If wheezing or sudden shortness of breath occurs, use your quick-relief inhaler (such as albuterol, also called salbutamol in some countries) as prescribed.

How should I take Tiotropium bromide?

Follow the instructions for test sprays in the air if you are using the inhaler for the first time or if you have not used it for more than 3 days or for more than 21 days. Make sure to spray away from the face so that you do not get the medication into your eyes. A slow-moving mist is a sign that the inhaler is working properly.

Inhale this medication by mouth as directed by your doctor, usually 2 sprays once daily. Do not inhale more than 2 sprays in 24 hours.

Avoid getting this medication into your eyes. It may cause eye pain/irritation, temporary blurred vision, and other vision changes. Therefore, when using the inhaler, put your lips tightly around the mouthpiece.

Rinse your mouth after using the inhaler to prevent dry mouth and throat irritation.

If you are using other inhalers at the same time, wait at least 1 minute between the use of each medication.

Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time each day.

Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

Clean the mouthpiece of the inhaler at least once a week as directed.

When this medication is used to treat asthma, it may take 4 to 8 weeks before you get the full benefit of this drug.

Learn which of your inhalers you should use every day and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing, increased sputum, waking up at night with trouble breathing, if you use your quick-relief inhaler more often, or if your quick-relief inhaler does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.

Tell your doctor if your symptoms do not improve or if they worsen.

How do I store Tiotropium bromide?

Tiotropium bromide is best stored in the refrigerator. To prevent drug damage, do not freeze. There may be different brands of Tiotropium bromide that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Tiotropium bromide down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Tiotropium bromide?

Before using tiotropium, tell your doctor or pharmacist if you are allergic to it; or to ipratropium; or to atropine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of glaucoma (angle-closure type), difficulty urinating, enlarged prostate, kidney disease.

This drug may make you dizzy or blur your vision. Alcohol, glaucoma (angle-closure type), or marijuana can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older men may be at greater risk for difficulty urinating while using this drug.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Tiotropium bromide during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Tiotropium bromide. Tiotropium bromide is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Tiotropium bromide?

Dry mouth and dizziness may occur. If either of these effects persists or worsens, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: difficulty urinating, painful urination.

Infrequently, this medication may cause severe sudden worsening of breathing problems right after use. If you have sudden worsening of breathing, use your quick-relief inhaler and get medical help right away.

Get medical help right away if you have any very serious side effects, including: eye pain/swelling/redness, vision changes (such as seeing rainbows around lights at night, blurred vision).

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.


What drugs may interact with Tiotropium bromide?

Some products that may interact with this drug include: other anticholinergics (such as ipratropium, atropine).

Tiotropium bromide may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Tiotropium bromide?

Tiotropium bromide may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Tiotropium bromide?

Tiotropium bromide may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.


The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Tiotropium bromide.

What is the dose of Tiotropium bromide for an adult?

Usual Adult Dose for Chronic Obstructive Pulmonary Disease – Maintenance

Tiotropium inhalation powder, hard capsule:

-18 mcg (2 inhalations) orally once a day using the HandiHaler device

Tiotropium, solution for inhalation:

-5 mcg (2 inhalations) orally once a day

Uses: Long-term maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; to reduce exacerbations in COPD patients

Usual Adult Dose for Asthma – Maintenance

-2.5 mcg (2 inhalations of 1.25 mcg) orally once a day


-The maximum benefits in lung function may take up to 4 to 8 weeks of dosing.

Use: Long-term maintenance treatment of asthma

Renal Dose Adjustments

Mild renal dysfunction (CrCl 60 mL/min or more): No adjustment recommended.

Moderate to Severe renal dysfunction (CrCl less than 60 mL/min): Use with caution.

Liver Dose Adjustments

No adjustment recommended.

Other Comments

Administration advice:

-Tiotropium inhalation spray should be administered only via the Respimat inhaler and it should not be used for administering other medications.

-Tiotropium capsules are for oral inhalation only and should not be swallowed; capsules should be used with the HandiHaler device only.

-Priming the inhalation device is essential to ensure appropriate content of the medication in each actuation.

-Consult the manufacturer’s product information for complete administration instructions.


-This drug should not be used for the initial treatment of acute episodes of bronchospasm, or for immediate relief of breathing problems (i.e., as a rescue medication).

Patient advice:

-Patients should report any signs and symptoms of narrow angle glaucoma (e.g., eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) and urinary retention (e.g., difficulty passing urine, painful urination).

-Patients should avoid getting this drug into the eyes as it may cause blurring of vision and pupil dilation.

-This drug may cause dizziness and blurred vision; avoid driving or operating machinery if you feel drowsy or dizzy.

What is the dose of Tiotropium bromide for a child?

Usual Pediatric Dose for Asthma – Maintenance

Less than 12 years: The safety and efficacy have not been established.

12 years or older:

-2.5 mcg (2 inhalations of 1.25 mcg) orally once a day


-The maximum benefits in lung function may take up to 4 to 8 weeks of dosing.

Use: Long-term maintenance treatment of asthma


COPD: Safety and efficacy have not been established in patients younger than 18 years.

Asthma: Safety and efficacy have not been established in patients younger than 12 years.

How is Tiotropium bromide available?

Tiotropium bromide is available in the following dosage forms and strengths:

  • Inhalation capsule,
  • Inhalation aerosol.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Tiotropium bromide, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: June 2, 2018 | Last Modified: September 12, 2019

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