bronchodilator lama

Tiotropium

Spiriva

Route: inhaled (dry powder — HandiHaler) · inhaled (soft mist — Respimat)
Onset: 30 minutes
Duration: 24+ hours (once-daily dosing)

Mechanism of action

Long-acting muscarinic antagonist (LAMA). Dissociates very slowly from M1 and M3 receptors, providing prolonged bronchodilation. Blocks parasympathetic bronchoconstriction and reduces mucus hypersecretion.

Dosing

Adult: HandiHaler: 18 mcg (one capsule) inhaled once daily. Respimat inhaler: 2.5 mcg × 2 actuations (5 mcg total) once daily

Once-daily dosing due to long receptor binding kinetics

Indications

COPD maintenance therapy (first-line)
Asthma (adjunct in adults uncontrolled on ICS/LABA)
Reduction of COPD exacerbations

Contraindications

Hypersensitivity to tiotropium, atropine, or ipratropium
Acute narrow-angle glaucoma

Side effects

Dry mouth (most common)
Constipation
Urinary retention
Pharyngitis
Sinusitis
Paradoxical bronchospasm

Monitoring parameters

FEV1 and spirometry
COPD exacerbation frequency
Urinary symptoms (especially in men with BPH)
Intraocular pressure (glaucoma patients)

Drug interactions

Other anticholinergics (additive effects)
Do not combine with ipratropium

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