Tiotropium (Spiriva)
Pronunciation: ty-oh-TROH-pee-um.
- Generic name
- tiotropium bromide
- Brand names
- Spiriva, Spiriva HandiHaler, Spiriva Respimat
- Drug class
- Long-acting muscarinic antagonist (LAMA) -- inhaled anticholinergic bronchodilator
- Form
- Dry-powder inhalation capsule (used only with the HandiHaler device) or inhalation solution cartridge (used only with the Respimat soft-mist inhaler)
- Route
- Oral inhalation only -- never swallowed
- Legal status
- Prescription-only
Availability and supply rules vary by country
Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand
Australia: Spiriva Respimat (6), Spiriva (6) · Full directory
What tiotropium bromide is and how it works
Tiotropium is a prescription-only, once-daily inhaled medicine that relaxes the muscles around the airways to make breathing easier. It is used for long-term maintenance treatment of chronic obstructive pulmonary disease (COPD), and the Respimat inhaler form is also used, in some countries, as an add-on treatment for severe asthma alongside other asthma medicines. (1) (2)
Tiotropium is a maintenance medicine taken once daily to help keep your airways open over time -- it is not a rescue inhaler for sudden breathlessness and will not work fast enough for that. Correct inhaler technique matters a great deal: if you use the HandiHaler capsule device, the capsule is pierced inside the device and its powder is inhaled -- the capsule itself must never be swallowed. If you use the Respimat inhaler, only a Respimat cartridge fits your device. Ask your pharmacist to show you the correct technique for your exact device.
Mechanism of action: how tiotropium bromide works
Tiotropium is a long-acting muscarinic (M1-M5) receptor antagonist with preferential kinetic selectivity for M3 receptors in airway smooth muscle, producing sustained bronchodilation over approximately 24 hours with once-daily dosing. (1) (2) (3)
What tiotropium bromide is used for
Chronic obstructive pulmonary disease (COPD)
Used once daily as a long-term maintenance treatment to ease breathlessness from COPD (including chronic bronchitis and emphysema) and to help reduce the number of flare-ups (exacerbations). Both HandiHaler and Respimat devices are approved for this use. (1) (2)
Severe asthma (Respimat inhaler, add-on treatment)
In some countries, the Respimat inhaler form is used as an add-on maintenance treatment for patients aged 6 years and older with severe asthma who have had at least one severe flare-up in the past year, used together with inhaled corticosteroids and other controller medicines -- not as a stand-alone asthma treatment. (2)
Before taking tiotropium bromide
Do not take / not appropriate for
- Do not swallow HandiHaler capsules -- they are for inhalation only, using the HandiHaler device, which pierces the capsule so its powder can be inhaled. (all countries, HandiHaler formulation) (1)
- Do not use tiotropium if you have had an allergic reaction to tiotropium, atropine-related substances (such as ipratropium or oxitropium), or any ingredient in the specific product. (all countries) (1) (6)
Tell your clinician about
- Any diagnosis of narrow-angle glaucoma or eye pressure problems.
- Any difficulty passing urine, or an enlarged prostate.
- Any kidney problems, especially moderate or severe kidney impairment.
- Whether you use any other inhaled anticholinergic-type medicines (some other COPD or nasal sprays contain related ingredients).
- Pregnancy, plans for pregnancy, or breastfeeding.
- Whether you have cystic fibrosis, since safety and effectiveness have not been established for this condition.
How to take tiotropium bromide
- Use exactly the device your prescriber has chosen -- HandiHaler (capsule, pierced and inhaled through the device) or Respimat (soft-mist inhaler, cartridge fits only that inhaler) -- once daily at the same time each day.
- Ask your pharmacist to demonstrate the correct technique for your specific device; incorrect technique can mean you do not get the full dose.
- This is a maintenance medicine, not a rescue inhaler -- keep a separate fast-acting rescue inhaler as prescribed for sudden breathlessness.
- Rinse your mouth with water after use if you experience dry mouth, but do not swallow the rinse water if instructed otherwise by your product's instructions.
- Store capsules in their sealed blister until immediately before use.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6) (7)
Missed dose
Take your next dose at the usual time the next day -- do not take an extra dose or a double dose to make up for one you missed. Contact your prescriber or pharmacist if you are unsure.
Overdose
Seek medical attention if you think you have used more than your prescribed dose, especially if you notice a dry mouth, blurred vision, a fast heartbeat, or difficulty passing urine, which can signal excess anticholinergic effect. (1)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms.
Dry mouth.
What to notice: Dry mouth.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Upper respiratory tract infection, sinusitis, or sore throat (pharyngitis).
What to notice: Upper respiratory tract infection, sinusitis, or sore throat (pharyngitis).
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Indigestion (dyspepsia) or a runny/blocked nose (rhinitis).
What to notice: Indigestion (dyspepsia) or a runny/blocked nose (rhinitis).
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Urinary tract infection.
What to notice: Urinary tract infection.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Chest pain.
What to notice: Chest pain.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Serious warnings
Sudden worsening of breathing (paradoxical bronchospasm) — emergency
Symptoms: Sudden wheezing or tightness in the chest shortly after using the inhaler.
Action: Use your rescue inhaler as instructed and seek prompt medical attention -- a clinician will assess whether tiotropium needs to be stopped and a different treatment considered. (1) (2)
Signs of a severe allergic reaction (including angioedema) — emergency
Symptoms: Swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; widespread rash or hives, sometimes after the very first dose.
Eye pain or vision changes (possible narrow-angle glaucoma) — high caution
Symptoms: Eye pain, blurred vision, seeing halos or colored images around lights, or red eyes.
Action: Contact your prescriber or an eye specialist promptly -- avoid getting the spray or powder in your eyes. (1) (2)
Difficulty or inability to pass urine — high caution
Symptoms: Difficulty starting urination, a weak stream, or inability to urinate, particularly in men with prostate enlargement.
Action: Contact your prescriber promptly -- this is a known anticholinergic effect that a clinician needs to assess. (1) (2)
Interactions
- Other anticholinergic medicines (including some other inhaled COPD medicines and certain nasal sprays) can add to tiotropium's anticholinergic side effects such as dry mouth and urinary retention -- tell your prescriber about all inhalers and medicines you use. (1)
- Tiotropium is generally compatible with beta-agonist bronchodilators, corticosteroids, and theophylline-type medicines commonly used together in COPD and asthma care. (1)
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Human data are limited. Tiotropium is not generally recommended in pregnancy; your prescriber will weigh the benefits and risks if COPD or asthma control is otherwise difficult to achieve. (1) (2) (3) (4) (5) (6) (7)
Breastfeeding
Not recommended while breastfeeding unless your prescriber judges that the expected benefit outweighs any possible risk to the infant, since data in humans are limited. (1) (2) (3) (4) (5) (6) (7)
Children
The Respimat inhaler is used from age 6 as an add-on severe asthma treatment in some countries; the HandiHaler COPD indication is for adults. (1) (2) (3) (4) (5) (6) (7)
Elderly
Standard dosing is generally appropriate; anticholinergic side effects such as urinary retention may be more relevant with age-related prostate enlargement. (1) (2) (3) (4) (5) (6) (7)
Hepatic Impairment
Standard dosing is generally considered appropriate based on the sources reviewed, since tiotropium is mainly eliminated by the kidneys. (1) (2) (3) (4) (5) (6) (7)
Renal Impairment
Moderate to severe kidney impairment requires closer monitoring for anticholinergic side effects, since tiotropium clearance is reduced. (1) (2) (3) (4) (5) (6) (7)
Monitoring
Before starting
- Confirmation of COPD or asthma diagnosis and correct inhaler technique
- Review of glaucoma, prostate/urinary, and kidney history
- Review of other anticholinergic medicines in use
During treatment
- Periodic review of inhaler technique.
- Watching for dry mouth, urinary difficulty, or eye symptoms.
- Monitoring COPD or asthma control and exacerbation frequency.
Storage
Store at room temperature (about 20-25C / 68-77F). Keep HandiHaler capsules in their sealed blister strip and remove only immediately before use, protected from moisture and heat. Follow the specific storage instructions provided with your Respimat inhaler and cartridge.
Study the drug class: Antimuscarinic bronchodilators
Professional information
Clinician-facing context only, sourced from the current US FDA HandiHaler prescribing information and UK Respimat SmPC reviewed; verify against the current full label for the exact device before prescribing.
United States
Indication: COPD maintenance (HandiHaler)
Dose summary: One 18 mcg capsule (two inhalations of its contents) once daily via the HandiHaler device. Not for acute bronchospasm relief.
Renal context: Monitor closely for anticholinergic side effects in moderate to severe renal impairment. (1)
United Kingdom
Indication: COPD maintenance and add-on severe asthma (age 6+) (Respimat)
Dose summary: 5 mcg total daily dose (2 puffs of 2.5 mcg) once daily via the Respimat inhaler, same time each day.
Renal context: Closer monitoring for anticholinergic side effects in patients with creatinine clearance 50 mL/min or less. (2)
Hepatic guidance
Tiotropium is eliminated predominantly renally; no dose adjustment is described for hepatic impairment in the sources reviewed.
Overdose note
Acute toxicity from inhaled tiotropium is unlikely at recommended doses; large overdoses could produce systemic anticholinergic effects (dry mouth, tachycardia, blurred vision, urinary retention) requiring supportive management. (1) (2) (3)
Frequently asked questions
Can I swallow the Spiriva HandiHaler capsule instead of inhaling it?
No. HandiHaler capsules must never be swallowed. They are placed in the HandiHaler device, which pierces the capsule so its powder can be inhaled. Swallowing it will not deliver the medicine to your lungs correctly. (1)
Is there a heart-safety concern with the Respimat inhaler?
An early analysis raised a possible mortality signal with the Respimat device, but the large TIOSPIR clinical trial later found its safety profile, including heart-related events and overall mortality, was similar to the HandiHaler device. This is a resolved historical safety question, not a current unresolved risk according to that trial's findings. (3) (7)
Can tiotropium be used for a sudden asthma or COPD attack?
No. Tiotropium is a once-daily maintenance medicine, not a fast-acting rescue inhaler. Use the separate quick-relief inhaler your prescriber has given you for sudden symptoms. (1)
Is tiotropium (Spiriva) available in the US, UK, Europe, Canada, Australia, and New Zealand?
Yes, it is approved and available in all of these regions, as either the HandiHaler capsule device, the Respimat soft-mist inhaler, or both depending on the country. (1) (2) (4) (5) (6) (7)
What is the mechanism of action of tiotropium bromide?
Tiotropium is a long-acting muscarinic (M1-M5) receptor antagonist with preferential kinetic selectivity for M3 receptors in airway smooth muscle, producing sustained bronchodilation over approximately 24 hours with once-daily dosing. (1) (2) (3)
References
- SPIRIVA HANDIHALER (tiotropium bromide) inhalation powder capsule -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information · United States · accessed 2026-07-29 · source 1
- Spiriva Respimat 2.5 microgram, inhalation solution -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom -- Boehringer Ingelheim · United Kingdom · accessed 2026-07-29 · source 2
- Tiotropium Respimat Inhaler and the Risk of Death in COPD (TIOSPIR trial)New England Journal of Medicine -- TIOSPIR randomised controlled trial (peer-reviewed clinical evidence cited within regulator-reviewed labelling context) · International (trial evidence underlying US/EU/other label safety sections) · accessed 2026-07-29 · source 3
- Spiriva Respimat (tiotropium bromide monohydrate) -- EMA paediatric investigation plan decision and EU-wide marketing authorisation statusEuropean Medicines Agency (EMA) · European Union · accessed 2026-07-29 · source 4
- SPIRIVA and SPIRIVA RESPIMAT (tiotropium) Product MonographsHealth Canada product monograph · Canada · accessed 2026-07-29 · source 5
- SPIRIVA and SPIRIVA RESPIMAT (tiotropium) -- ARTG registrations and Consumer Medicine InformationTherapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-29 · source 6
- SPIRIVA and SPIRIVA RESPIMAT -- New Zealand Data SheetsMedsafe (New Zealand regulator) · New Zealand · accessed 2026-07-29 · source 7
Brand names by country
Single-ingredient tiotropium bromide names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Spiriva HandiHaler18 ug · a-s medication solutions
- Spiriva Respimat1.562 ug, 3.124 ug · boehringer ingelheim pharmaceuticals, inc.
United Kingdom
Canada
- SPIRIVA
- SPIRIVA RESPIMAT
Australia
New Zealand
View brands in additional countries.
European Union
Spiriva Respimat / Spiriva (4)