Prescription onlyNo lower cost generic available



  • Inhaler
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Makes it easier to breathe.

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Prescription onlyNo lower cost generic available

Our pharmacists’ bottom line

Spiriva (Tiotropium) works well to reduce COPD symptoms and flare-ups with fewer side effects than some medicines that open airways, but you have to use it every day.

Worth it?Is it worth it?
Works well?Does it work?
Hassle?Is it a hassle?
  • Helps you breathe easier and lessens the need for a fast-acting (rescue) inhaler.
  • Reduces flare-ups and hospitalizations with fewer side effects compared to some other medicines that open airways.
  • You only need to take it once a day.
  • Won't cure your COPD (but it will relieve your symptoms).
  • You'll need to use this medicine for a long time, and you have to take it every day.
  • Can make symptoms of enlarged prostate or urinary blockage worse.
  • Can worsen a certain type of glaucoma.
  • You might feel dizzy or have blurry vision while taking this medicine.

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Side effects for Spiriva (Tiotropium)

From clinical trials of Spiriva / COPD (18 mcg) ( 921)

  • Respiratory tract infectionRespiratory tract infection41% for Spiriva vs.37% for placebo
  • Dry mouthDry mouth16% for Spiriva vs.3% for placebo
  • Sore throatSore throat13% for Spiriva vs.11% for placebo
  • Sinus inflammationSinus inflammation11% for Spiriva vs.9% for placebo
  • Sore throatSore throat9% for Spiriva vs.7% for placebo
  • Sinus inflammationSinus inflammation7% for Spiriva vs.5% for placebo
  • Urinary tract infectionUrinary tract infection7% for Spiriva vs.5% for placebo
  • Chest pain (non-specific)Chest pain (non-specific)7% for Spiriva vs.5% for placebo
  • HeadacheHeadache6% for Spiriva vs.5% for placebo
  • IndigestionIndigestion6% for Spiriva vs.5% for placebo

Manufacturers don’t say how common these side effects are

  • Dehydration
  • Dry skin
  • Gum inflammation
  • Joint swelling
  • Oropharyngeal candidiasis
  • Skin infection
  • Skin ulcer

What to expect when you start Spiriva (Tiotropium)

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Tips from our pharmacists
  • Don't swallow the capsule. Insert the capsule into an inhaler device only.
  • Use daily to control your COPD.
  • Starts working the first few hours, but it may take longer to feel full effects.
  • Prevents breathing problems, but doesn't stop sudden cough or wheezing once they start.
  • Don't breathe out into the inhaler.
  • You might feel dizzy and notice changes in your vision.
  • Don't use it if you have an allergy to atropine.
  • Contains lactose, so don't use it if you're allergic to milk protein.

Risks and Warnings for Spiriva (Tiotropium)

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    • Higher risk if:
    • History of atropine allergic reaction

    There are reports of severe allergic reactions in people taking Spiriva (Tiotropium) with a history of atropine allergy. Spiriva (Tiotropium) has a similar chemical structure to atropine so if you've had an allergic reaction to atropine, there is a possibility you will be allergic to Spiriva (Tiotropium). Call 911 or your doctor right away if you develop severe rash, itching, swelling or difficulty breathing while taking Spiriva (Tiotropium). Talk to your doctor about other medication choices to treat your COPD if you know you have an allergy to the drug atropine.

Means that some groups have a high risk of experiencing this side effect

Tips from pharmacists and people taking Spiriva (Tiotropium)

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The FDA category for this medication is C. It is advised that you: Weigh risks vs. benefits
Kidneys & liver
  • Risks from our pharmacists
  • The kidney is mainly responsible for removing Spiriva (Tiotropium) from the body so people with kidney disease or reduced function need to be watched closely. Spiriva (Tiotropium) can build up in the body and cause certain side effects. Tell your doctor if you develop dry mouth, blurry vision, confusion, sweating, increased heart rate or constipation. You may need to discuss other medication options to treat your COPD.