Spiriva, also known by its generic name tiotropium bromide, is a prescription medication that comes in the form of an inhaler. It is primarily used to manage symptoms of COPD, including chronic bronchitis and emphysema. Spiriva works by blocking the action of a chemical called acetylcholine, which helps to relax and widen the airways, making it easier to breathe.

Spiriva is not a rescue medication and should not be used for the immediate relief of sudden breathing difficulties. Instead, it is intended for long-term use to control symptoms and reduce the frequency of exacerbations in individuals with COPD.

Spiriva Handihaler and Capsules

The Spiriva Handihaler is an inhalation device specifically designed for individuals with COPD. It is a handheld device that delivers a precise dose of medication directly to the lungs. The device consists of a mouthpiece, a capsule, and a device chamber. The Handihaler is available in the UK market.

To use the Spiriva Handihaler, you need to insert a capsule into the device chamber and pierce it with the inhaler. When you inhale through the mouthpiece, the medication is released from the capsule and enters your lungs.

The Spiriva Handihaler contains tiotropium bromide, which is an anticholinergic medication. It works by blocking certain receptors in the airways, preventing the muscles around the airways from tightening. This action helps to keep the airways relaxed, allowing for easier breathing.

The tiotropium bromide delivered by the Spiriva Handihaler acts as a long-acting bronchodilator, providing 24-hour relief from COPD symptoms. It is important to note that the Spiriva Handihaler is not a rescue medication and should not be used for sudden breathing problems.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a chronic lung disease that progressively restricts airflow due to inflammation and damage to the airways and air sacs in the lungs. It is primarily caused by long-term exposure to irritants such as cigarette smoke, air pollution, and occupational hazards.

Common symptoms of COPD include shortness of breath, chronic cough with mucus production, wheezing, chest tightness, fatigue, and frequent respiratory infections. These symptoms may worsen over time, leading to a significant impact on a person’s quality of life.

The main cause of COPD is tobacco smoking, accounting for the majority of cases. Other risk factors include long-term exposure to secondhand smoke, air pollution, occupational dust and chemicals, genetic predisposition, and respiratory infections.

Warnings and Precautions

When using Spiriva, there are several important warnings and precautions to consider

Pregnancy and Breastfeeding

Spiriva should only be used during pregnancy if the potential benefits outweigh the risks. It is recommended to consult with a healthcare professional before using Spiriva while pregnant or breastfeeding.

Allergic Reactions

Some individuals may experience allergic reactions to Spiriva, such as rash, itching, swelling, severe dizziness, or difficulty breathing. If any of these symptoms occur, seek immediate medical attention.

Eye Problems

Spiriva may cause blurred vision, eye pain, or other vision changes. If you experience any eye-related issues while using Spiriva, consult your healthcare provider promptly.

Urinary Retention

In rare cases, Spiriva can lead to urinary retention, especially in individuals with a history of urinary conditions. Contact your doctor if you experience difficulty urinating while using Spiriva.

Worsening of Glaucoma

Spiriva may worsen symptoms of glaucoma, a condition characterized by increased pressure in the eye. If you have glaucoma or a history of the disease, inform your healthcare provider before starting Spiriva.

Cardiovascular Effects

There have been reports of cardiovascular events, such as increased heart rate and palpitations, in individuals using Spiriva. If you have a heart condition or a history of cardiovascular issues, consult your doctor before using this medication.

Side Effects

Spiriva is a medication that affects the respiratory system and bronchial muscles. While it can provide relief for individuals with respiratory conditions, it may also lead to various side effects.

Common Side Effects

  • Dry Mouth: A common side effect of Spiriva is dry mouth. This occurs due to the medication’s anticholinergic properties, which can reduce saliva production.
  • Constipation: Spiriva may cause constipation in some individuals due to its effect on the digestive system.
  • Blurred Vision: In rare cases, individuals taking Spiriva may experience blurred vision. If this occurs, it’s important to consult a healthcare professional.
  • Urinary Retention: Spiriva can sometimes lead to difficulty in emptying the bladder fully, resulting in urinary retention.

Rare Side Effects

  • Allergic Reactions: Although rare, some individuals may develop allergic reactions to Spiriva. Symptoms may include rash, itching, swelling, severe dizziness, and difficulty breathing. Seek immediate medical attention if you experience these symptoms.
  • Rapid Heartbeat: In rare cases, Spiriva may cause an increased heart rate or palpitations. If you notice these symptoms, consult your healthcare provider.
  • Glaucoma: Individuals with a history of glaucoma may experience an increase in intraocular pressure while taking Spiriva. Regular eye exams are recommended for these individuals.
  • Voice Changes: Spiriva may cause changes in voice quality, such as hoarseness or throat irritation. If these symptoms persist, consult your healthcare professional.

Severe Side Effects

  • Chest Pain: Severe chest pain may occur in some individuals taking Spiriva. This can be a sign of a serious condition and requires immediate medical attention.
  • Difficulty Breathing: If you experience worsening of breathing difficulties or shortness of breath while taking Spiriva, seek medical help immediately.
  • Swelling: Swelling of the face, lips, tongue, or throat may indicate an allergic reaction. This is a severe side effect and requires immediate emergency care.
  • Skin Reactions: In rare cases, Spiriva may cause severe skin reactions, including rash, blisters, or peeling. If you notice any unusual skin changes, consult a healthcare professional.


While Spiriva can be highly effective in managing respiratory conditions, it’s important to be aware of its potential interactions with other drugs, herbal products and food.

  • Anticholinergic Medications: Combining Spiriva with other anticholinergic medications may increase the risk of side effects such as dry mouth, constipation, and blurred vision. It is essential to inform your healthcare provider about all the medications you are taking to avoid potential complications.
  • Beta-Adrenergic Agonists: When used together with Spiriva, beta-adrenergic agonists can enhance the bronchodilating effects, providing better relief for individuals with COPD or asthma. However, close monitoring is necessary, as these combinations can also increase the risk of side effects such as palpitations and tremors.
  • Steroids: Spiriva can be safely used alongside inhaled corticosteroids, which are commonly prescribed for managing respiratory conditions. The combination of these medications can provide more significant benefits in controlling symptoms and improving lung function.
  • Xanthine Derivatives: Combining Spiriva with xanthine derivatives, such as theophylline, can lead to an increased risk of side effects, including nausea, headache, and rapid heartbeat. Regular monitoring of blood levels may be required to ensure appropriate dosing and minimize adverse effects.
  • Diuretics: Diuretics, also known as water pills, are often prescribed to manage conditions like high blood pressure and edema. Some diuretics, particularly potassium-sparing diuretics, can cause low blood potassium levels. Spiriva can also lead to a similar side effect. Therefore, combining the two may increase the risk of developing hypokalemia. Your healthcare provider may monitor your potassium levels and adjust your medication accordingly.
  • Antidepressants: Certain classes of antidepressants, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), may interact with Spiriva. These interactions can lead to an increased risk of side effects such as dry mouth, constipation, and urinary retention. It is crucial to inform your doctor if you are taking any antidepressant medications.
  • Antifungal Medications: Some antifungal medications, like ketoconazole, can inhibit the metabolism of Spiriva, leading to increased drug concentrations in the body. This can potentially increase the risk of adverse effects. It’s important to inform your healthcare provider if you are using any antifungal medications to ensure appropriate dosing and monitoring.
  • Antiviral Medications: Certain antiviral medications, such as ritonavir, can also affect the metabolism of Spiriva. This can result in increased Spiriva concentrations in the body, leading to a higher risk of side effects. If you are taking antiviral medications, consult with your healthcare provider to determine the best course of action.
  • Antibiotics: Some antibiotics, such as clarithromycin, may interact with Spiriva and increase the risk of side effects. If you are prescribed antibiotics while using Spiriva, inform your healthcare provider to ensure safe and effective treatment.
  • Antiarrhythmic Medications: Combining Spiriva with certain antiarrhythmic medications may increase the risk of irregular heart rhythms. It is crucial to discuss your complete medication list, including antiarrhythmics, with your healthcare provider before starting Spiriva.
  • Beta-Blockers: Beta-blockers are commonly prescribed for heart conditions. However, they can potentially worsen bronchospasm in individuals with asthma or COPD. If you require treatment with both Spiriva and beta-blockers, your healthcare provider may need to carefully monitor your respiratory function.
  • MAO Inhibitors: Monoamine oxidase inhibitors (MAOIs) are a class of medications used to treat depression and other mental health conditions. MAOIs can interact with Spiriva, leading to an increased risk of anticholinergic side effects. Inform your healthcare provider if you are taking MAOIs to ensure safe and effective treatment.
  • Antihistamines: Combining Spiriva with antihistamines may increase the risk of dry mouth and other anticholinergic side effects. It’s important to discuss the use of antihistamines with your healthcare provider to minimize potential interactions.
  • Anticonvulsant Medications: Some anticonvulsant medications may interact with Spiriva, leading to an increased risk of side effects. If you are taking anticonvulsants, inform your healthcare provider before starting Spiriva to ensure appropriate monitoring.
  • Opioid Analgesics: Spiriva may potentially enhance the side effects of opioid analgesics, such as respiratory depression and sedation. Close monitoring is essential when using these medications together.
  • Antidiabetic Medications: Certain antidiabetic medications, such as insulin and sulfonylureas, can interact with Spiriva and may require dosage adjustments. It is crucial to inform your healthcare provider if you are taking antidiabetic medications.
  • Anticoagulants: Spiriva is not known to interact with anticoagulant medications like warfarin. However, it is always advisable to inform your healthcare provider about all the medications you are taking to ensure proper monitoring and prevent any potential interactions.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, are commonly used for pain relief. While Spiriva is not known to have significant interactions with NSAIDs, it’s always best to consult with your healthcare provider before combining these medications.
  • Herbal Supplements: Some herbal supplements, such as St. John’s wort and ginkgo biloba, can potentially interact with Spiriva. These interactions can lead to an increased risk of side effects or reduced efficacy of the medication. Always inform your healthcare provider about any herbal supplements you are taking.
  • Grapefruit Juice: Grapefruit juice can interfere with the metabolism of certain medications, including Spiriva. It’s advisable to avoid consuming grapefruit juice while using Spiriva to ensure optimal drug effectiveness.
  • Caffeine: While caffeine itself does not directly interact with Spiriva, it can potentially worsen symptoms like heart palpitations and tremors. If you are sensitive to caffeine, it’s best to limit your intake while using Spiriva.
  • Alcohol: Alcohol consumption may increase the risk of dizziness and drowsiness when combined with Spiriva. It’s important to use caution and limit alcohol intake while taking this medication.
  • Birth Control Medications: Oral contraceptives, commonly known as birth control pills, are not known to interact with Spiriva. However, it’s always advisable to discuss your complete medication list, including birth control medications, with your healthcare provider.
  • Antiemetic Medications: Some antiemetic medications, used for the prevention of nausea and vomiting, may interact with Spiriva. If you are using antiemetics while taking Spiriva, inform your healthcare provider to ensure safe and effective treatment.
  • Immunosuppressants: Immunosuppressant medications, such as corticosteroids or methotrexate, may interact with Spiriva and increase the risk of infections. If you are taking immunosuppressants, it’s crucial to discuss the potential interactions with your healthcare provider.

How To Use

Proper usage of Spiriva is crucial for its effectiveness and to minimize potential side effects.

Step 1: Prepare the Spiriva Inhaler

  1. Remove the Spiriva inhaler cap by squeezing the sides and lifting it off.
  2. Check the mouthpiece to ensure it is clean and free from any debris.
  3. Hold the inhaler upright with the white dot on top.

Step 2: Using the Spiriva Inhaler

  1. Exhale fully, away from the inhaler.
  2. Place your lips around the mouthpiece, ensuring a tight seal.
  3. Breathe in slowly and deeply through your mouth while pressing the green button on the inhaler.
  4. Continue inhaling until your lungs are full.
  5. Hold your breath for a few seconds, then remove the inhaler from your mouth.
  6. Exhale slowly and gently away from the inhaler.

Step 3: Cleaning and Maintenance of the Inhaler

  1. After each use, wipe the mouthpiece with a dry cloth to remove any powder residue.
  2. Do not wash the inhaler or put it in water.
  3. Keep the inhaler dry and protected from moisture.


Spiriva is a commonly prescribed medication for the management of chronic obstructive pulmonary disease (COPD). It helps improve lung function and reduce symptoms such as shortness of breath. However, it is crucial to follow the correct dosage guidelines to ensure its effectiveness and minimize the risk of adverse effects.


    • The recommended dose for COPD is one inhalation of Spiriva HandiHaler (18 mcg) once daily.
    • To take Spiriva HandiHaler, follow the instructions provided with the inhaler device. It usually involves opening a capsule and inhaling the powder using the HandiHaler device.

For Asthma

    • The recommended dose for asthma is two inhalations of Spiriva Respimat (1.25 mcg per inhalation) once daily.
    • To use Spiriva Respimat, follow the instructions provided with the inhaler device. It involves loading a cartridge into the device and releasing the medication by pressing the dose-release button.

Missed Dose of Spiriva

If you miss a dose of Spiriva, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for the missed one.

Overdose of Spiriva

Taking more than the prescribed dose of Spiriva can lead to an overdose. If you suspect an overdose or experience severe symptoms such as rapid heartbeat, dizziness, blurred vision, difficulty breathing, or chest pain, seek immediate medical attention or contact your local poison control center. It is essential to follow the prescribed dosage to minimize the risk of overdose.

It is important not to exceed the prescribed dosage without consulting your healthcare professional.


As with any medication, proper storage is crucial to maintain its effectiveness and safety.

  • Understanding Temperature Requirements: Temperature plays a crucial role in the storage of Spiriva. The medication should be stored at room temperature, ideally between 59°F and 86°F (15°C and 30°C). It is important to avoid extreme temperatures, as they can affect the stability of the medication. Spiriva should never be exposed to freezing temperatures, as it can cause damage to the inhaler device and decrease the effectiveness of the medication. Similarly, high temperatures can lead to degradation of the active ingredients, rendering the medication less potent.
  • Storing Spiriva Away from Moisture: Moisture can have a detrimental effect on the integrity of Spiriva. It is important to store the medication in a dry environment to prevent moisture absorption. Avoid storing Spiriva in the bathroom or any other humid areas. Moisture can impact the stability of the medication and compromise its efficacy. To ensure the longevity of Spiriva, store it in a cool and dry place, away from sources of humidity.
  • The Impact of Light on Spiriva: Exposure to light can also impact the potency of Spiriva. It is advisable to store the medication in its original packaging, which is designed to protect it from light exposure. Avoid leaving Spiriva in direct sunlight or near sources of intense light, such as windowsills or countertops. By protecting Spiriva from light, you can help maintain its effectiveness over time.
  • Handling and Storage Containers: Proper handling and storage containers are essential for preserving the quality of Spiriva. Ensure that the inhaler device is securely closed when not in use to prevent exposure to air and contaminants. Additionally, it is recommended to keep Spiriva in its original blister packaging until ready for use. The blister packaging provides an extra layer of protection against environmental factors. If you are using a multi-dose inhaler, be sure to clean it regularly according to the manufacturer’s instructions.
  • Checking Expiration Dates: Always check the expiration date before using Spiriva. Expired medication may not provide the intended therapeutic benefits and can even pose potential health risks. Dispose of any expired Spiriva properly and avoid using medications beyond their expiration dates. Remember to replace your Spiriva inhaler before it expires to ensure the continuous effectiveness of your treatment.


If you have finished using your Spiriva inhalers or they have expired, it’s important to know how to dispose of them correctly.

Step 1: Check for Expiration

Before disposing of any medication, including Spiriva inhalers, always check the expiration date. Expired medications may lose their effectiveness, and using them can potentially be harmful. Look for the expiration date on the packaging or the canister itself. If your Spiriva inhaler is expired, it’s time to dispose of it properly.

Step 2: Remove Packaging and Labels

When preparing your Spiriva inhaler for disposal, it’s important to remove any packaging, labels, or personal information from the canister. This ensures that no personal information is visible and helps maintain privacy. It also prevents confusion and potential misuse of the medication.

Step 3: Empty the Inhaler

To ensure the safe disposal of your Spiriva inhaler, you need to empty the contents completely. Follow these steps:

  1. Remove the cap from the mouthpiece.
  2. Shake the inhaler well to ensure all the medication is used.
  3. Exhale fully and place the mouthpiece in your mouth, ensuring a tight seal.
  4. Inhale deeply and hold your breath for a few seconds to allow the medication to reach your lungs.
  5. Remove the mouthpiece from your mouth and exhale slowly.
  6. Repeat the process if necessary, as instructed by your healthcare provider.
  7. Once you have finished using the inhaler, it is empty and ready for disposal.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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