How does it work?

This medicine contains the active ingredient tiotropium, which is a type of medicine known as an antimuscarinic or anticholinergic bronchodilator. It works by opening the airways to make it easier to breathe.Tiotropium works in the lungs, where it blocks receptors called muscarinic receptors that are found on the muscle surrounding the airways. A natural chemical called acetylcholine normally acts on these receptors, causing the muscle in the airways to contract and the airways to narrow. In chronic obstructive lung diseases (COPD), such as chronic bronchitis or emphysema, the airways are very narrowed, and this makes breathing in and out difficult. Tiotropium blocks the muscarinc receptors in the lungs and therefore stops the action of acetylcholine on them. This allows the muscle around the airways to relax and the airways to open. This makes it easier for people with COPD to breathe.Tiotropium is taken using an inhaler device called a HandiHaler. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.Tiotropium should not be used to relieve an attack of breathing difficulty. Instead, it should be used regularly each day to keep the airways open and help prevent breathing difficulties. The medicine works over 24 hours so it is best to always take it at the same time of day.

What is it used for?

• Chronic obstructive pulmonary disease (COPD)

Warning!

• Inhalers may cause an unexpected increase in wheezing (paradoxical bronchospasm) straight after using them. If this happens, stop using the inhaler immediately and consult your doctor. The medicine should be stopped and an alternative treatment found.
• Do not exceed the recommended dose of this medicine, which will be stated in the product packaging or information leaflet supplied with the medicine.
• Do not swallow the capsules. The powder in the capsules should be inhaled using the HandiHaler device provided with your medicine. Follow the instructions provided carefully, and talk to your doctor, pharmacist or nurse if you are unsure how to use the device, or have any problems using it.
• When using the inhaler you should take care to avoid getting the powder from inside the capsules in your eyes. If any powder does get in your eyes you may experience eye pain or discomfort, red eyes, blurred vision and/or visual haloes around lights. You should rinse your eyes in warm water immediately if this happens and then consult your doctor for further advice.

Use with caution in

• Blockage of the drainage passage of the bladder (bladder neck obstruction)
• Closed angle glaucoma
• Decreased kidney function
• Enlarged prostate gland (prostatic hypertrophy)

Not to be used in

• Allergy to atropine or similar medicines, eg ipratropium or oxitropium
• Children and adolescents under 18 years of age

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• The safety of this medicine in pregnancy has not been established. It should therefore be used with caution during pregnancy, and only if the benefits to the mother outweigh any risks to the foetus. Seek medical advice from your doctor.
• It is not known if this medicine passes into breast milk. It should be used with caution in nursing mothers, and only if the benefits to the mother outweigh any risks to the nursing infant. Discuss this with your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Constipation
• Dry mouth
• Irritation of the throat and airways due to inhalation of powder
• Difficulty in passing urine (urinary retention)
• Inflammation of the throat (pharyngitis)
• Increased heart rate (tachycardia)
• Inflammation of the sinuses (sinusitis)
• Allergic reactions such as narrowing of the airways (bronchospasm) or swelling of the lips, throat and tongue (angioedema)
• Fungal infection of the throat (moniliasis)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

The manufacturer of this medicine has not performed any formal studies to confirm whether it can affect other medicines. However, it has been used safely with the following medicines for COPD:- sympathomimetic bronchodilators, such as salbutamol and terbutaline- theophylline and aminophylline- corticosteroids taken by mouth, eg prednisolone, or by inhaler, eg beclometasone, budesonide. This medicine has not been studied in combination with other anticholinergic medicines such as those below, and these are therefore not recommended while you are taking this medicine:- atropine- ipratropium- oxitropium.Tell your doctor or pharmacist if you are taking any other medicines, including those bought without a prescription and herbal medicines, before you start treatment with this medicine.

Other medicines containing the same active ingredients