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Tiotropium: Drug information

Tiotropium: Drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Tiotropium: Patient drug information" and "Tiotropium: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Spiriva HandiHaler;
  • Spiriva Respimat
Brand Names: Canada
  • LUPIN-Tiotropium;
  • Spiriva;
  • Spiriva Respimat
Pharmacologic Category
  • Anticholinergic Agent;
  • Anticholinergic Agent, Long-Acting
Dosing: Adult
Asthma, moderate to severe, maintenance

Asthma, moderate to severe, maintenance:

Note: For symptoms not well controlled with a medium- to high-dose inhaled corticosteroid and long-acting beta agonist (LABA), may consider as add-on therapy or substitute tiotropium for the LABA. In patients intolerant to LABAs, may use in combination with an inhaled corticosteroid (Ref).

Spiriva Respimat: Soft-mist inhaler (1.25 mcg/actuation): Oral inhalation: 2 inhalations once daily.

Chronic obstructive pulmonary disease, maintenance

Chronic obstructive pulmonary disease, maintenance:

Note: Depending on symptoms and exacerbation risk, use monotherapy long-acting bronchodilator (long-acting beta agonist or long-acting muscarinic antagonist). In patients with more symptoms (eg, Group B), use in combination with long-acting beta agonist. In addition, a short-acting bronchodilator is used for intermittent symptom relief (Ref).

Spiriva HandiHaler: Dry powder inhaler (18 mcg/capsule): Oral inhalation: Contents of 1 capsule inhaled once daily using HandiHaler device. Note: To ensure drug delivery, the contents of each capsule should be inhaled twice.

Spiriva Respimat: Soft mist inhaler (2.5 mcg/actuation): Oral inhalation: 2 inhalations once daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

CrCl >60 mL/minute: No dosage adjustment necessary.

CrCl ≤60 mL/minute: No dosage adjustment necessary; use with caution and closely for anticholinergic adverse events.

Dosing: Hepatic Impairment: Adult

No dosage adjustment necessary.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Tiotropium: Pediatric drug information")

Note: Maximum benefits may take up to 4 to 8 weeks of dosing.

Asthma, maintenance therapy

Asthma, maintenance therapy: Children ≥6 years of age and Adolescents: Spiriva Respimat (1.25 mcg/actuation): Soft-mist inhaler: Oral inhalation: Two inhalations (2.5 mcg) once daily; maximum daily dose: 2 inhalations/day.

Asthma, severely uncontrolled or acute exacerbation

Asthma, severely uncontrolled or acute exacerbation: Children ≥6 years and Adolescents: Inhalation: Spiriva Respimat (2.5 mcg/actuation): Soft-mist inhaler: Oral inhalation: Two inhalations (5 mcg) once daily as add-on therapy to inhaled corticosteroids and other maintenance therapies (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Children ≥6 years and Adolescents:

CrCl >60 mL/minute: No dosage adjustment necessary.

CrCl ≤60 mL/minute: No dosage adjustment necessary; use with caution and closely for anticholinergic adverse events.

Dosing: Hepatic Impairment: Pediatric

No dosage adjustment necessary.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Gastrointestinal: Xerostomia (4% to 16%)

Respiratory: Pharyngitis (9% to 16%), sinusitis (3% to 11%), upper respiratory tract infection (41%)

1% to 10%:

Cardiovascular: Angina pectoris (1% to 3%; includes exacerbation of angina pectoris), chest pain (≤7%), edema (dependent: 5%), hypertension (1% to 2%), palpitations (≤3%)

Dermatologic: Pruritus (1% to 3%), skin rash (1% to 4%)

Endocrine & metabolic: Hypercholesterolemia (1% to 3%), hyperglycemia (1% to 3%)

Gastrointestinal: Abdominal pain (5%; upper abdominal pain: <1%), constipation (1% to 5%), diarrhea (1% to 2%), dyspepsia (6%), gastroesophageal reflux disease (≤3%), oropharyngeal candidiasis (1% to 3%), stomatitis (includes ulcerative stomatitis: 1% to 3%), vomiting (4%)

Genitourinary: Urinary tract infection (1% to 7%)

Hypersensitivity: Hypersensitivity reaction (≤3%)

Infection: Candidiasis (4%), herpes zoster (≤3%), infection (4%)

Nervous system: Depression (1% to 4%), dizziness (1% to 3%), headache (4% to 6%), insomnia (≤4%), paresthesia (1% to 3%), voice disorder (≤3%)

Neuromuscular & skeletal: Arthralgia (≤4%), arthritis (≥3%), limb pain (≤3%), myalgia (4%), skeletal pain (1% to 3%)

Ophthalmic: Cataract (1% to 3%)

Respiratory: Allergic rhinitis (1% to 2%), bronchitis (3%), cough (≥1%), epistaxis (≤4%), flu-like symptoms (≥3%), laryngitis (≤3%), rhinitis (≤6%)

Miscellaneous: Fever (1% to 2%)

<1%:

Cardiovascular: Atrial fibrillation, supraventricular tachycardia

Dermatologic: Dermal ulcer, skin infection, xeroderma

Endocrine & metabolic: Dehydration

Gastrointestinal: Dysphagia, gingivitis, intestinal obstruction, paralytic ileus

Genitourinary: Dysuria, urinary retention

Hepatic: Abnormal hepatic function tests, hepatic insufficiency

Hypersensitivity: Angioedema

Neuromuscular & skeletal: Joint swelling, muscle spasm

Respiratory: Oropharyngeal pain, tonsillitis

Postmarketing:

Cardiovascular: Tachycardia

Dermatologic: Urticaria

Gastrointestinal: Glossitis, oral mucosa ulcer

Hypersensitivity: Type I hypersensitivity reaction

Local: Application site irritation

Ophthalmic: Blurred vision, glaucoma, increased intraocular pressure

Respiratory: Bronchospasm, hoarseness, pharyngolaryngeal pain, throat irritation

Contraindications

Hypersensitivity to ipratropium, tiotropium, or any component of the formulation

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to atropine or its derivatives

Warnings/Precautions

Concerns related to adverse effects:

• Bronchospasm: Paradoxical bronchospasm may occur with use of inhaled agents; discontinue use and consider other therapy if bronchospasm occurs.

• CNS effects: May cause dizziness and blurred vision; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).

• Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm, anaphylaxis, itching) have been reported. Discontinue immediately if signs/symptoms occur. Use with caution in patients with a history of hypersensitivity to atropine.

Disease-related concerns:

• Glaucoma: May worsen symptoms of narrow-angle glaucoma; use with caution.

• Prostatic hyperplasia/bladder neck obstruction: May worsen the symptoms of prostatic hyperplasia and/or bladder neck obstruction; use with caution.

• Renal impairment: Use with caution in patients with moderate to severe renal impairment (CrCl ≤60 mL/minute); monitor closely for anticholinergic adverse events.

Dosage form specific issues:

• Lactose: Capsule for oral inhalation may contain lactose; use with caution in patients with severe milk protein allergy.

Other warnings/precautions:

• Appropriate administration: Not indicated for the initial (rescue) treatment of acute episodes of bronchospasm.

• Appropriate use: Spiriva HandiHaler: The contents of Spiriva capsules are for inhalation only via the HandiHaler device. Capsules should not be swallowed; there have been reports of incorrect administration (swallowing of the capsules).

• Appropriate use: Spiriva Respimat: The contents of Spiriva inhalation spray are for inhalation only via the Respimat inhaler.

• Avoid ocular contact: Avoid inadvertent instillation into the eyes; may dilate pupils and/or cause blurred vision.

Dosage Forms Considerations

Spiriva Respimat 4 g cartridges contain 60 metered actuations (institutional pack contains 10 metered actuations).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Aerosol Solution, Inhalation:

Spiriva Respimat: 1.25 mcg/actuation (4 g); 2.5 mcg/actuation (4 g) [contains benzalkonium chloride, disodium edta]

Capsule, Inhalation:

Spiriva HandiHaler: 18 mcg [contains milk protein]

Generic: 18 mcg

Generic Equivalent Available: US

May be product dependent

Pricing: US

Aerosol solution (Spiriva Respimat Inhalation)

1.25 mcg/ACT (per gram): $158.22

2.5 mcg/ACT (per gram): $22.50

Capsules (Spiriva HandiHaler Inhalation)

18 mcg (per each): $20.48

Capsules (Tiotropium Bromide Monohydrate Inhalation)

18 mcg (per each): $18.43

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Aerosol Solution, Inhalation:

Spiriva Respimat: 2.5 mcg/actuation (1 ea) [contains benzalkonium chloride, disodium edta]

Capsule, Inhalation:

Spiriva: 18 mcg [contains milk protein]

Generic: 18 mcg

Administration: Adult

Inhalation: For oral inhalation only.

Spiriva HandiHaler: Dry powder inhaler: Do not swallow capsule. Administer at the same time each day. Do not remove capsule from blister until immediately before use. Place capsule in the center chamber of the HandiHaler Inhaler. Must only use the HandiHaler Inhaler. Close mouthpiece firmly until a click is heard, leaving dustcap open. The capsule is pierced by pressing and releasing the green piercing button on the side of the HandiHaler device. Exhale fully. Close lips tightly around mouthpiece; do not exhale into inhaler. Tilt head slightly back and inhale (rapidly, steadily, and deeply); the capsule vibration (rattle) may be heard within the device. Hold breath for a few seconds then repeat inhalation procedure using the same tiotropium capsule. Do not pierce the capsule a second time. Throw away empty capsule by tipping into a trash can without touching it; do not leave in inhaler. Keep capsules and inhaler dry. Discard any capsules that are exposed to air and not used immediately.

Spiriva Respimat: Soft-mist inhaler: Prior to first use, insert cartridge into the inhaler and prime the unit by actuating the inhaler toward the ground until an aerosol cloud is visible; repeat three more times and then the unit is primed and ready for use. If not used for more than 3 days, actuate the inhaler once to prepare the inhaler for use. If not used for more than 21 days, actuate the inhaler until an aerosol cloud is visible and then repeat the process three more times to prepare the inhaler for use.

Administration: Pediatric

Inhalation: For oral inhalation only.

Spiriva Respimat: Asthma: Soft-mist inhaler: Prior to first use, insert cartridge into the inhaler and prime the unit by actuating the inhaler toward the ground until an aerosol cloud is visible; repeat 3 more times and then the unit is primed and ready for use. If not used for more than 3 days, actuate the inhaler once to prepare the inhaler for use. If not used for more than 21 days, actuate the inhaler until an aerosol cloud is visible and then repeat the process 3 more times to prepare the inhaler for use.

Use: Labeled Indications

Asthma , moderate to severe, maintenance (Spiriva Respimat only): Maintenance treatment of asthma in patients ≥6 years.

Chronic obstructive pulmonary disease, maintenance: Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; reduction of COPD exacerbations.

Limitations of use: Not indicated for the relief of acute bronchospasm.

Medication Safety Issues
Sound-alike/look-alike issues:

Spiriva may be confused with Apidra, Inspra, Serevent

Tiotropium may be confused with ipratropium

Administration issues:

Spiriva capsules for inhalation are for administration via HandiHaler device and are not for oral use

Metabolism/Transport Effects

Substrate of CYP2D6 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Agents with Clinically Relevant Anticholinergic Effects. Agents with Clinically Relevant Anticholinergic Effects may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid combination

Agents with Clinically Relevant Anticholinergic Effects: May enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination

Amantadine: May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor therapy

Benperidol: Agents with Clinically Relevant Anticholinergic Effects may diminish the therapeutic effect of Benperidol. Risk C: Monitor therapy

Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor therapy

Bromperidol: Agents with Clinically Relevant Anticholinergic Effects may enhance the anticholinergic effect of Bromperidol. Risk C: Monitor therapy

Cannabinoid-Containing Products: Agents with Clinically Relevant Anticholinergic Effects may enhance the tachycardic effect of Cannabinoid-Containing Products. Risk C: Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor therapy

Chlorprothixene: Agents with Clinically Relevant Anticholinergic Effects may enhance the anticholinergic effect of Chlorprothixene. Risk C: Monitor therapy

Cimetropium: Agents with Clinically Relevant Anticholinergic Effects may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination

Eluxadoline: Agents with Clinically Relevant Anticholinergic Effects may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination

Gastrointestinal Agents (Prokinetic): Agents with Clinically Relevant Anticholinergic Effects may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy

Glucagon: Agents with Clinically Relevant Anticholinergic Effects may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy

Glycopyrrolate (Oral Inhalation): Agents with Clinically Relevant Anticholinergic Effects may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X: Avoid combination

Glycopyrronium (Topical): May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid combination

Ipratropium (Nasal): May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor therapy

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid combination

Itopride: Agents with Clinically Relevant Anticholinergic Effects may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy

Levosulpiride: Agents with Clinically Relevant Anticholinergic Effects may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination

Loxapine: Agents to Treat Airway Disease may enhance the adverse/toxic effect of Loxapine. More specifically, the use of Agents to Treat Airway Disease is likely a marker of patients who are likely at a greater risk for experiencing significant bronchospasm from use of inhaled loxapine. Management: This is specific to the Adasuve brand of loxapine, which is an inhaled formulation. This does not apply to non-inhaled formulations of loxapine. Risk X: Avoid combination

Methacholine: Long-acting muscarinic antagonists (LAMAs) may diminish the therapeutic effect of Methacholine. Management: Hold long-acting muscarinic antagonists (LAMAs) for at least 7 days before methacholine use. Risk D: Consider therapy modification

Mianserin: May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor therapy

Mirabegron: Agents with Clinically Relevant Anticholinergic Effects may enhance the adverse/toxic effect of Mirabegron. Risk C: Monitor therapy

Nitroglycerin: Agents with Clinically Relevant Anticholinergic Effects may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor therapy

Opioid Agonists: Agents with Clinically Relevant Anticholinergic Effects may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor therapy

Oxatomide: May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid combination

Potassium Chloride: Agents with Clinically Relevant Anticholinergic Effects may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination

Potassium Citrate: Agents with Clinically Relevant Anticholinergic Effects may enhance the ulcerogenic effect of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid combination

Pramlintide: May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. These effects are specific to the GI tract. Risk X: Avoid combination

QuiNIDine: May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor therapy

Ramosetron: Agents with Clinically Relevant Anticholinergic Effects may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy

Revefenacin: Agents with Clinically Relevant Anticholinergic Effects may enhance the anticholinergic effect of Revefenacin. Risk X: Avoid combination

Rivastigmine: Agents with Clinically Relevant Anticholinergic Effects may diminish the therapeutic effect of Rivastigmine. Rivastigmine may diminish the therapeutic effect of Agents with Clinically Relevant Anticholinergic Effects. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider therapy modification

Secretin: Agents with Clinically Relevant Anticholinergic Effects may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider therapy modification

Thiazide and Thiazide-Like Diuretics: Agents with Clinically Relevant Anticholinergic Effects may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Topiramate: Agents with Clinically Relevant Anticholinergic Effects may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid combination

Pregnancy Considerations

Uncontrolled asthma is associated with adverse events in pregnancy (increased risk of perinatal mortality, preeclampsia, preterm birth, low birth weight infants, cesarean delivery, and the development of gestational diabetes). Poorly controlled asthma or asthma exacerbations may have a greater fetal/maternal risk than what is associated with appropriately used asthma medications. Maternal treatment improves pregnancy outcomes by reducing the risk of some adverse events (eg, preterm birth, gestational diabetes) (ERS/TSANZ [Middleton 2020]; GINA 2023).

Although data related to tiotropium use in pregnancy are limited, use is likely acceptable. Maternal asthma symptoms should be monitored monthly during pregnancy (ERS/TSANZ [Middleton 2020]).

Data collection to monitor pregnancy and infant outcomes associated with asthma and the medications used to treat asthma in pregnancy is ongoing. Health care providers are encouraged to enroll exposed pregnant patients in the MotherToBaby Pregnancy Studies conducted by the Organization of Teratology Information Specialists (877-311-8972 or https://mothertobaby.org). Patients may also enroll themselves.

Breastfeeding Considerations

It is not known if tiotropium is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.

Monitoring Parameters

FEV1, peak flow (or other pulmonary function studies); anticholinergic adverse reactions (patients with CrCl ≤50 mL/min); signs and symptoms of narrow angle glaucoma and urinary retention

Mechanism of Action

Competitively and reversibly inhibits the action of acetylcholine at type 3 muscarinic (M3) receptors in bronchial smooth muscle causing bronchodilation

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Poorly absorbed from GI tract, systemic absorption may occur from lung

Distribution: Vd: 32 L/kg

Protein binding: 72%

Metabolism: Hepatic (minimal), via CYP2D6 and CYP3A4

Bioavailability: Following inhalation, 19.5% (dry powder inhaler) or ~33% (soft-mist inhaler); Oral solution: 2% to 3%

Half-life elimination:

Dry powder inhaler: COPD: ~25 hours

Soft-mist inhaler: Asthma: 44 hours; COPD: 25 hours

Time to peak, plasma:

Dry powder inhaler: 7 minutes (following inhalation)

Soft-mist inhaler: 5 to 7 minutes (following inhalation)

Excretion: Urine (7% of an inhaled dose [dry powder inhaler]; 18.6% of an inhaled dose [COPD] or 12.8% [asthma] [soft-mist inhaler])

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Reduced clearance and increased plasma concentrations may occur.

Older adult: Reduced clearance may occur.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Neumotropio | Spiriva | Spiriva respimat;
  • (AR) Argentina: Aspire fan | Neumotropio | Nubibron | Spiriva | Spiriva respimat;
  • (AT) Austria: Spiriva | Spiriva respimat | Tiotropium mylan;
  • (AU) Australia: Braltus | Spiriva | Spiriva respimat;
  • (BD) Bangladesh: Dilriva unicap | Tioriva | Topium dpi | Tropex;
  • (BE) Belgium: Spiriva | Srivasso;
  • (BG) Bulgaria: Braltus | Plubrom | Spiriva | Spiriva respimat;
  • (BR) Brazil: Spiriva | Spiriva respimat;
  • (CH) Switzerland: Spiriva | Spiriva respimat;
  • (CL) Chile: Braltus zonda | Spiriva | Spiriva respimat;
  • (CN) China: Neng bei le | Spiriva | Tian qing su le | Tiotropium bromide;
  • (CO) Colombia: Bromuro de tiotropio | Neumotropio | Spiriva | Spiriva respimat | Teromar rotacaps | Tiosynt | Tiozide;
  • (CZ) Czech Republic: Braltus | Dilochob | Spiriva | Srivasso;
  • (DE) Germany: Acopair | Braltus | Spiriva | Spiriva respimat | Srivasso;
  • (DO) Dominican Republic: Spiriva | Spiriva respimat;
  • (EC) Ecuador: Neumotropio | Spiriva | Spiriva respimat | Tiotropio;
  • (EE) Estonia: Spiriva;
  • (EG) Egypt: Inhalex | Spiriva | Spiriva respimat;
  • (ES) Spain: Braltus | Gregal | Spiriva | Spiriva respimat | Tavulus;
  • (FI) Finland: Sirkava | Spiriva | Spiriva respimat | Srivasso | Tiogiva;
  • (FR) France: Spiriva | Spiriva respimat | Tiotropium biogaran eolip | Tiotropium mylan;
  • (GB) United Kingdom: Acopair | Braltus | Spiriva | Spiriva respimat | Tiogiva;
  • (GR) Greece: Spiriva;
  • (HK) Hong Kong: Spiriva;
  • (HR) Croatia: Braltus | Spiriva | Spiriva respimat;
  • (HU) Hungary: Braltus | Plubrom | Spiriva | Spiriva respimat | Srivasso;
  • (ID) Indonesia: Spiriva;
  • (IE) Ireland: Braltus | Spiriva | Spiriva respimat;
  • (IN) India: Aerotrop | Airtio | Quikhale t | Solbihale T | Tiomist | Tiova;
  • (IT) Italy: Braltus | Sirkava | Spiriva | Spiriva respimat | Tioklira | Tiotropio doc;
  • (JO) Jordan: Spiriva;
  • (JP) Japan: Spiriva;
  • (KE) Kenya: Neumotropio | Spiriva;
  • (KR) Korea, Republic of: Spiriva | Spiriva combi | Spiriva refill | Spiriva respimat | Tiropium breezhaler;
  • (KW) Kuwait: Spiriva;
  • (LB) Lebanon: Neumotropio | Spiriva | Tiova;
  • (LT) Lithuania: Ontipria | Spiriva | Spiriva respimat;
  • (LU) Luxembourg: Spiriva | Srivasso;
  • (LV) Latvia: Ontipria | Spiriva | Spiriva respimat | Srivasso;
  • (MA) Morocco: Spiriva | Spiriva respimat | Tiova rotacaps;
  • (MX) Mexico: Spiriva | Tiotropio;
  • (MY) Malaysia: Spiriva | Spiriva respimat;
  • (NL) Netherlands: Spiriva | Spiriva respimat | Tavulus | Tiotropium mylan | Tiotrus | Tiotrus zonda;
  • (NO) Norway: Spiriva | Spiriva respimat | Srivasso | Tiogiva;
  • (NZ) New Zealand: Spiriva | Spiriva respimat | Tiotropium;
  • (PE) Peru: Spiriva | Spiriva respimat;
  • (PH) Philippines: Spiriva;
  • (PK) Pakistan: Aprexo | Gentrop | Respy | Ti air | Tio b | Tio veez | Tioflow | Tioget | Tiovair | Tyo | Wilpium;
  • (PL) Poland: Braltus | Ontipria | Spiriva | Srivasso;
  • (PR) Puerto Rico: Spiriva handihaler;
  • (PT) Portugal: Braltus | Gregal | Sirkava | Spiriva;
  • (PY) Paraguay: Neumotropio | Spiriva | Spiriva handihaler | Spiriva respimat;
  • (QA) Qatar: Spiriva | Spiriva Respimat;
  • (RO) Romania: Dilochob | Gregal;
  • (RU) Russian Federation: Respium | Spiriva | Spiriva respimat | Tiotropium nativ;
  • (SA) Saudi Arabia: Spiriva | Spiriva respimat;
  • (SE) Sweden: Braltus | Spiriva | Spiriva respimat | Tiogiva;
  • (SG) Singapore: Spiriva | Spiriva respimat;
  • (SI) Slovenia: Spiriva | Spiriva respimat;
  • (SK) Slovakia: Spiriva | Spiriva respimat;
  • (TH) Thailand: Spiriva | Spiriva respimat;
  • (TN) Tunisia: Spiriva | Spiriva respimat | Xtiova easy flow;
  • (TR) Turkey: Brontio | Coriva | Spiract | Spiriva | Spiriva respimat | Tioday | Tioday Capsair | Tioumit;
  • (TW) Taiwan: Spiriva | Spiriva respimat;
  • (UA) Ukraine: Spiriva | Spiriva respimat;
  • (UY) Uruguay: Spiriva | Spiriva respimat | Tiova;
  • (VE) Venezuela, Bolivarian Republic of: Spiriva | Spiriva handihaler;
  • (ZA) South Africa: Forvent | Spiriva | Spiriva respimat | Tiores | Tiotor
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Topic 10300 Version 311.0

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