Spiriva caps 18mcg #30

Spiriva user manual

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Composition

Active Ingredient:
INN - tiotropium bromide 22.5 μg (18 μg of tiotropium, respectively) in one capsule and 3.1235 μg of tiotropium bromide (2.5 μg of tiotropium, respectively) in a single dose of the inhalation solution.
Capsules, in addition to the active ingredient, include lactose monohydrate.
In addition to the active ingredient, the inhalation solution includes: benzalkonium chloride, hydrochloric acid, disodium edetate, water.

Form of issue

Spiriva - capsules, including powder for inhalation of 10, 30 or 60 pieces. The package may include an inhaler.
Spiriva Respimat (Spiriva Respimat) - inhalation solution, enclosed in cartridges of 4.5 ml (60 doses in 4 ml).

pharmachologic effect

Bronchodilator, holinoliticheskoe.

Pharmacodynamics and pharmacokinetics

Tiotropium is an antimuscarinic long-acting drug (anticholinergic drug) and exhibits the same affinity for different muscarinic receptors from M1 to M5. Due to the depression in the airways of the M3 receptors, relaxation of their smooth muscles takes place, which in turn leads to a bronchodilator effect of the drug, which, depending on the dose taken, persists for 24 hours and even longer. With the inhalation method of administration, tiotropium has a selective local character, without, in therapeutic doses, leading to systemic anticholinergic negative effects. Thus, bronchodilation is manifested not by systemic, but by local action of the drug.
30 minutes after the inhalation of 1 dose, there is a significant increase in lung function, which continues throughout the day. Pharmacodynamic equilibrium was observed within 7 days of admission, and pronounced bronchodilator effect was achieved on day 3. There were no manifestations of tolerance to Spiriva, when assessing its bronchodilator effect for 12 months. Taking the drug reduces the number of exacerbations of COPD compared with placebo, lengthens the time before the first exacerbation, positively affects the quality of life throughout the period of use, reduces the number of involuntary hospitalizations associated with exacerbation of COPD, and also postpones the time of the first hospitalization.
Absolute bioavailability of tiotropium at its reception in the form of inhalations is 19.5%, which guarantees its high content in the lungs with insignificant influence on the patient's organism as a whole. From the gastrointestinal tract is absorbed rather poorly, in connection with which, its absorption does not depend on the intake of food. In patients with COPD, Cmax is reached 5 minutes after inhalation and is 17-19 pg / ml, with an equilibrium plasma concentration of 3-4 pg / ml. Plasma proteins bind to 72%, with a volume of distribution - 32 l / kg. Has no ability to pass GEB.
Subject to minor biotransformation. The cleavage pathway is non-enzymatic and leads to the formation of dithienylglycolic acid and alcohol N-methylskopine, not binding to muscarinic receptors.
Terminal T1 / 2 after inhalation - 5-6 days.
14% of the dose is excreted in the urine by the kidneys left with feces.

Indications for use

    maintenance treatment in patients with COPD, including those with emphysema, persistent dyspnea, chronic bronchitis, and with the aim of preventing exacerbations;
    additional treatment of patients suffering from bronchial asthma, to reduce the frequency of exacerbations and symptoms, as well as to improve the quality of life.

Contraindications

    age to 18 years;
    the first trimester of pregnancy;
    hypersensitivity to one or the sum of the ingredients of the drug.
Carefully:
    angle-closure glaucoma;
    obstruction of the neck of the bladder;
    hyperplasia of the prostate.

Side effects

Inhalations with the drug Spiriva and Spiriva Respimat can be accompanied by:
    a rash;
    dry mouth;
    Candidiasis of the oral mucosa;
    bronchospasm;
    dysphonia;
    tachycardia;
    dizziness;
    itching;
    urticaria;
    dysphagia;
    constipation;
    gastroesophageal reflux;
    cough;
    supraventricular tachycardia;
    irritation of pharynx;
    increased intracranial pressure;
    intestinal obstruction;
    difficulty urinating;
    anaphylaxis;
    nosebleeds;
    urinary tract infections;
    atrial fibrillation;
    blurred vision;
    glaucoma;
    angioedema.

Spiriva, instructions for use

Instructions for use Spiriva in the form of capsules assumes their use in the form of inhalations with the aid of an instrument (inhaler) HandiHaler. The recommended daily dose equals one capsule. Application of capsules Spiriva orally (internally) is not allowed.
Medication Spiriva Respimat in the form of a solution is also intended for inhalation with the help of the inhaler Respimat. The recommended daily dose is 5 mcg (2 inhalations) once a day at one time.
Elderly patients and patients with hepatic pathologies take drugs without correction of doses.
In case of kidney disease, dosage adjustment is also not required, however, it is advisable to undergo a regular examination of kidney function.
To produce inhalations of the drug Spiriva in the form of capsules, a special inhaler KhandiHaler was developed, which should not be used for other medicines. The life of this inhaler is 12 months.
The inhaler kit includes: a mouthpiece, a dust cap, a base, a central chamber and a piercing button.
When using it, you should:
    press the puncture button to open the dust cap;
    Lifting up, fully open the cap, and then in the same way the mouthpiece;
    Place the capsule in the central chamber (by any side), beforehand taking it out of the package;
    thoroughly close the mouthpiece (this will sound a characteristic click) without closing the dust cap;
    when the inhaler is positioned with the mouthpiece up, make one complete push to the piercing button and release (to create a hole in the capsule);
    produce as much as possible a full exhalation (not in the mouthpiece of the inhaler);
    place the inhaler in the mouth, tightly grasping the mouthpiece;
    when the head is positioned directly, take a deep, slow, but strong enough breath (while hearing or feeling the vibration of the capsule) until the lungs are completely saturated;
    Hold your breath until you feel discomfort, while taking the inhaler out of your mouth;
    repeat such breaths until the contents of the capsule are fully released;
    open the mouthpiece and remove the capsule, then close the mouthpiece and the dust cap.
Cleaning the inhaler HandiHaler should be done every 30 days.
To do this, first lifting the piercing button, you need to open the dust cap and mouthpiece, as well as the base of the device. Using warm water, rinse the inhaler until the remnants of the powder are removed. Wipe with a paper towel and allow to dry for 24 hours in the air. If necessary, you can clean the outer surface of the mouthpiece with a damp cloth.
When removing the capsule from the blister, it is necessary to separate its strip along the perforation line. Open the capsule bed and remove it before use. Do not allow the extracted capsule to remain in the open for long periods of time.
For the inhalation of medicinal product Spiriva Respimat use inhaler Respimat:
    the first opening is carried out by pushing out the transparent base by pressing the fuse, with the green cap closed;
    remove the cartridge from the package and insert it with a narrow end into the inhaler, while it should sound click (do not remove the cartridge after installing it);
    establish a transparent base on the former place;
    while holding the inhaler in the right hand, rotate its base until it clicks, following the instructions of the red arrows (half turn);
    fully open the green cap;
    directing the inhaler down, pressing the button until the drug is released, and then closing the cap.
After that, the inhaler is charged and ready for further use.
For inhalation, you should:
    with the green cap closed, while holding the inhaler in the right hand, rotate its base until it clicks, following the instructions of the red arrows (half turn);
    fully open the green cap;
    make a slow full exhalation, then tightly grasp the mouthpiece without closing the ventilation holes;
    directing the mouthpiece towards the back wall of the pharynx, draw a deep, slow breath, while pressing the inhaler button (inhale as long as possible);
    hold your breath for at least 10 seconds;
    repeat the procedure until the dose is fully received.
Inhalations are carried out once every 24 hours, after which the cap is closed.
If the inhaler is not used for a week, it is necessary to do a prophylactic spraying by sending the mouthpiece down.
Inhaler Respimat is designed for 60 breaths and is equipped with a dose indicator. Indicator indicator at the beginning of the red zone, indicates a 7-day supply of the drug (14 breaths). This is the reason for purchasing a new inhaler.
The inhaler can be used for 3 months, after which, even with incomplete use, it must be discarded.
Cleaning the mouthpiece is done once a week, using a damp cloth.

Overdose

When inhaled tiotropium in high doses observed anticholinergic manifestations: dryness in the oral cavity, increased heart rate, accommodation disorders.
Symptomatic treatment is indicated.

Interaction

It is possible to perform inhalations of tiotropium in parallel use of other drugs commonly used for COPD therapy (methylxanthines, sympathomimetics, inhaled or oral steroids).
The appointment with other anticholinergics is not recommended.

Terms of sale

To buy Spiriva online you don't need a prescription.

Storage conditions

The storage temperature of both preparations should not exceed 25 ° C.
Shelf life - 24 months.
Spiriva Respimat - 36 months.

special instructions

Preparations Spiriva and Spiriva Respimat are not used to treat bronchospasm, especially in acute attacks.
Perhaps the emergence of bronchospasm and immediate hypersensitivity reactions, immediately after the inhalation.
The patient must provide complete information on the use of an inhaler.
Do not allow drugs to enter the eyes. Discomfort in the eyes, pain, blurred vision, redness, corneal edema, conjunctival stasis may indicate an acute attack of angle-closure glaucoma. When observing any of these symptoms, it is necessary to inform the attending physician about it.

Children

Due to insufficient information, children under the age of 18 are not appointed.

During pregnancy (and lactation)

Tiotropium bromide is contraindicated in the first trimester of pregnancy.
During the remaining period of pregnancy, as well as during lactation, it is possible to appoint it only in extreme cases and under constant medical supervision.

Reviews

Reviews about Spiriva, as well as reviews about Spiriva Respimat are almost 100% positive. In the opinion of many doctors, these medications are the "golden mean" in carrying out maintenance therapy for COPD. It confirms the high effectiveness and duration of action of the drugs and on the part of the patients who apply it.
Not bad results showed the use of drugs in bronchial asthma, but only as an additional tool to facilitate the overall condition.
Some problems arise when using inhalers. For correct use, the procedure described in the inhaler instruction manual should be repeated exactly as well as several inhalations in the presence of an experienced physician who can correct the errors that occur.