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{{drugbox |
Tiotropium Bromide CAS:136310-93-5 White crystal powder Purity>=99
| image = Tiotropium.png
| width = 150
| image2 = Tiotropium-3D-balls.png
|IUPAC_name = (1&alpha;,2&beta;,4&beta;,7&beta;)-<br />7-[(hydroxidi-2-thienylacetyl)oxy]-9,9-dimethyl-<br />3-oxa-9-azoniatricyclo[3.3.1.0<sup>2,4</sup>]nonane
| CAS_number = 186691-13-4
| ATC_prefix = R03
| ATC_suffix = BB04
| PubChem = 131950
| DrugBank = DB01409
| C=19 | H=22 | N=1 | O=4 | S=2 |charge=+
| molecular_weight = 490.4
| smiles = [Br-].O=C(OC1C[C@H]2[C@@H]3O[C@@H]3[C@@H](C1)[N+]2(C)C)C(O)(c1cccs1)c1cccs1
| bioavailability = 19.5% (inhalation)
| metabolism = [[hepatic]] 25%<br />([[CYP2D6]], [[CYP3A4]])
| elimination_half-life = 5–6 days
| excretion = [[renal]]
| pregnancy_AU = B1
| pregnancy_US =
| pregnancy_category =
| legal_AU = S4
| legal_CA =
| legal_UK = POM
| legal_US = Rx-only
| legal_status =
| routes_of_administration = inhalation (oral)
}}
'''Tiotropium''' ({{pronEng|ˌtaɪəˈtroʊpiəm}}) (administered as tiotropium bromide) is a long-acting, 24 hour, [[anticholinergic]] [[bronchodilator]] used in the management of [[chronic obstructive pulmonary disease]] (COPD). Tiotropium bromide ([[International Nonproprietary Name|INN]]) capsules for inhalation are co-marketed by [[Boehringer-Ingelheim]] and [[Pfizer Inc.|Pfizer]] under the trade name "Spiriva".


== Mode of delivery ==
Methyl di(2-thienyl)glycolate CAS:26447-85-8 White crystal powder Purity>=99


The patient removes one tiotropium capsule from the blister pack, places it into the piercing chamber of the inhalation device and closes the mouthpiece.
Scopine CAS:498-45-3 White crystal powder Purity>=97


The capsule is manually pierced, and the medication is inhaled through the mouthpiece. It is recommended that inhalations are repeated 2 to 3 times to ensure all medication is drawn from the capsule. When properly done, the capsule will make a distinctive flutter or rattle, audible to the patient.
Scopine Hel CAS:85700-55-6 White crystal powder Purity>=97


Once the powder capsules are removed from the blister pack, it should be immediately taken, via through the inhalation device. If a capsule is exposed to the air it will rapidly degrade to the point the dose will become ineffective. Any previously exposed capsules should be discarded.
Scopine di(2-thienyl)glycolate CAS:136310-64-0 White crystal powder Purity>=99


The capsules cannot be taken orally - they will not be effective as respiratory medication if absorbed through the gastrointestinal tract and may have side effects if absorbed via this route.
Scopine Hel CAS:114-49-8 White crystal powder Purity>=99


==Mode of action==
5,6-Dimethoxy-1-indanone CAS:2107-69-9
Tiotropium is a [[muscarinic receptor]] [[receptor antagonist|antagonist]], often referred to as an antimuscarinic or [[anticholinergic]] agent. Although it does not display selectivity for specific muscarinic receptors, on topical application it acts mainly on M<sub>3</sub> muscarinic receptors located in the airways to produce [[smooth muscle]] relaxation, thus producing a [[bronchodilator]]y effect.


==Clinical use==
Loratadine 79794-75-5 >=99
===Indications===
Tiotropium is indicated as a daily, 24 hour, maintenance treatment of [[chronic obstructive pulmonary disease]] (COPD).


===Adverse effects===
Ozagrel 82571-53-7 >=98.5
Adverse effects are mainly related to its antimuscarinic effects. Common [[adverse drug reaction]]s (≥1% of patients) associated with tiotropium therapy include: dry mouth and/or throat irritation. Rarely (<0.1% of patients) treatment is associated with: [[urinary retention]], constipation, acute [[angle closure glaucoma]], palpitations, and/or allergy (rash, [[angioedema]], [[anaphylaxis]]) (Rossi, 2006).
A study of more than 15,000 patients published in the Journal of the American Medical Association has linked tiotropium and another member of its class ipratropium to increased risk of heart attacks, stroke and cardiovascular death (Singh, 2008)


==References==
Pioglitazone Hcl 112529-15-4 >=99
*Rossi S, editor. [[Australian Medicines Handbook]] 2006. Adelaide: Australian Medicines Handbook; 2006
*Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and the risk of major adverse cardiovascular events. JAMA 2008;300(12)1439-1450.


==See also==
*[[Chronic obstructive pulmonary disease]]


==External links==
*[http://spiriva.com/ Official SPIRIVA Site]
*[http://www.centerwatch.com/patient/drugs/dru848.html Thomson CenterWatch]


==Image collection==
contact:Alice

phone:+86-531-82375818
{| border="0" cellpadding="0" cellspacing="0" align="left"
Tel:013969142597
|+
MSN:xuezhongyan888@hotmail.com
|-
|[[Image:Spiriva3.png|thumb|Front view]]
|[[Image:Tiocap.png|thumb|160px|A previously pierced Spiriva capsule]]
|[[Image:SP2.png|thumb|Open (cleaning) view]]
|}

{{Anticholinergics}}
{{Asthma_and_copd_rx}}

[[Category:Bronchodilators]]
[[Category:Muscarinic antagonists]]
[[Category:Thiophenes]]
[[Category:Epoxides]]
[[Category:Pfizer]]
[[de:Tiotropiumbromid]]
[[pl:Tiotropium]]

Revision as of 10:02, 21 November 2008

Tiotropium bromide
File:Tiotropium.png
Clinical data
Pregnancy
category
  • AU: B1
Routes of
administration		inhalation (oral)
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • UK: POM (Prescription only)
  • US: ℞-only
Pharmacokinetic data
Bioavailability19.5% (inhalation)
Metabolismhepatic 25%
(CYP2D6, CYP3A4)
Elimination half-life5–6 days
Excretionrenal
Identifiers
  • (1α,2β,4β,7β)-
    7-[(hydroxidi-2-thienylacetyl)oxy]-9,9-dimethyl-
    3-oxa-9-azoniatricyclo[3.3.1.02,4]nonane
CAS Number
PubChem CID
DrugBank
CompTox Dashboard (EPA)
ECHA InfoCard100.234.575 Edit this at Wikidata
Chemical and physical data
FormulaC19H22NO4S2+
Molar mass490.4 g·mol−1
3D model (JSmol)
  • [Br-].O=C(OC1C[C@H]2[C@@H]3O[C@@H]3[C@@H](C1)[N+]2(C)C)C(O)(c1cccs1)c1cccs1

Tiotropium (Template:PronEng) (administered as tiotropium bromide) is a long-acting, 24 hour, anticholinergic bronchodilator used in the management of chronic obstructive pulmonary disease (COPD). Tiotropium bromide (INN) capsules for inhalation are co-marketed by Boehringer-Ingelheim and Pfizer under the trade name "Spiriva".

Mode of delivery

The patient removes one tiotropium capsule from the blister pack, places it into the piercing chamber of the inhalation device and closes the mouthpiece.

The capsule is manually pierced, and the medication is inhaled through the mouthpiece. It is recommended that inhalations are repeated 2 to 3 times to ensure all medication is drawn from the capsule. When properly done, the capsule will make a distinctive flutter or rattle, audible to the patient.

Once the powder capsules are removed from the blister pack, it should be immediately taken, via through the inhalation device. If a capsule is exposed to the air it will rapidly degrade to the point the dose will become ineffective. Any previously exposed capsules should be discarded.

The capsules cannot be taken orally - they will not be effective as respiratory medication if absorbed through the gastrointestinal tract and may have side effects if absorbed via this route.

Mode of action

Tiotropium is a muscarinic receptor antagonist, often referred to as an antimuscarinic or anticholinergic agent. Although it does not display selectivity for specific muscarinic receptors, on topical application it acts mainly on M3 muscarinic receptors located in the airways to produce smooth muscle relaxation, thus producing a bronchodilatory effect.

Clinical use

Indications

Tiotropium is indicated as a daily, 24 hour, maintenance treatment of chronic obstructive pulmonary disease (COPD).

Adverse effects

Adverse effects are mainly related to its antimuscarinic effects. Common adverse drug reactions (≥1% of patients) associated with tiotropium therapy include: dry mouth and/or throat irritation. Rarely (<0.1% of patients) treatment is associated with: urinary retention, constipation, acute angle closure glaucoma, palpitations, and/or allergy (rash, angioedema, anaphylaxis) (Rossi, 2006). A study of more than 15,000 patients published in the Journal of the American Medical Association has linked tiotropium and another member of its class ipratropium to increased risk of heart attacks, stroke and cardiovascular death (Singh, 2008)

References

  • Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006
  • Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and the risk of major adverse cardiovascular events. JAMA 2008;300(12)1439-1450.

See also

Image collection

Front view
File:Tiocap.png
A previously pierced Spiriva capsule
File:SP2.png
Open (cleaning) view
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