Spiriva, capsules with powder for inhalations. Spiriva: Instructions for the use of capsules and solution IPRATRUPIA Bromide 18 μg Instructions for use

Recipe (international)

RP: Tiotropii Bromidi 0.000018
D.T.D: №30 IN CAPS.
S: For inhalations through the aircase 1 capsule 1 time per day

Recipentar Blank - 107-1 / U (Russia)

pharmachologic effect

Cholinolitic, bright means. As a result of inhibiting M3 receptors in respiratory tract is relaxing smooth muscles Bronchi. High affinity for receptors and slow dissociation from M3 receptors cause a pronounced and long-lasting bright effect local application In patients with COPD.

In the inhalation method of administration, the absolute bioavailability of tyotropy bromide is 19.5%. Due to the chemical structure (quaternary ammonium compound), tyotropia Bromide is poorly absorbed from the gastrointestinal tract. For the same reason, food intake does not affect the bromide tiotropium absorption. The maximum concentration in blood serum after the inhalation of the powder at a dose of 18 μg is achieved after 5 minutes and is in patients with COPD 17-19 pg / ml, an equilibrium concentration in the blood plasma -3-4 pg / ml. Bonding with blood plasma proteins 72%, distribution volume - 32 l / kg. Does not penetrate the BC. Biotransformation is insignificant, which is confirmed by the fact that after a / in the administration of the drug, 74% of unchanged tiotropia is found in the urine in the urine. Tiotropi is cleaved by a non-enzyme method to alcohol N-methylskopin and dietienglycolic acid, which are not associated with muscarinic receptors. Even in ultra-high doses of tiotropia, it does not curb cytochrome P450, 1A1, 1A2, 2B6, 2C9, 2C19, 2D6, 2E1 or 3A in human liver microsomes.

After inhalation, the terminal half-life is 5-6 days, is excreted by the kidneys (14% dose), the rest of the inesecanic in the intestine - with the feces.
The bright effect is a consequence of local, rather than a systematic action, depends on the dose and remains at least 24 hours. The use of tiotropia significantly improves the function external breathing After 30 minutes after one-time inhalation, for 24 hours. The equilibrium state was achieved during the first week, and the expressed bright effect was observed on the 3rd day.
The assessment of the bridal effect during the year did not reveal the manifestation of tolerance. Reduces the number of exacerbations of COPD, increases the period until the first exacerbation compared with placebo, improves the quality of life throughout the entire period of treatment, reduces the number of hospitalization cases associated with exacerbation hobl and increases the time until the first hospitalization.

Mode of application

For adults: Inhalation with the help of a special inhaler, 1 capsule per day at the same time. Capsules should not swallow. Elderly people, patients with impaired kidney or liver function can apply the drug in recommended doses.

Indications

As supporting therapy in patients with COPD, including chronic obstructive bronchitis and emphysee (with the continuing shortness of breath and to prevent exacerbations).

Contraindications

increased sensitivity to tiotropia Bromide, as well as to atropyne or its derivatives (for example, and oxytropy), I trimester of pregnancy, age up to 18 years.

Side effects

From the head of the gastrointestinal bodies - dryness in the mouth (usually a light degree of severity, often disappears during the continuation of treatment), constipation.
From the respiratory system: cough, local irritation, the development of bronchospasm is possible, as well as when receiving other inhaled funds.

Others: Tachycardia, difficulty or retention of urination (in men with prostate gland hyperplasia), angioedema edema, fuzzy vision, acute glaucoma (associated with anticholinergic effect).

Form release

Capsules with powder for inhalation 1 caps., Tiotropia Bromide 18 μg (which corresponds to 22.5 μg Tiotropia monohydrate bromide), excipients:
lactose monohydrate
in the contour cellular package 10 pcs.; In a pack of cardboard 1, 3 or 6 packs complete with a chandihyer inhaler or without an inhaler.

ATTENTION!

Information on the page you will be viewed exclusively for informational purposes and does not promote self-treatment. Resource is intended to familiarize health officers with additional information About certain medications, thereby increasing their level of professionalism. The use of the drug "" necessarily provides for advice with a specialist, as well as its recommendations for the method of application and dosage of the medicine you have chosen.

Broncholic drug - Blocator M-cholinoreceptors

Active substance

Tiotropia Monohydrate Bromide (Tiotropium Bromide)

Release form, composition and packaging

Powder capsules for inhalation Solid gelatin, size number 3, light greenish blue color, opaque; with a symbol of the company and "TI 01", printed by black ink; Content capsules - white powder.

	1 caps.
tiotropia monohydrat bromide	22.5 μg,
what corresponds to the content of tiotropia	18 μg

Auxiliary substances: monohydrate lactose, 200 m - 5.2025 mg, micronized monohydrate lactose - 0.2750 mg.

The composition of the capsule (mg / capsule): Macroogol - 2.4000 mg, (E132) - 0.0120 mg, titanium dioxide (E171) - 1.0240 mg, iron oxide yellow (E172) - 0.0120 mg, gelatin - 44.5160 mg.

10 pieces. - Blisters (1) Complete with Handihaler® or without inhaler - Cardboard packs.
10 pieces. - Blisters (3) complete with Handihaler® or without inhaler - Cardboard packs.
10 pieces. - Blisters (6) Complete with Khandihaler® or without inhaler - Cardboard packs.

pharmachologic effect

Blocator M-cholinoreceptors of continuous action.

It has the same affinity for various subtypes of muscarinic receptors from M 1 to M 5. As a result of the inhibition of M 3-receptors in the respiratory tract there is a relaxation of smooth muscles. The bright effect depends on the dose and is preserved at least 24 hours. Significant duration of action is probably linked, with a very slow release due to M 3-receptors, compared with the bromide and the bromide. With the inhalation administration of tiotropia Bromide, as an anticholinergic agent of the N-quaternary structure, has a local electoral action, while in therapeutic doses does not cause systemic anticholinergic side Effects. The release of the tiotropium of bromide from communication with m 2 -receptors is faster than from m 3-receptors. High affinity for receptors and slow release due to them determine the intensive and long-lasting bright effect in patients with COPD.

Bromide thiotropic inhalation is a consequence of local, rather than a systematic action.

IN clinical studies It was shown that 30 minutes after single dose Spiriva for 24 hours significantly improves the function of the lungs (increasing FEV 1 and FERZ). Pharmacodynamic equilibrium was achieved during the 1st week, and a pronounced bright effect was observed on the 3rd day. Spiriva significantly increases the morning and evening peak streaming rate of exhalation, measured by patients. The armored effect of Spiriva, estimated throughout the year, did not reveal the manifestations of tolerance.

Spiriva significantly reduces his breath throughout the entire period of treatment. In two randomized double-blind placebo-controlled studies, it was proved that Spiriva significantly improved tolerability exercise compared with placebo.

Much improves the quality of life, which is observed during the entire period of treatment. Spiriva significantly reduces the number of hospitalization cases associated with the exacerbation of COPD, and increases the time until the first hospitalization.

It was also shown that Spiriva leads to a resistant improvement in FEV 1 after use for 4 years without changing the rate of annual decline in FEV 1.

During treatment, there is a decrease in the risk of death by 16%.

Compared to the reception of Salmetherol, the use of the drug Spiriv increases the time to the first exacerbation (187 days against 145), with a decrease in the risk of developing exacerbations by 17% (risk ratio 0.83; 95% confidence interval [di], from 0.77 to 0.90;<0.001). Также прием препарата Спирива увеличивает время наступления первого тяжелого (требующего госпитализации) обострения (отношение рисков 0.72; 95% ДИ от 0.61 до 0.85; Р<0.001) снижает ежегодное число средних или тяжелых (требующих госпитализации) обострений (0.64 против 0.72; отношение рисков 0.89; 95% ДИ от 0.83 до 0.96; Р=0.002), снижает ежегодное число тяжелых (требующих госпитализации) обострений (0.09 против 0.13; отношение рисков 0.73; 95% ДИ от 0.66 до 0.82; Р<0.001).

Pharmacokinetics

Tiotropia Bromide is a quaternary ammonium compound, moderately soluble in water.

Tiotropia Bromide has linear pharmacokinetics in the therapeutic limits after in / in the introduction and inhalation of dry powder.

Suction

In the inhalation administration, the absolute bioavailability of tyotropy bromide is 19.5%, which indicates a high bioavailability of the fraction of the drug achieving the lungs. C Max in the blood is achieved in 5-7 minutes after inhalation. Tiotropia Bromide is poorly absorbed from the gastrointestinal tract. For the same reason, food intake does not affect tiotropium absorption. When taking inside the tiotropium of bromide in the form of a solution, absolute bioavailability was 2-3%.

Distribution

Binding with plasma proteins - 72%. V d - 32 l / kg.

In the equilibrium condition C Max in the blood plasma in patients with COPD is 12.9 pg / ml and is quickly reduced. This indicates a multi-category type of drug distribution. In the equilibrium state of C min Tiotropia in the blood plasma is 1.71 pg / ml.

Does not penetrate the BC.

Metabolism

The degree of biotransformation is insignificant. This is confirmed by the fact that after the drug introduction to young healthy volunteers in the urine, 74% of the unchanged substance is found.

Tiotropia Bromide is cleaved by the neopenmen to alcohol-N-methylskopin and dietiumylglycolic acid, which are not associated with muscarinic receptors.

During the studies, it is shown that the drug (<20% от дозы после в/в введения) метаболизируется при участии изоферментов цитохрома P450, путем окисления и последующей конъюгации с глутатионом с образованием различных метаболитов. Нарушение метаболизма может иметь место при использовании ингибиторов CYP2D6 и CYP3А4 (хинидина, и гестодена). Таким образом, изоферменты CYP2D6 и CYP3А4 включаются в метаболизм препарата.

Election

T 1/2 Tiotropia after inhalation varies from 27 to 45 hours. General clearance when introducing young healthy volunteers is 880 ml / min. Tyotropi after a / in administration is mainly excreted by the kidneys unchanged (74%). After the inhalation of dry powder in an equilibrium state, renal excretion is 7% per day from the dose, the remaining non-discovered part is excreted through the intestine. Kidney clearance tiotropia exceeds creatinine clearance, which indicates the channel secretion of the drug. After a long-term intake of the drug once a day with COPD patients, pharmacokinetic equilibrium is achieved on day 7, while no cumulation is observed.

Pharmacokinetics in special groups of patients

Elderly patients there is a decrease in the renal clearance of Tiotropia (365 ml / min in patients with COPD under 65 years old, up to 271 ml / min in patients with COPD over 65 years old). These changes did not lead to an appropriate increase in the values \u200b\u200bof AUC 0-6 or C MAX.

In patients with COPD and light impairment of kidney function (KK 50-80 ml / min), the inhalation use of tiotropium 1 time / day in equilibrium condition led to an increase in the value of AUC 0-6 by 1.8-30%. The value C MAX was preserved in the same way as in patients with normal kidney function (QC\u003e 80 ml / min). In patients with COPD and medium or heavy impaired kidney function (QC< 50 мл/мин) в/в введение тиотропия приводило к двукратному увеличению концентрации препарата в плазме (значение AUC 0-4 ч увеличивалось на 82% а значение C max увеличивалось на 52%) по сравнению с пациентами с ХОБЛ и нормальной функцией почек. Аналогичное повышение концентрации тиотропия в плазме отмечалось и после ингаляции сухого порошка.

It is assumed that it will not have a significant effect on the pharmacokinetics of the Tiotropia of the bromide, because The drug is mainly derived from the urine and the formation of pharmacologically active metabolites is not associated with the participation of enzymes.

Indications

• as supporting therapy in patients with COPD, including chronic bronchitis and emphysee (supporting therapy under the continuing shortness of breath and to prevent exacerbations).

Contraindications

• I trimester of pregnancy;
• children's and teenage age up to 18 years;
• increased sensitivity to or its derivatives (including to ipratopia and oxytropy);
• increased sensitivity to the components of the drug.

Carefully The drug should be used with the closed-curved glaucoma, prostate hyperplasia, the obstruction of the neck of the bladder.

Dosage

Assign 1 caps. / Day at the same time in the form of inhalation using the Handihaler inhaler.

The drug should not swallow. Spiriva should not be used more often than 1 time / day. Spiriva capsules should be applied only with Handihaler inhaler.

Elderly patients The drug should be taken in the recommended doses.

For violations of kidney function Patients can apply Spiriva preparation in recommended doses. However, it is necessary to carefully monitor patients with moderate or severe Receiving the preparation of Spiriva (as in the case of other drugs that excreted mainly kidneys).

Patients with hepatic insufficiency Can take the drug in recommended doses.

How to use inhaler Handihaler

The Handihaler inhaler is designed specifically for the use of Spiriva and is not intended to receive other drugs. The patient can use his Handihaler for one year.

The inhaler includes: dust cap, mouthpiece, base, piercing button, central chamber.

Using the Handihaler inhaler:

1. Open the dust cap by clicking on the piercing button completely and then released.

2. Fully open the dust cap, lifting it up; Then open the mouthpiece by lifting it up.

3. Immediately before use, get a spiries capsule from a blister and put it in the central chamber (it does not matter which side of the capsule is placed in the chamber).

4. Close the mouthpiece tightly until it clicks, dustproof cap leave open.

5. Holding the Handihaler mouthpiece up, press the piercing button once to the end and then release; Thus, a hole is formed through which the drug is released from the capsule during the inhalation.

6. Fully exhale; Never exhale in the mouthpiece.

7. Take the handihaler in the mouth and tightly squeeze the lips around the mouthpiece; Holding your head straight, you should inhale slowly and deep, but at the same time with enough power to hear or feel the vibration of the capsule; do inhale to complete lung fill; Then delay the breath as long as possible and take out Handihaler from the mouth; continue to breathe calmly; Repeat procedures 6 and 7 for complete devastation of the capsule.

Cleaning inhaler Handihaler.

Cleaning Handihaler should be carried out once a month. To do this, open the mouthpiece and dust cap, then open the base of the instrument by lifting the piercing button. Wash inhaler thoroughly in warm water until the powder is completely removed. Handihaler should be wiped with a paper towel and with an open mouthpiece, the base and dust cap leave to dry in the air for 24 hours. After cleaning, the device is ready for subsequent use. If necessary, the outer surface of the mouthpiece can be cleaned with a wet, but not wet fabric.

Opening blister

Separate a blister strip along the perforated line. Open the blister strip immediately before use so that one capsule is completely visible. The capsule contains a small amount of powder, so it is not completely filled.

In the event that the capsule was accidentally opened and exposed to air, it should not be used. Neither in the device, nor in the blister capsules should not be exposed to high temperatures, the effects of sunlight.

Side effects

From the metabolism:dehydration*.

From the digestive system:often (≥1% and<10%) – сухость во рту обычно легкой степени выраженности; нечасто (≥0.1% и <1%) , запор, гастроэзофагеальный рефлюкс; редко (≥0.01% и <0.1%) – кандидоз ротоглотки, гингивит, глоссит; кишечная непроходимость, включая паралитический илеус, дисфагия.

From the respiratory system:infrequently (≥0.1% and<1%) - дисфония, кашель, фарингиты; редко (≥0.01% и <0.1%) – пародоксальный бронхоспазм, ларингиты, синуситы, носовое кровотечение.

From the side of the cardiovascular system:infrequently (≥0.1% and<1%) - мерцательная аритмия; редко (≥0.01% и <0.1%) – тахикардия (включая суправентрикулярную тахикардию), ощущение сердцебиения.

From the urinary system:infrequently (≥0.1% and<1%) - затрудненное мочеиспускание и задержка мочеиспускания (у мужчин с предрасполагающими факторами), дизурия; редко (≥0.01% и <0.1%) - инфекции мочевыводящих путей.

Allergic reactions:infrequently (≥0.1% and<1%) - сыпь; редко (≥0.01% и <0.1%) - крапивница, зуд, реакции повышенной чувствительности, включая реакции немедленного типа, ангионевротический отек*.

From the side of the skin:skin infections and ulcers on the skin, dry skin *.

On the side of the musculoskeletal system:the edema of the joints *.

From the nervous system:infrequently (≥0.1% and<1%) - головокружение; редко - (≥0.01% и <0.1%) - бессонница.

From the body of the vision:infrequently (≥0.1% and<1%) - нечеткое зрение; редко - (≥0.01% и <0.1%) - повышение внутриглазного давления, глаукома.

* In the combined base of clinical studies, these adverse reactions were not detected; Only single reports of these adverse reactions are noted with a wide use of the drug, however, the connection with the M-choline-blocking effect of the Spiriva preparation is not proven; The frequency of these rare phenomena is difficult to assess.

Overdose

Symptoms: When using high doses, anticholinergic action is possible - dry mouth, accommodation violations, an increase in heart rate.

After the inhalation of a single dose to 282 μg in healthy volunteers did not identify systemic anticholinergic effects. After repeated reception of a single daily dose of 141 μg in healthy volunteers, bilateral conjunctivitis was observed in combination with dry mouth, which disappeared with the continuation of treatment. In the study, which studied the effects of tiotropium in repeated use in patients with COPDs received the maximum 36 μg of the drug for more than 4 weeks, dry mouth was the only side effect.

Acute intoxication associated with a random intake of capsules inside is unlikely due to the low bioavailability of the drug.

Medicinal interaction

It is possible to prescribe a Spiriva preparation in combination with other drugs, usually used for the treatment of COPD: sympathomimetics, methylxantine derivatives, oral and inhaled GKS. Co-use with durable beta 2 -agonists, inhalation GCS and their combinations do not affect tiotropia.

Limited information on co-use with anticholinergic preparations was obtained from two clinical studies: one-time dose of 1 dose of bromide ipratopia Against the background of permanent treatment of Spiriva in patients with COPD (64 people) and healthy volunteers (20 people) did not lead to a decrease in adverse reactions, change Life parameters and ECG. However, the constant combined use of anticholinergic preparations and the Spiriva preparation has not been studied and, therefore, is not recommended.

special instructions

The drug Spiriv is not intended to relocate sharp attacks of bronchospasm.

After the inhalation of Spiriva powder is possible the development of immediate-type hypersensitivity reactions.

The process of inhalation of spirits (like other inhalation drugs) can cause bronchospasm.

Patients with renal failure (QC ≤50 ml / min) When appointing Spiriva should be carefully observed.

Patients should be familiar with the rules for using the inhaler. Do not allow the powder into the eyes. Pain in the eyes or discomfort, blurred vision, visual halo in combination with redness of the eyes, conjunctival stagnation and edema cornea may indicate an acute attack of the closed gloomy. With the development of any combination of these symptoms, the patient must immediately consult a doctor. The use of only alone drugs is not an effective treatment in this case.

One capsule contains 5.5 mg of monohydrate lactose.

Impact on the ability to driving vehicles and control mechanisms

Research on the study of the effect of the drug on the ability to driving vehicles and the management of the mechanisms was not carried out. Cases of dizziness and fuzziness of vision When applying the drug can have a negative impact on the aforementioned ability.

Pregnancy and lactation

Data on the use of tiotropium during pregnancy in humans are limited. In animal studies, indications of direct or indirect adverse effects on pregnancy, the development of the embryo / fetus, the process of childbirth or postnatal development are not obtained.

As a precautionary measure, it is preferable to refrain from the use of the Spiriva preparation during pregnancy.

Clinical data on the use of Tiotropia in women, nursing breasts, is not available. In preclinical studies, data were obtained that, a small amount of tiotropium is excreted into breast milk.

Spiriva should not be applied in pregnant or nursing women, unless the expected benefits do not exceed the possible risk to the fetus or child.

Application in old age

Conditions of vacation from pharmacies

The drug is released by the prescription.

Terms and Storage Terms

The drug should be stored in an inaccessible place for children at a temperature not higher than 25 ° C; Do not freeze. Shelf life - 2 years.

After opening, the blister should be used within 9 days.

Medicine Medicine Instructions

Spiriva®

Tradename

Spiriva®

International non-proprietary title

Tiotropia bromide

Dosage form

Capsules with a powder for inhalations of 18 μg in a set of a syngulator Handihaler

One capsule contains

active substance - Tiotropia 18 μg

(equal to 22.5 μg of tiotropia monohydrate bromide),

the auxiliary substance is the lactose monohydrate (containing protein).

Description

Solid gelatin capsules, size 3, light greenish-bluing, opaque, with imprint of the company's symbol and Ti 01 inscriptions.

Content capsules - white powder.

Pharmacotherapeutic group

Other inhalation preparations for the treatment of obstructive diseases of the respiratory tract. Cholinoblocators.

ATC RO3BB04 code

Pharmacological properties

Pharmacokinetics

Tiotropia is a quaternary ammonium compound moderate in water.

Suction. With an inhalation method of administration, the absolute-capacity of tiotropia is 19.5%, indicating that the fraction preparation, reaching the lungs, is highly available. Based on the compound chemical structure, tiotropi is poorly absorbed from the gastrointestinal tract. For the same reason, food intake does not affect the absorption of tiotropia. Maximum concentration of tiotropium in the blood plasma after inhalation is achieved for 5 minutes.

Distribution. 72% of the adopted dose of the drug binds to the plasma rates and the distribution volume is 32 l / kg. At the dynamic substitution stage, the peak concentration of tiotropium in the blood plasma in patients with chronic protective pulmonary disease (COPD) is 17-19 pg / ml after 5 minutes of inhalation of powder in a dose of 18 μg and quickly decreases. At the stage of equilibrium interconnection in the blood plasma was 3-4 pg / ml. Tiotropi does not penetrate the hemate monohangephalical barrier.

Biotransformation. The degree of biotransformation is insignificant. Ntyotropy is cleaved by a peteral method to alcohol N-methylskopin idytiensyl glycolic acid, which are not associated with muscarinov-receptors.

The drug is metabolized by cytochrome P450, this process is process dependent on oxidation and subsequent conjugation with glutathyon with formation of various metabolites. Violation of metabolism can take place to use CYP 450 2D6 and 3A4 inhibitors (quinidine, ketoconazole ignition). Thus, CYP450 2D6 and 3A4 are included in the metabolism of the drug. Ntyotropi even in super-temperature concentrations does not inhibit cytochromer450, 1A1, 1A2, 2B6, 2C9, 2C19, 2D6, 2E1 or 3A in human liver microsomes.

Deletion. The terminal period of half-life thiotropia posting is 5-6 days. After the inhalation of the dry powder, the renal emission is 14% of the dose, the remaining non-absorbing part is excreted through the intestine. The kidney clearance of tiotropia exceeds Cleianskreatinin, which indicates the channel secretion of the drug. Furious treatment of the drug once a day with COPD patients, pharmacokinetic equilibrium is achieved after 2-3 weeks, while accumulating accumulation in the future.

Elderly patients

After inhalation, the excretion of tiotropia kidneys is reduced from 14% (healthy) to 7% (patients with COPD), however, the plasma concentration of significant is changing in elderly patients with COPD, if we take into account the ever-yvnutriditrial variability (43% increase in AUC0-4 after inhaled powder) .

Patients with impaired kidney function

As in the case of other means that excreted by the incent kidney, the decrease in the kidney function led to an increase in the concentration of the blood plasma and a decrease in the renal clearance after the inhalation transfer. With a light degree of decrease in the renal function (creatinine clearance 50-80ml / min), often observed in elderly patients, an increase in the concentration of tiotropic blood plasma is insignificant. In patients with COPD with medium or pronounced reduction of renal function (creatinine clearance< 50 мл/мин) послевнутривенного введения тиотропия наблюдалось двойное увеличение егоконцентрации в плазме крови (82 % повышение AUC0-4), по сравнению сконцентрациями в плазме крови, определяемыми после ингаляционного введениясухого порошка.

Patients with impaired liver function

It is assumed that hepatic insufficiency does not have a significant effect on tiotropia pharmacokinetics, since Tiotropiyv is mainly derived from the urine and the formation of pharmacologically non-optomethabolites is not associated with the enzyme process.

Pharmacodynamics

Spiriva - antimuskarin drug for continuing, in clinical practice is often referred to as anticholinergic care. It has the same affinity for various racks of muscarinovchetoceptors from M1 to M5. The result of the inhibition of M3 receptors in the respiratory path is the relaxation of smooth muscles. The bright effect depends on the maintenance and is saved at least 24 hours. A significant duration is valuable, probably with a very slow dissociation from M3 receptors, poisoning with the ipratropium. In the inhalation method of administration of tiotropium as a N-quaternaryanticholinergic agent, it has a local electoral effect, while the therapeutic doses does not cause systemic anticholinergic effects. The dissociation from M2 receptors is faster than from M3. High-fed to receptors and slow dissociation cause a pronounced and-air brightening effect in patients with a chronic prestructive pulmonary disease.

Browsing after tiotropia inhalation is a local, rather than the system effect.

Spiriva significantly increases the function of the lungs (of the total exhalation of 1 second (OFV1), the life capacity of the lungs (jerking) is 30 minutes after a single dose for 24 hours. Pharmacodynamic equilibrium was achieved during the first week, and the pronounced armored energy effect was observed on 3 days. Spiriva significantly increases the morning Ivelet peak streaming rate of exhalation, measured by patients. Bronating the effect of Spiriva, estimated throughout the year, not revealing tolerance.

Spiriva significantly reduces the number of exacerbations of COPD, and exists the period until the first exacerbation compared to placebo.

Spiriva significantly improves the quality of life. This is improved on the entire period of treatment.

It was shown that Spiriva significantly reduces the number of hospitalization associated with the exacerbation of COPD and increases the time of the first hospitalization domain.

Indications for use

treatment of hobl and chronic bronchitis and lung emphysema, accompanied by shortness of breath

Method of application and dose

Inhalation

When using Spiriva in the form of inhalations using inhalerAndihaler, it is recommended to use one capsule per day at the same time.

Capsules with the drug should not be swallow!

Elderly patients should take Spyriv in recommends.

Patients with impaired kidney function can use spiritualized doses. However, it is necessary to carefully monitor patients with a humble or severe renal failure by the receiving Spyriv (as well as luster with other drugs that are escruiting in the main kidney).

Patients with liver failure can take spiritualized doses.

No data on the use of Spiriva in newborns and children, the use of the drug in this age group is not recommended.

Instructions for the use of Spiriva

Please read these instructions and carefully.

Opening blister

Separate the blister strip along the perforated line.

Open the blister strip directly to running so that only one capsule is completely visible. In case the second capsule was accidentally opened (subjected to air acting) does not use it.

Get the capsule.

Neither in the device, nor in the blister capsules should not be exposed to high temperatures, i.e. The action of sunlight and others.

The capsule contains a small amount of powder - therefore it is not fully filled.

Instructions for the use of the device Khandichaler

The chandihaler device was specifically designed for Spiriva. Onne should be used to receive other medicines. You can use Handihaler for one year.

The device Handichaler includes:

1. Dustproof cap

2. MUNDSTUK

3. Base

4. Piercing button

5. Central Camera

Using the device Handichaler

Open the dust cap by pressing the piercing button completely and then released.

Completely open the dust cap, raising it up.

Then open the mouthpiece by lifting it up.

Capsula Spiriva from blister (directly to running use) and put it in the central chamber, as shown in the figure. There is no meaning of which side of the capsule is placed in the chamber.

Tightly close the mouthpiece until it clicks, the dust barcling leave open.

Holding a chandihaler mouthpiece up, press the piercing button only once and then let go.

Thus, a hole is formed through which the drug-coming from the capsule during the inhalation.

Fully exhale.

ATTENTION: Never exhale in the mouthpiece.

Take the chandihaler in the mouth and tightly squeeze the lips of the aroundMundstuk. Holding your head straight, inhale slowly and deep, but at the same time awarded force to hear or feel the vibration of the capsule. Make a breathtone of full filling of the lungs; Then hold the breath to the feeling of discomfort, while at the same time removing the Handichaler from his mouth. Continue to breathe calmly. Ratiateceraces 6 and 7, for complete devastation of the capsule

Open the mouthpiece again. Remove and diluted capsule. Close the mouthpiece and dust cap for the storage device of the Khandichaler.

Cleaning inhaler Handihaler spend once a month.

Open the mouthpiece and dust cap. Then open the device by lifting the piercing button. Thoroughly rinse the inhaler with heat water until the powder is completely removed. The chandihaler will be wrapped with a paper lump and leave to dry in the air with an open mouthpiece, the base of the tubing cap for 24 hours. After cleaning the instrument of the adoption, it will be ready for the next use. In the case of the necessary surface, the mouthpiece can be cleaned with a wet, but nemonary fabric.

Side effects

dry mouth (usually moderate), constipation

dehydration

candidiasis orofaringletal

gastroesophageal reflux

dispony, bronchospasm, cough, nasal bleeding

heartbeat, Tachycardia

difficult urination and urination delay (worm with predisposing factors), urinary tract infections, Dizuriy

rash, urticaria, itching, dry skin, hypersensitivity (initiation of immediate type)

dizziness, insomnia

fuzzy vision, increasing intraocular pressure

inflammation of the joints

In isolated cases

intestinal obstruction, including paralytic ileus, dysphagia

stomatitis, gingivitis, inflammation of the yoke

larygitis, pharyngitis, sinusitis

supported Tachycardia, Cleaning arrhythmia

angioedema swelling

skin infections and ulcers

glaucoma

Most of the above adverse reactions can be linted with the anticholinergic effect of Spiriva.

Contraindications

increased sensitivity to atropyne or its derivatives (for example, iptropy or oxytropy) or to other components of the drug (see "Composition")

I-th trimester of pregnancy

children's and teenage age up to 18 years

Medicinal interactions

The combined use of Spiriva with other antiholinergic materials is not recommended.

It is possible to use tiotropia in combination with enems, usually used for the treatment of COPD: sympathomimetics, methylksanthines, oral and inhalation glucocorticosteroids.

special instructions

Spiriva - as an armored tutor, used once a day for pretending treatment, should not be used as an initial therapypri of acute barks of bronchospasm, i.e. In urgent cases.

After the inhalation of Spiriva powder can develop the heightened sensitivity reactions.

Inhalation of the drug can lead to bronchospasm.

Patients with moderate or pronounced renal failure (creatinine clearance ≤ 50 ml / min) When taking Spiriva, it should be thoroughly flashing as necessary in other cases of prescribing drugs excreted mainly by the kidneys.

Patients must be familiar with the rules for using capsulespoil. Do not allow the powder into the eyes. Pain in the eye or Ph.D., fuzzy vision, visual halo in combination with redness of the eyes, conjunctival status and edema of the cornea may indicate a sharpness of the closed-coronal glaucoma. With the development of any combination of these symptoms, it will immediately turn to a specialist. The use of drugs, causing me, is not an effective method of treatment in this case.

Spiriva should not be used more often than once a day.

Spiriva Capsules should be applied only with the instrumentohandihaler!

Carefully

Clothing glaucoma, prostate hyperplasia, urinary bubble neck obstruction.

Pregnancy and lactation

Spiriva should be used by pregnant women (II and III-th trimesterbility) and nursing women, only if the expected uses any possible risk to the fetus or a newborn.

Features of the influence of the medicinal product on the ability to receive vehicles or other potentially hazardous mechanisms

Research has not been conducted to study such an influence. There is a taking place of dizziness and fuzziness of vision when taking the drug, caution should be taken.

Overdose

Symptoms - when using high doses, anticholinergichestivity is possible: dry mouth, accommodation violations, evaporation of heart rate frequency.

Treatment is symptomatic.

However, systemic antiholinergic side effects were unlikely after a single inhalation dose to 282 μg of Tiotropia.

Bilateral conjunctivitis in combination with dryness in the mercinated after repeated reception of a single daily dose of 141 μg, which is examined by continuing treatment. In patients with COPDs who received the maximum 33mkg of the drug for more than 4 weeks, dry mouth was the only side effect.

Acute inxication associated with a random intake of the capsuilt, unlikely due to the low bioavailability of the drug.

Result: positive feedback

Knows his business and performs

Advantages: Safely, effectively, it is addictive.

Disadvantages: price

The drug is very necessary and efficient. Two years ago, I stumbled, unsuccessfully fell and earned pneumothorax. Here since I started with my problems with the lungs. Naturally, he tried many inhalers for all time. Yes, some of them got out of me, temporarily true, others were given to the side, especially in the heart. Spirivo doctor prescribed relatively recently. This is a drug in the form of capsules, inside of which is a powder for inhalations. Also included in the inhaler itself. I take Spyriva daily in the morning. Thanks to this medicine, it is easier for me to breathe, no attacks of shortness of breath.

Result: neutral feedback

Not bad drug, but expensive.

Advantages: Comfortable, fast

Disadvantages: price

Assigned to me Spiriva. I have asthma, often choking. I will say honestly, that is expensive for him. He helped me, it became easier to breathe, and the cough disappeared, but there are medications cheaper with the same actions. Before that, I bought other cheaper, but apparently the body was used to, and nothing helped. The inhaler is very convenient. But after its use, I constantly arise dry mouth. As a result, refused him. The medicine is not bad if there is money. Not everyone can afford it. Well helps with chronic bronchitis, but if asthma, it is better to take another drug.

Result: negative feedback

Result: neutral feedback

Did not particularly help with bronchitis

Advantages: It became easier to breathe after inhalation

Disadvantages: not convenient to use, dry mouth

I had a cold in the bronchitis. Doctor appointed inhalation of Spiriva. Rather, he gave me this device, as it turned out later, in the pharmacy it is problematic to acquire it and expensive. Performed the procedure 1 time per day and did not feel such an effect in accelerating the recovery. The disease passed in a week, or in time it was time to recover, or other medicines helped, perhaps everything has worked in the complex, but still I would like a more speedy effect. From the sideings there was dry mouth, I really wanted to drink. The instructions read that the drug helps with asthma, perhaps this disease is more efficiently cured by this preparation.

Result: positive feedback

Short-lived tool

Advantages: Efficiency, there was no side

Disadvantages: expensive, cartridges are not separately sold separately

Strange story with this medicine in our pharmacies. Assigned it to me in the hospital to help in the fight against shortness of breath. It really acted well and I took it everywhere with me. But one day (rather soon) the cartridges ended. And when I went to the pharmacy to buy new, it turned out that new separately sold. It is necessary to buy the whole set, with an inhaler. What will come out expensive. And why do I need so many inhalers, do not dispersed their friends. Apparently, you will have to ask for me to offer another remedy, it is not ready to spend so much to spend regularly on the remedy for shortness of breath. Full set costs 2500 rubles so that you understand why I do not want to do this.

This article allows you to familiarize yourself with the instructions for the use of the drug. Spiriva. There are reviews of site visitors - consumers of this medicine, as well as the opinions of the doctors of specialists in the use of Spiriva in their practice. A big request to more actively add your reviews about the preparation: helped or did not help the medicine to get rid of the disease, which complications were observed and side effects, possibly not stated by the manufacturer in annotations. Analogs of Spiriva in the presence of available structural analogues. Use for the treatment of bronchial asthma, obstructive bronchitis in adults, children, as well as in pregnancy and breastfeeding.

Spiriva - Broncholic drug.

Tiotropia Bromide (active ingredient of the drug Spiriva) is a long-acting M-cholinoblocator. The drug has the same affinity for M1-M5 subtypes of muscarinic receptors. The result in the inhibition of M3 receptors in the respiratory tract is to relax a smooth muscles. The bright effect depends on the dose and is preserved at least 24 hours. Significant duration of action is probably due to a very slow dissociation of the drug from M3 receptors; The half-Dissociation period is significantly longer than that of the bromide ipratopia.

In the inhalation method of administering tiotropia Bromide, as a N-quaternary ammonium derivative, has a local electoral effect (on bronchi), while in therapeutic doses does not cause systemic M-choline-blocking side effects. The dissociation from M2 receptors occurs faster than from M3 receptors, which indicates the predominance of selectivity with respect to M3 subtype of receptors over M2 receptors. High affinity for receptors and slow dissociation of the drug due to receptors cause a pronounced and long-lasting bright effect in patients with chronic obstructive pulmonary disease (COPD).

Bromide thiotropic inhalation is a consequence of local, rather than a systematic action.

In clinical studies, it was shown that 30 minutes after a single dose of Spiriva for 24 hours significantly improves the function of the lungs (increasing FEV1 and Fire). Pharmacodynamic equilibrium was achieved during the 1st week, and a pronounced bright effect was observed on the 3rd day. Spiriva significantly increases the morning and evening peak streaming rate of exhalation, measured by patients. The armored effect of Spiriva, estimated throughout the year, did not reveal the manifestations of tolerance.

Spiriva significantly reduces the frequency of COPD exacerbations and increases the period until the first exacerbation compared to placebo. Much improves the quality of life, which is observed during the entire period of treatment. Spiriva significantly reduces the number of hospitalization cases associated with the exacerbation of COPD, and increases the time until the first hospitalization.

With a retrospective analysis of individual clinical studies, a statistically false increase was observed, compared with placebo, the number of deaths in patients with patients with impaired heart rhythm. However, these data are not statistically confirmed and may be associated with heart disease.

In clinical studies in patients suffering from bronchial asthma and continuing to test symptoms of the disease, despite supporting therapy inhalation glucocorticosteroid (GKS), incl. In combination with a long-acting Beta2-adrenoreceptor agonist, it was found that the addition of the drug Spyriv respirat to supporting therapy led to a reliable improvement in the function of the lungs compared to placebo, significantly reduced the number of serious exacerbations and periods of deterioration of the symptoms of bronchial asthma, increased the period before the first oncoming , led to a reliable improvement in the quality of life and an increase in the number of patients with a positive response to supporting therapy.

The bright effect of the drug remained for 1 year of application, the signs of addiction were not noted.

Structure

Tiotropia monohydrate bromide + excipients.

Pharmacokinetics

In the inhalation administration, the absolute bioavailability of tyotropy bromide is 19.5%, which indicates a high bioavailability of the fraction of the drug achieving the lungs. Tiotropia Bromide is poorly absorbed from the gastrointestinal tract. For the same reason, food intake does not affect tiotropium absorption. When taking inside the tiotropium of bromide in the form of a solution, absolute bioavailability was 2-3%. Does not penetrate the hematorencephalic barrier (GEB). The degree of biotransformation is insignificant. Tiotropia Bromide is cleaved by the neopenimensional pathway to alcohol N-methylskopin and dietienglycolic acid, which are not associated with muscarinic receptors. Violation of metabolism is possible when using inhibitors of CYP2D6 and 3A4 isoenzymes (quinidine, ketoconazole, gestode). Thus, CYP2D6 and 3A4 isoenzymes are included in the medication of the drug. Tiotropia Bromide Even in superhemeterate concentrations does not inhibit cytochrome P450 1A1, 1A2, 2B6, 2C9, 2C19, 2D6, 2E1 or 3A4 in human liver microsomes. Tiotropia Bromide after intravenous administration is excluded, mainly with urine unchanged - 74%. After the powder inhalation, the renal excretion is 14%, the rest, not attempted in the intestine, is excreted in the feces. After a long admission of the drug 1 time per day in patients with COPD, the equilibrium state of pharmacokinetic parameters is reached after 2-3 weeks, and the cumulation is not observed in the future.

Indications

• for supporting treatment for patients with COPD, chronic bronchitis, emphysemic lungs, for maintenance therapy with continued shortness of breath, to improve the quality of life, impaired due to COPD, to reduce the frequency of exacerbations;
• for additional supporting therapy in patients with bronchial asthma with persistent symptoms of the disease against the background of inthalation GKS, to reduce the symptoms of bronchial asthma, improving the quality of life and reduce the frequency of exacerbations.

Forms of release

Capsules with powder for inhalation of 18 μg.

The solution for inhalation with the Spiriva inhaler will respi.

Instructions for use and method of use

Capsules with powder

Assign 1 capsule per day at the same time in the form of inhalation using the Handihaler inhaler.

The drug should not swallow. Spiriva should not be used more often than 1 time per day. Spiriva capsules should be applied only with Handihaler inhaler.

In case of violations of the kidney function, patients can apply Spyriv in recommended doses. However, when the disposition is prescribed in combination with other drugs, which are derived mainly by the kidneys, monitoring the state of patients. Patients with renal failure of medium or severe (QC less than 50 ml / min) need careful observation.

Patients with liver failure can take the drug in recommended doses.

How to use inhaler Handihaler

The Handihaler inhaler is designed specifically for the use of Spiriva and is not intended to receive other drugs.

The inhaler includes: dust cap, mouthpiece, base, piercing button, central chamber.

Using the Handihaler inhaler

1. Open the dust cap by clicking on the piercing button completely and then released.
2. Fully open a dust cap, raising it up; Then open the mouthpiece by lifting it up.
3. Immediately before use, get a spiries capsule from a blister and put it in the central chamber (it does not matter which side of the capsule is placed in the chamber).
4. Tightly close the mouthpiece until it clicks, dustproof cap leave open.
5. Holding a handihaler mouthpiece up, press the piercing button once to the end and then release; Thus, a hole is formed through which the drug is released from the capsule during the inhalation.
6. Completely exhale; Never exhale in the mouthpiece.
7. Take the handihaler in the mouth and tightly squeeze the lips around the mouthpiece; Holding your head straight, you should inhale slowly and deep, but at the same time with enough power to hear the vibration of the capsule; do inhale to complete lung fill; Then delay the breath as long as possible and take out Handihaler from the mouth; continue to breathe calmly; Repeat procedures 6 and 7 for complete devastation of the capsule.
8. Next, you should open the mouthpiece again, get and throw away the used capsule. Close the mouthpiece and dust cap.

Cleaning inhaler Handihaler.

Cleaning Handihaler should be carried out once a month. To do this, open the mouthpiece and dust cap, then open the base of the instrument by lifting the piercing button. Wash inhaler thoroughly in warm water until the powder is completely removed. Handihaler should be wiped with a paper towel and with an open mouthpiece, the base and dust cap leave to dry in the air for 24 hours. After cleaning, the device is ready for subsequent use. If necessary, the outer surface of the mouthpiece can be cleaned with a wet, but not wet fabric.

Opening blister

Separate a blister strip along the perforated line. Open the blister strip immediately before use so that one capsule is completely visible. The capsule contains a small amount of powder, so it is not completely filled.

In the event that the capsule was accidentally opened and exposed to air, it should not be used. Neither in the device, nor in the blister capsules should not be exposed to high temperatures, the effects of sunlight.

In the treatment of bronchial asthma, the full therapeutic effect occurs in a few days.

In elderly patients, patients with violations of the liver and patients with insignificant impairment of the kidney function (KK 50-80 ml / min), you can use the preparation of Spiriva respirat in the recommended dose.

However, the use of the drug in patients with moderate or significant violations of the kidney function (QC is less than 50 ml / min) should be carefully monitored.

COPD is usually not found in children. The safety and efficacy of the use of the drug Spiriva respirats in children were not studied.

Rules of application of the inhaler Spiriv Respimat

Inserting cartridge and preparation for use

Before the first use of the inhaler, it is necessary to carry out the actions below:

1. When the green cap is closed, press the lock button and simultaneously remove the transparent sleeve by pulling it down.
2. Remove the cartridge from the package. Insert it with a narrow end in the inhaler before fixing. To make sure that the cartridge is fully inserted, it is necessary to strongly press the cartridge on a solid surface. In this case, the bottom of the cartridge should not be on the same level with the lower edge of the inhaler, the lower part of the silver cartridge must be visible. After the cartridge is inserted into the inhaler, it should not be removed.
3. Dress over a transparent sleeve again. After that, the sleeve should not be removed anymore.

Preparations for the first use of the inhaler Spiriv Respimat

1. You should keep the Spiriva inhaler will respimatically vertically with a dressed green cap. You need to turn the transparent sleeve in the direction of the red arrows specified on the label, before clicking (half turn).
2. Remove the green cap.
3. Send Spiriva inhaler respipped down. Press the dose feed button. Close the green cap.

Stages A, B and C should be repeated until an aerosol cloud appears.

Then repeat the steps a, b and c another 3 times to ensure the preparation of the inhaler for use.

Now the Spiriv inhaler respirate is ready for use.

The implementation of these stages does not reduce the number of doses of the drug. After preparation, the Spiriva inhaler respipped allows you to free up 30 doses (60 inhalations).

Using Spiriva inhaler Respimat

You should use this inhaler only 1 time per day. Every time you need to make 2 inhalations.

1. Keep the Spiriva inhaler respipped vertically with a dressed green cap to prevent the random release of the medicine. Rotate the transparent sleeve in the direction of the red arrows indicated on the label, before clicking (half turn).

2. Remove the green cap. Exhale slowly and deep. End tight lips close mouthpiece. The inhaler's air hole should be free. Direct the inhaler to the back of the throat.

During a slow and deep breath through the mouth, press the dose button and continue inhale as long as possible. Hold your breath for 10 seconds or so long as convenient.

3. Repeat steps 1-2 to get a full dose. You should use this inhaler only 1 time per day. Every time you need to make 2 inhalations.

Close the green cap of the inhaler before it is applied.

If the Spiriva inhaler respirates did not use more than 7 days, it should be directed before applying down and press 1 time on the dose button. If the inhaler was not used more than 21 days, repeat the steps 4-6 before the aerosol cloud is obtained. Then repeat the steps 4-6 three more times.

Determining the moment when you need to start using a new inhaler

Spiriva inhaler Respimates contains 30 doses (60 inhalations). The dose index shows how much about the drug is still left. When the inhaler pointer will show on the red scale of the scale, this means that the medications remained about 7 days (14 inhalations). At this time period, you need to get a recipe for a new Spiriva inhaler respirat.

When the inhaler index reaches the end of the Red Scale region (i.e., when 30 doses were used), this means that the Spiriva inhaler respipped is empty. There will be automatic blocking of the inhaler. From this point on, the turn of the transparent sleeve will be impossible.

After the first use, the Spiriva inhaler respipped should be disposed of no later than 3 months, even if not all the amount of medication was applied.

Caring for the inhaler

The mouthpiece and metal part of the sprayer must be cleaned with a damp soft tissue napkin, at least 1 time per week.

A small discoloration of the mouthpiece does not affect the functioning of the inhaler. If necessary, wipe the inhaler also outside the wet fabric napkin.

Side effect

• dehydration;
• dizziness;
• insomnia;
• an increase in intraocular pressure, glaucoma;
• fuzzy vision;
• cleaning arrhythmia;
• tachycardia (including reductricular tachycardia);
• feeling of heartbeat;
• cough;
• nose bleed;
• pharyngitis;
• dysphonia;
• paradoxical bronchospasm;
• laryngitis;
• sinusitis;
• minor transient dryness of the mucous membrane of the pharynx;
• constipation;
• candidiasis of the oral cavity;
• dysphagia;
• gastroesophageal reflux;
• gingivitis;
• glossitis;
• stomatitis;
• intestinal obstruction, including paralytic intestinal obstruction;
• skin infections and ulcers on the skin;
• dry skin;
• rash;
• angioedema edema;
• hives;
• hypersensitivity, including immediate-type reactions;
• swelling of the joints;
• dysuria;
• urine delay (more often in men with presence of predisposing factors);
• urinary tract infection.

Contraindications

• 1 trimester of pregnancy;
• children's and adolescent age up to 18 years (due to the lack of data on efficiency and safety);
• hypersensitivity to atropyne or its derivatives, for example, a bromide and an oxytropy of bromide or to any component of the drug.

With caution, the drug should be used with the closed-curved glaucoma, prostate hyperplasia, the obstruction of the bladder cervix.

Application in pregnancy and breastfeeding

The drug is contraindicated to use in 1 trimester of pregnancy.

In 2 and 3 trimesters of pregnancy and during lactation, the drug should be prescribed only in cases where the expected benefit of therapy for the mother exceeds the potential risk to the fetus or infant.

Data on the effect of the drug Spiriva for pregnancy is limited. When studying reproductive toxicity on animals, indications of direct or indirect adverse effects of the drug were not obtained. As a precautionary measure, it is preferable to refrain from the use of the Spiriva preparation during pregnancy.

There is no clinical data on the influence of the tiotropium of bromide during breastfeeding period.

Application in children

Contraindicated appointment to children and adolescents under the age of 18.

Application in elderly patients

Elderly patients should take the drug in recommended doses.

special instructions

The drug Spiriv is not intended to relocate sharp attacks of bronchospasm.

After the inhalation of Spiriva powder is possible the development of immediate-type hypersensitivity reactions.

The process of inhalation of spirits (like other inhalation drugs) can cause bronchospasm.

Patients with renal failure (QC less than 50 ml / min) When appointing Spiriva should be carefully observed.

Patients should be familiar with the rules for using the inhaler. Do not allow the powder into the eyes. Pain in the eyes or discomfort, blurred vision, visual halo in combination with redness of the eyes, conjunctival stagnation and edema cornea may indicate an acute attack of the closed gloomy. With the development of any combination of these symptoms, the patient must immediately consult a doctor. The use of only alone drugs is not an effective treatment in this case.

One capsule contains 5.5 mg of monohydrate lactose.

The drug Spiriv will respimatizer, as a broutine, used 1 time per day for supporting treatment, should not be used as initial therapy during acute barks of bronchospasm or to eliminate acute symptoms. In the case of the development of acute attack, high-speed beta2 agonists are used.

The preparation of Spyriv Respimates should not be used to treat bronchial asthma as therapy of the first line. Patients should be recommended against the background of the preparation of the Spiriva preparation will continue anti-inflammatory therapy (for example, inhalation GKS), even if the symptoms decrease.

After applying the drug, immediately increased sensitivity reactions may develop.

Spiriva respirat should not be used more often than 1 time per day.

Spiriva cartridges should only be used with the respirat inhaler.

Impact on the ability to driving vehicles and control mechanisms

Research on the study of the effect of the drug on the ability to driving vehicles and the management of the mechanisms was not carried out. Cases of dizziness and fuzziness of vision When applying the drug can have a negative impact on the aforementioned ability.

Medicinal interaction

Although the special research of drug interaction was not carried out, Tiotropia Bromide was used in conjunction with other drugs used to treat COPD, including sympathomometric broutine, methylxantins, GCS for intake and inhalation use, antihistamines, musolics, leukotriene modifiers, cromons, anti-IgE drugs; In this case, clinical signs of drug interaction were not observed.

Long-term joint use of bromide tiotropium with other M-choline-blocking drugs has not been studied. Therefore, the long-term joint use of the Spiriva preparation respirat with other M-choline-blocking drugs is not recommended.

Analogs of the Drug Spiriva

Structural analogues for the acting substance:

• Spiriva respiration;
• Tiotropia monohydrad bromide.

Analogs in therapeutic effect (means for the treatment of chronic obstructive pulmonary disease):

• Ambroxol;
• Amoxiclav;
• Amoxicillin;
• Astmopent;
• ACS LONG;
• Beclomeletazone;
• BenaCort;
• Brillide;
• Budesonide;
• Vicef;
• Daksas;
• Doxycycline;
• Imunofan;
• Ipramol;
• IPratropium;
• Clenbuterol;
• Codela Croncho;
• Landacin;
• Likopid;
• Natsef;
• Orifim;
• Perch;
• Ploksacin;
• Pizillin;
• Pulmikort Turbukhaler;
• Bulk;
• Salamol eco light breathing;
• Salbutamol;
• Symbicort Turbukhaler;
• Spiriva respiration;
• Super;
• Tazocin;
• Tarcefandol;
• Tarcephoxy;
• Tevacomb;
• Theophylline;
• Terceph;
• Flavmed;
• Flukoxacillin;
• FROMILID UNO;
• Halixol;
• Cefalaball;
• Ceftriaball;
• Cyclocaps cybutol;
• Ciprofloxacin;
• Erdomed.

In the absence of analogues of drugs on the active substance, you can follow the links below on the disease, which helps the appropriate drug, and see the analogues on therapeutic effects.