Uses of Triomid: - Chronic obstructive pulmonary disease (COPD) - Asthma Triomid is indicated for the long term once daily maintenance treatment of bronchospasm and dyspnoea associated with, chronic obstructive pulmonary disease (COPD), including, chronic bronchitis and emphysema. Hypersensitivity to atropine and its derivatives (e.g. ipratropium).

Anticholinergic bronchodilators

Tiotropium is a long-acting, antimuscarinic agent, which is often referred to as an anticholinergic. It has similar affinity to the subtypes of muscarinic receptors, M1 to M5. In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilation. The competitive and reversible nature of antagonism was shown with human and animal origin receptors and isolated organ preparations. In preclinical in vitro as well as in vivo studies, prevention of methacholine-induced bronchoconstriction effects was dose-dependent and lasted longer than 24 hours. The bronchodilation following inhalation of Tiotropium is predominantly a site-specific effect.

How to use Tiotropium: Rotacaps must not be swallowed. Check the label for directions before use. Place the capsule at the base of rotahaler, not in the mouthpiece. Twist the mouthpiece completely until your hear a click and breathe in deeply through the mouthpiece. Hold your breath for up to 10 seconds. If some powder remains in the rotahaler repeat the process. Adult Dose: Inhalation Chronic obstructive pulmonary disease Adult: As Inhaler: 2 puffs (18mcg) once daily. As inhalation cap: 1 cap (18 mcg) daily via inhaler device, at the same time each day. Child Dose: Inhalation Chronic obstructive pulmonary disease Child> 12 years: As Inhaler: 2 puffs (18mcg) once daily. Child> 18 years: As inhalation cap: 1 cap (18 mcg) daily via inhaler device, at the same time each day. Renal Dose: Renal impairment: CrCl (ml/min) Dosage Recommendation <50 Use w/ caution.

Other anticholinergic agents.

Hypersensitivity to atropine and its derivatives (e.g. ipratropium).

Common - Blurred vision - Increased heart rate - Dryness in mouth - Upper respiratory tract infection - Constipation >10% Upper respiratory tract infection (41%),Dry mouth (16%),Sinusitis (11%) 1-10% Abdominal pain,Allergic reaction,Angina pectoris (including aggravated angina pectoris),Cataract,Chest pain (nonspecific),Constipation,Depression,Dyspepsia,Dysphonia,Edema,Epistaxis,Gastroesophageal reflux,Herpes zoster,Hypercholesterolemia,Hyperglycemia,Infection,Laryngitis,Leg pain,Moniliasis,Myalgia,Paresthesia,Pharyngitis,Rash,Rhinitis,Skeletal pain,Stomatitis (including ulcerative stomatitis),Urinary tract infection,Vomiting <1% Angioedema,Fibrillation,Supraventricular tachycardia,Urinary retention

Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women with Tiotropium. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. The safety and effectiveness of Tiotropium has not been studied during labor and delivery.

Precaution: Not intended for use as initial treatment for acute bronchospasm and as monotherapy for asthma. Patient w/ narrow-angle glaucoma, prostatic hyperplasia/bladder neck obstruction, cystic fibrosis. History of MI (<6 mth), or unstable or life threatening cardiac arrhythmia w/in the past yr. Moderate to severe renal impairment (CrCl ≤50 mL/min). Pregnancy and lactation. Patient Counselling This drug may cause dizziness and blurred vision, if affected, do not drive or operate machinery. Monitoring Parameters Monitor pulmonary function.

High doses of Tiotropium may lead to anticholinergic signs and symptoms. However, there were no systemic anticholinergic adverse effects following a single inhaled dose of up to 282 mcg Tiotropium in 6 healthy volunteers. In a study of 12 healthy volunteers, bilateral conjunctivitis and dry mouth were seen following repeated once-daily inhalation of 141 mcg of Tiotropium

Tiotropium Dry Powder Inhaler capsules must not be swallowed. Avoid storage in direct sunlight or heat. Store below 30°C. Keep away from children.

Anticholinergic bronchodilators

Tiotropium bromide, a long-acting quaternary ammonium antimuscarinic, is structurally related to ipratropium. It is a nonselective competitive antagonist of muscarinic (M1-M5) receptors and causes bronchodilation by inhibiting the actions of acetylcholine and other cholinergic stimuli at M3 receptors in the smooth muscle of the respiratory tract.

Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women with Tiotropium. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. The safety and effectiveness of Tiotropium has not been studied during labor and delivery.