Tiotropium bromide

Tiotropium bromide, sold under the brand name Spiriva among others, is a long-acting bronchodilator (LAMA: long acting muscarinic antagonist) used in the management of chronic obstructive pulmonary disease (COPD) and asthma.^[10][11] Specifically it is used during periods of breathing difficulty to prevent them from getting worse, rather than to prevent them from happening.^[10] It is used by inhalation through the mouth.^[10] Onset typically begins within half an hour and lasts for 24 hours.^[10]

Common side effects include a dry mouth, runny nose, upper respiratory tract infection, shortness of breath and headache.^[10] Severe side effects may include angioedema, worsening bronchospasm, and QT prolongation.^[10] Tentative evidence has not found harm during pregnancy, however, such use has not been well studied.^[1] It is an anticholinergic medication and works by blocking acetylcholine action on smooth muscle.^[10]

Tiotropium was patented in 1989, and approved for medical use in 2002.^[12] It is on the World Health Organization's List of Essential Medicines.^[13] In 2022, it was the 154th most commonly prescribed medication in the United States, with more than 3 million prescriptions.^[14][15]