Brands of tiotropium
This list is not intended to be exhaustive.
Inhaled: Acopair®, Braltus®, Spiriva®, Tiogiva®
Inhaled (combination product, with beta-2 adrenoceptor agonist): Yanimo®
Issues for surgery
For asthma and chronic obstructive pulmonary disease (COPD) – increased risk of exacerbation if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue (including combination products).
Combination product: Tiotropium and olodaterol - see Olodaterol monograph.
There are a number of inhaled preparations which contain tiotropium, either as single agents or in combination products with beta-2 adrenoceptor agonist – all of these can be continued pre-operatively. Check active ingredients of currently available preparations in British National Formulary.
Advise patients who are prescribed regular inhaled antimuscarinics but do not usually take them regularly to do so pre-operatively to optimise breathing prior to anaesthesia.
Confirm the inhaler brand, device, and strength with the patient.
Post-operative advice
Restart post-operatively as soon as next dose is due.
If patients are unable to resume their usual inhaled medication post-operatively consider nebulised ipratropium if clinically appropriate.
Interactions with common anaesthetic agents
Antimuscarinic action
The antimuscarinic action of tiotropium may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium. Concomitant administration of inhaled antimuscarinics with other medication known to have antimuscarinic effects has not been studied and is therefore not recommended by the manufacturers; however, in practice monitor patient for adverse effects.
Interactions with other common medicines used in the perioperative period
Antimuscarinic action
Antiemetics
The antimuscarinic action of tiotropium may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine.
Nefopam
The antimuscarinic action of tiotropium may be additive with nefopam which also has antimuscarinic effects.
Concomitant administration of inhaled antimuscarinics with other medication known to have antimuscarinic effects has not been studied and is therefore not recommended by the manufacturers; however, in practice monitor patient for adverse effects.
Further information
None relevant.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 4th February 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 4th February 2021]
Summary of Product Characteristics – Spiriva® 18 microgram inhalation powder, hard capsule (aclidinium) Genuair 322 micrograms inhalation powder. Boehringer Ingelheim Limited. Accessed via www.medicines.org.uk 04/02/2021 [date of revision of the text January 2019]