Spiriva (tiotropium bromide)

Medically Reviewed By Dena Westphalen, Pharm.D.

About Spiriva

Spiriva HandiHaler and Spiriva Respimat* are brand-name prescription medications. They’re approved by the Food and Drug Administration (FDA) to treat the following conditions.

  • Asthma. Doctors prescribe Spiriva Respimat to treat asthma in adults and children ages 6 years and older. However, Spiriva HandiHaler is not approved for this use. Asthma is a lung condition that causes inflammation in the airways. Spiriva Respimat is used for the long-term treatment of asthma. This drug is not approved for the short-term relief of bronchospasm related to asthma. (Bronchospasm is the sudden tightening of the airways that can make it hard to breathe.)
  • Chronic obstructive pulmonary disease (COPD). Doctors prescribe Spiriva HandiHaler and Spiriva Respimat to treat COPD in adults. COPD is a group of lung conditions that reduce airflow to the lungs, making it hard to breathe. Spiriva HandiHaler and Spiriva Respimat are used for the long-term treatment of COPD. These drugs are also used to reduce the likelihood of a sudden COPD flare-up. (A flare-up is a period of worsening symptoms.) However, Spiriva HandiHaler and Spiriva Respimat are not approved for the short-term relief of COPD symptoms.

For more information about these conditions and how the drugs are used to treat them, see the “Spiriva: Uses” section below.

* Throughout this article, the term “Spiriva” is often used to describe both forms of the drug.

Key points

The following table provides key facts about Spiriva.

Active drug tiotropium bromide
Drug class anticholinergics
Forms • Spiriva HandiHaler: dry powder inhaler
• Spiriva Respimat: spray mist inhaler

Finding a healthcare professional

If you’re interested in taking these drugs, search here to find a doctor who might prescribe them.

Spiriva: Generic

Both Spiriva HandiHaler and Spiriva Respimat contain the active drug tiotropium bromide. They are only available as brand-name medications. They aren’t currently available as generic drugs.

A generic is an identical copy of the active drug found in a brand-name medication. Generics typically cost less than brand-name drugs.

Spiriva: Side effects

As with most drugs, it’s possible to have side effects with Spiriva. These can include some mild side effects but also some serious ones.

Side effects might differ slightly depending on the form of Spiriva used. They may also vary between people with asthma and people with chronic obstructive pulmonary disease (COPD).

To learn more about Spiriva’s side effects, talk with your doctor or pharmacist. They may also provide information about managing certain side effects of this drug.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Spiriva, you can do so through MedWatch.

Mild and serious side effects

Mild and serious side effects of Spiriva are listed below. This article does not include all of Spiriva’s possible side effects.

Mild side effects

Mild side effects* of Spiriva may include:

Most times, mild side effects of a drug go away within a few days or a couple of weeks. Talk with your doctor or pharmacist if any side effects become severe or don’t go away.

* This is not a complete list of Spiriva’s mild side effects. To learn about other mild side effects of this drug, ask your doctor or pharmacist. Or you can view the prescribing information for Spiriva HandiHaler and Spiriva Respimat.
† To learn more about allergic reaction, see below.

Serious side effects

Serious side effects of Spiriva may include:

Serious side effects from Spiriva aren’t common, but they are possible. If you have serious side effects, call your doctor right away. However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

* To learn more about allergic reaction, see below.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Spiriva. A more severe allergic reaction is rare but possible. However, this side effect was rare in clinical studies of Spiriva HandiHaler and Spiriva Respimat.

Possible symptoms of mild and serious allergic reactions are listed in the table below.

Mild allergic reaction symptoms Serious allergic reaction symptoms
flushing • swelling under your skin, possibly in your hands, feet, lips, or eyelids
rash • swelling in your throat or mouth
• itching trouble breathing

If you have an allergic reaction to Spiriva, call your doctor right away. This is important because the reaction could become severe.

However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Spiriva: Dosage

Below, you’ll find dosages that are commonly recommended for Spiriva. However, you should take the dosage your doctor prescribes for you. They’ll recommend the dosage that’s best for your needs.

The dosage of Spiriva that your doctor prescribes will depend on factors such as:

  • whether you use Spiriva HandiHaler or Spiriva Respimat
  • the condition you’re using Spiriva HandiHaler or Spiriva Respimat to treat

Spiriva’s forms and strengths

Spiriva is available as follows.

  • Forms:
    • Spiriva HandiHaler: dry powder inhaler, which comes as a powder inside a capsule that you’ll inhale using the HandiHaler device
    • Spiriva Respimat: spray mist inhaler, which comes as a liquid inside a canister and turns into a mist that you’ll inhale using the Respimat device
  • Strengths:
    • Spiriva HandiHaler: 18 micrograms (mcg) per capsule
    • Spiriva Respimat: 1.25 mcg and 2.5 mcg per inhalation*

* Each Spiriva Respimat device contains 60 inhalations. The device comes with a built-in dose indicator that tells you how many inhalations remain in the inhaler.

Spiriva’s recommended dosages

Recommended dosages for Spiriva in adults and children are described below.

Adult dosage

Spiriva Respimat is approved to treat asthma in adults. However, Spiriva HandiHaler is not approved for this use.

The recommended dosage of Spiriva Respimat for adults with asthma is as follows:

  • Dose: two inhalations of 1.25 mcg, for a total of 2.5 mcg
  • Frequency: once per day

Both Spiriva HandiHaler and Spiriva Respimat are approved to treat chronic obstructive pulmonary disease (COPD) in adults.

The recommended dosage of Spiriva HandiHaler for adults with COPD is as follows:

  • Dose: two inhalations of one 18-mcg capsule for a total of 18 mcg
  • Frequency: once per day

The recommended dosage of Spiriva Respimat for adults with COPD is as follows:

  • Dose: two inhalations of 2.5 mcg, for a total of 5 mcg
  • Frequency: once per day

Child dosage

Spiriva Respimat is approved to treat asthma in children ages 6 years and older. However, Spiriva HandiHaler is not approved for use in children.

The recommended dosage of Spiriva Respimat for children with asthma is as follows:

  • Dose: two inhalations of 1.25 mcg, for a total of 2.5 mcg
  • Frequency: once per day

Dosage considerations

Below are some things to consider about Spiriva’s dosage.

  • Missing a dose. If you miss a dose of Spiriva HandiHaler, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take your next one at its usual time. Do not take more than one dose of Spiriva HandiHaler in a 24-hour period. For Spiriva Respimat, the manufacturer hasn’t recommended what to do about a missed dose of the drug. If you miss a dose of Spiriva Respimat, talk with your doctor or pharmacist. They’ll recommend what to do. Try these medication reminder options to help avoid missing doses. You could also set an alarm, use a timer, or download a reminder app on your phone.
  • Length of treatment. Doctors typically prescribe Spiriva as a long-term treatment. You’ll likely take it long term if you and your doctor feel it’s safe and effective for your condition.

Spiriva: Alternatives

Doctors may prescribe drugs other than Spiriva for your condition. Certain drugs may work better for you than others.

Spiriva is used to treat asthma and chronic obstructive pulmonary disease (COPD) in certain people. Here are summaries of other drugs that doctors sometimes prescribe for asthma and COPD.

To learn more about some alternatives to Spiriva, view the following articles:

Your doctor can tell you about other similar drugs, such as:

For additional information about alternatives to Spiriva, ask your doctor. They can tell you about other medications that could be prescribed for your condition.

Spiriva: How to use

Your doctor will recommend how you should take Spiriva. It’s important to take the drug exactly as your doctor instructs.

Spiriva is available in two forms: Spiriva HandiHaler (a dry powder inhaler) and Spiriva Respimat (a spray mist inhaler).

How to use Spiriva HandiHaler

Spiriva HandiHaler is a dry powder inhaler. It comes as a powder inside a capsule. The HandiHaler device is used to break open the capsule. This allows the powder to be inhaled from the capsule using the HandiHaler device.

Your doctor or pharmacist will show you how to use Spiriva HandiHaler. You can also view these instructions.

How to use Spiriva Respimat

Spiriva Respimat is a spray mist inhaler. It comes as a liquid inside a canister. The Respimat device is used to turn the liquid into a mist. This mist is inhaled using the Respimat device.

Your doctor or pharmacist will show you how to use Spiriva Respimat. You can also visit the manufacturer’s website or view these instructions.

Questions about using Spiriva

Here’s a list of common questions related to taking Spiriva.

  • Should I use Spiriva in the morning or at night? Either option is fine. You can use Spiriva in the morning or at night. Try to take your doses around the same time each day. Taking Spiriva around the same time of day helps keep a steady level in your body. This helps the medication work effectively. Try these medication reminder options to help avoid missing doses of Spiriva. You could also set an alarm, use a timer, or download a reminder app on your phone.
  • Do I need to use Spiriva with food? You can use Spiriva with food or without it.
  • Is there a best time of day to use Spiriva? No, there isn’t a best time of day to use Spiriva. You can use Spiriva any time of day.

Spiriva: Uses

Prescription drugs, such as Spiriva, are approved by the Food and Drug Administration (FDA) to treat certain conditions.

Spiriva is available in two forms: Spiriva HandiHaler (a dry powder inhaler) and Spiriva Respimat (a spray mist inhaler). Each form of Spiriva may be used to treat different conditions. Keep reading to learn about the uses for each form of Spiriva.

Using Spiriva for asthma

The FDA has approved Spiriva Respimat to treat asthma in adults and children ages 6 years and older. However, Spiriva HandiHaler isn’t approved for this use.

Asthma is a lung condition that causes inflammation in the airways. This inflammation reduces airflow to the lungs and causes the symptoms of asthma. Examples of these symptoms include:

  • chest tightness
  • shortness of breath
  • cough
  • wheezing

Doctors prescribe Spiriva Respimat for the long-term treatment of asthma. However, this drug is not approved for the short-term relief of bronchospasm related to asthma. (Bronchospasm is the sudden tightening of the airways that can make it hard to breathe. This typically occurs during an asthma attack.) Spiriva should not be used as a rescue inhaler.

For short-term symptom relief, doctors may prescribe a rescue inhaler with Spiriva Respimat. To learn more, see “Using Spiriva with other drugs” below.

Using Spiriva for COPD

The FDA has approved Spiriva HandiHaler and Spiriva Respimat to treat chronic obstructive pulmonary disease (COPD) in adults.

COPD describes a group of lung conditions that includes long-term bronchitis and emphysema. These conditions reduce airflow to the lungs, which causes the symptoms of COPD. Examples of these symptoms include:

  • chest tightness
  • shortness of breath
  • long-term wet cough
  • wheezing
  • frequent chest infections, such as pneumonia

Doctors prescribe Spiriva HandiHaler and Spiriva Respimat for the long-term treatment of COPD. These drugs also reduce the likelihood of a sudden COPD flare-up. (A flare-up is a period of worsening symptoms.)

However, Spiriva HandiHaler and Spiriva Respimat are not approved for the short-term relief of COPD symptoms. Spiriva is not a rescue inhaler. For this use, doctors typically prescribe a rescue inhaler together with Spiriva. To learn more, see “Using Spiriva with other drugs” below.

Using Spiriva with other drugs

Doctors won’t prescribe Spiriva for the short-term relief of asthma or COPD symptoms. Instead, they’ll likely prescribe a rescue inhaler for this purpose.

A rescue inhaler is a drug that works quickly to increase airflow to the lungs. Examples include levalbuterol (Xopenex HFA) and albuterol (ProAir HFA, Proventil HFA, Ventolin HFA).

If you’d like to know more about using Spiriva with a rescue inhaler, talk with your doctor.

Using Spiriva in children

Spiriva Respimat is approved to treat asthma in children ages 6 years and older. For details about this condition, see “Using Spiriva for asthma” above.

Spiriva HandiHaler is not approved for use in children.

Finding a healthcare professional for Spiriva

If you’re interested in using Spiriva HandiHaler or Spiriva Respimat, you can find a doctor who might prescribe them by searching here. You can prepare for your appointment by visiting Healthgrades’ appointment guide for asthma or COPD.

Spiriva: Questions you may have

Here are some common questions about Spiriva and brief answers to them. If you’d like to know more about these topics, ask your doctor.

What’s to know about stopping Spiriva abruptly?

If you suddenly stop using Spiriva, watch for the symptoms of the condition you’re using it to treat.

Spiriva is a long-term treatment for asthma and chronic obstructive pulmonary disease (COPD). If you stop using it, symptoms of these conditions may return. (For examples of these symptoms, see “Spiriva: Uses” above.)

If you’d like to stop using Spiriva, talk with your doctor first. They can advise whether it’s safe to stop using it. If they tell you it’s safe, your doctor may switch you to a different treatment instead. Starting a new treatment after stopping Spiriva can lower the chances of your asthma or COPD symptoms returning.

Will Spiriva cure my condition?

No, it’s not likely. Doctors prescribe Spiriva to treat asthma and chronic obstructive pulmonary disease (COPD). Asthma and COPD are often long-term conditions. At this time, there isn’t a known cure for either condition.

Spiriva can help with the long-term management of asthma and COPD symptoms. To learn more about these conditions and how the drug is used to treat them, see the “Spiriva: Uses” section above.

Is Spiriva a steroid?

No, Spiriva is not a steroid. Instead, it belongs to a class of drugs called anticholinergics. The drug works by relaxing the muscles in your airway, making it easier for you to breathe.

Steroids are another group of drugs used to treat breathing conditions. In some cases, doctors may prescribe Spiriva in combination with steroids to reduce inflammation. However, steroids work differently than anticholinergic drugs.

If you have questions about how Spiriva and steroids are alike and different, talk with a doctor or pharmacist.

Spiriva: How it works

Spiriva is available in two forms: Spiriva HandiHaler (a dry powder inhaler) and Spiriva Respimat (a spray mist inhaler). 

Spiriva HandiHaler and Spiriva Respimat are approved to treat chronic obstructive pulmonary disease (COPD). Spiriva Respimat is also approved to treat asthma. These conditions are caused by inflammation of the airways and reduced airflow to the lungs. (To learn more about these conditions, see “Spiriva: Uses” above.)

Spiriva belongs to a class of drugs called anticholinergics. Its mechanism of action (how it works) is to relax the muscles around the airways. When these muscles are relaxed, your airway is able to expand. Having an expanded airway improves airflow to the lungs, which eases the symptoms of asthma and COPD. 

How long does Spiriva take to start working?

It may take several weeks for the symptoms of your condition to ease after starting Spiriva.

Spiriva: Consuming alcohol during treatment

Spiriva isn’t known to interact with alcohol. If you drink alcohol, talk with your doctor about an amount that’s safe to consume while using Spiriva.

Spiriva: Interactions

Spiriva may interact with other medications. However, the drug isn’t known to interact with supplements or foods.

Different interactions can cause different effects. Some interactions can interfere with a drug’s effectiveness. Others can increase a drug’s side effects or cause them to be severe.

Before you start Spiriva, be sure to tell your doctor about any medications, herbs, vitamins, or supplements you take. They can check for any possible interactions between these products and Spiriva.

If any of the interactions listed below might pertain to you, talk with your doctor. They can tell you what to do to avoid the interaction.

  • Spiriva and other anticholinergic drugs. Anticholinergics are used to treat numerous conditions. Examples include frequent urination, irritable bowel syndrome, and bladder spasms. Spiriva also belongs to this drug class. The drug’s manufacturer advises that Spiriva should not be taken with other anticholinergics. Be sure to talk with your doctor if these drugs have been prescribed together for you. Examples include:
    • oxybutynin (Ditropan XL, Oxytrol)
    • darifenacin (Enablex)
    • dicyclomine (Bentyl)
    • benztropine
    • hyoscyamine (Hyosyne, Levsin, others)
  • Spiriva and herbs and supplements. Spiriva isn’t known to interact with any herbs or supplements. If you have questions about taking specific supplements with Spiriva, talk with your doctor or pharmacist.
  • Spiriva and foods. There aren’t any known interactions between Spiriva and foods. If you have questions about eating certain foods with Spiriva, talk with your doctor or pharmacist.

For information about drug-condition interactions, see the “Spiriva: Precautions” section below.

Spiriva: Cost

As with other medications, prices for Spiriva may vary. The drug’s price will depend on factors such as:

Cost considerations for Spiriva

Here are some things to consider when looking into the cost of Spiriva.

Option for a 90-day supply. For some drugs, it’s possible to get a 90-day supply. If this option is approved by your insurance company, it can help lower the cost of the drug. It can also help you avoid frequent trips to your pharmacy. If you’d like to learn more about this option, ask your doctor, pharmacist, or insurance company.

Need for prior authorization. Before insurance coverage for Spiriva is approved, your insurance company may require prior authorization. In this case, your doctor and insurance company will communicate about your prescription for Spiriva. Then, the insurance company will decide if the drug will be covered. To find out if you need prior authorization for Spiriva, contact your insurance company.

Possible cost assistance options. Financial assistance to help lower the cost of Spiriva may be available. To learn more about support for Spiriva Respimat, visit the drug manufacturer’s website. For additional information on cost assistance, visit Medicine Assistance Tool’s website. Also, check out this article to learn about ways to save on prescription drugs.

Use of a mail-order pharmacy. Spiriva may be dispensed through mail-order pharmacies. Getting your prescription through a mail-order pharmacy could lower its cost. It can also allow you to get the drug without leaving home. To find out more about this option, check with your doctor, pharmacist, or insurance company.

Availability of a generic form. Spiriva HandiHaler and Spiriva Respimat do not come in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Typically, generics cost less than brand-name drugs.

Spiriva: Using while pregnant

It isn’t known whether Spiriva is safe to use during pregnancy. There haven’t been enough clinical studies of Spiriva HandiHaler and Spiriva Respimat in pregnant people to know for sure.

If you’re pregnant or planning a pregnancy, talk with your doctor before using Spiriva. They can advise you on the risks and benefits of Spiriva treatment during pregnancy.

Spiriva and birth control needs

Doctors aren’t sure whether it’s safe to take Spiriva during pregnancy. Talk with your doctor about your birth control needs with Spiriva if you’re sexually active and you or your partner can become pregnant. Your doctor can recommend if you should use birth control with this medication.

Spiriva: Using while breastfeeding

It isn’t known whether Spiriva passes into breast milk. It also isn’t known if the drug may cause side effects in a breastfed child.

Animal studies have shown that Spiriva can pass into the milk of lactating animals. Keep in mind that animal studies do not always reflect what happens in humans.

If you’re breastfeeding or planning to do so, talk with your doctor. They can discuss the risks and benefits of using Spiriva while breastfeeding. Your doctor can also suggest other healthy ways to feed your child during treatment with Spiriva.

Spiriva: Precautions

Tell your doctor about your health history before starting treatment with Spiriva. Your doctor may not recommend this medication if you have certain factors affecting your health or specific medical conditions. These situations are considered drug-condition interactions.

These factors and conditions include those listed below.

  • Problems with urination. Before using Spiriva, tell your doctor if you have a condition that causes problems with urination. Examples include having an enlarged prostate, blockage in your bladder, or urinary retention. Spiriva may worsen any problems with urination that you have. Tell your doctor right away if you have painful urination or worsened problems with urination while using Spiriva.
  • Closed-angle glaucoma. Before using Spiriva, tell your doctor if you have closed-angle glaucoma. Spiriva may worsen this condition, which could lead to severe eye pain and vision loss. Your doctor may prescribe a drug other than Spiriva for your condition.  
  • Kidney problems. It’s typically safe to use Spiriva if you have mild or moderate kidney problems. However, if you have severe kidney problems such as kidney failure, your doctor will watch you closely for side effects of the drug. This is because your kidneys help get rid of Spiriva. If they don’t function well, Spiriva could build up in your body. And having a high level of Spiriva in the body could increase your risk of side effects.
  • Allergic reaction. Your doctor will likely not prescribe Spiriva if you’ve had an allergic reaction to it or any of its ingredients. And if you’ve had an allergic reaction to milk proteins, your doctor will likely not prescribe Spiriva HandiHaler. (Spiriva HandiHaler contains a milk protein called lactose, while Spiriva Respimat does not contain milk proteins.) To find out about other treatment options, talk with your doctor.
  • Pregnancy. It’s not known whether Spiriva is safe to use while pregnant. If you’d like additional information about taking Spiriva while pregnant, view the “Spiriva: Using while pregnant” section above.
  • Breastfeeding. It’s not known whether Spiriva passes into breast milk. If you’d like additional information about taking Spiriva while breastfeeding, view the “Spiriva: Using while breastfeeding” section above.

To learn more about effects of Spiriva that could be harmful, see the “Spiriva: Side effects” section above.

Spiriva: Overdose

Serious effects can occur if you use more than the recommended dosage of Spiriva. Do not use more Spiriva than your doctor recommends.  

Symptoms of overdose

Symptoms that an overdose could cause include:

  • dry mouth, throat, or nose
  • inflammation or infection of the eye
  • constipation
  • tremor
  • abdominal pain
  • changes in mental function, such as being confused or disoriented

What to do in case of overdose

Call your doctor if you think you’ve taken too much of this drug. Also, you can call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. However, if your symptoms are severe, call 911 or a local emergency number. Or go to the nearest emergency room right away.

Spiriva: Expiration, storage, and disposal

Here’s some information about Spiriva’s expiration date, as well as how to store and dispose of the drug.

Expiration. Your pharmacist will add an expiration date to the label on Spiriva’s packaging. This date is usually 1 year from the date the medication was dispensed to you. Expiration dates help ensure that a medication is effective during a period of time.

The Food and Drug Administration (FDA) advises that you avoid taking expired drugs. If you have an unused medication and it’s past the drug’s expiration date, talk with your pharmacist. They can let you know whether you might still be able to use the medication.

Storage. Many factors determine how long a medication remains good to use. These factors include how and where you store the drug.

Spiriva HandiHaler capsules should be stored at a temperature between 68°F and 77°F (20°C and 25°C). However, they can be stored at temperatures between 59°F and 86°F (15°C and 30°C) for a short time, such as while traveling. Avoid storing them in areas where they could get damp or wet, such as bathrooms. The capsules should be kept in their original packaging until you’re ready to use them. Do not store the capsules inside the HandiHaler device.

Store Spiriva Respimat canisters at a temperature between 68°F and 77°F (20°C and 25°C). They can be stored at temperatures between 59°F and 86°F (15°C and 30°C) for a short time, such as while traveling. Once assembled for use, you can store a canister inside the Respimat device for up to 3 months. Safely discard any canister that has been used for more than 3 months.

Disposal. It’s important to safely dispose of Spiriva if you no longer need to take it and have unused medication. Doing so helps prevent others, including children and pets, from accidentally taking the drug. It also helps avoid causing harm to the environment.

Ask your pharmacist for information about disposing of Spiriva. Also, check out this page for several tips on safe medication disposal.

Spiriva: Questions for your doctor

If you have questions about Spiriva, talk with your doctor. They can advise you on whether Spiriva could be a good treatment option for you.

Here’s a list of questions you may want to ask your doctor:

  • Can I switch from Spiriva HandiHaler to Spiriva Respimat or vice versa?
  • Do I take any medications that may interact with Spiriva?
  • How is Spiriva different from other medications that treat my condition?

Your doctor may tell you about other treatment options for your condition. You may also find these articles helpful in learning about alternative drugs for asthma and chronic obstructive pulmonary disease (COPD). And view our selection of videos on asthma and COPD.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Medical Reviewer: Dena Westphalen, Pharm.D.
Last Review Date: 2022 Aug 12
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.