Spiriva Handihaler dosage, forms, and strengths

Spiriva Handihaler is a prescription powdered inhaler for people with chronic obstructive pulmonary disease (COPD), a group of lung diseases that affects day-to-day breathing and causes occasional tightening of the air passages (bronchospasms). Spiriva Handihaler is a once-a-day maintenance treatment that helps make breathing easier and reduces the frequency of bronchospasms. 

Spiriva Handihaler forms and strengths

• Powder for oral inhalation: 18 mcg/capsule

Spiriva Handihaler dosage for adults

The FDA has approved Spiriva Handihaler as a COPD maintenance treatment. It helps reduce the incidence and severity of bronchospasms, improves breathing, and slows the progress of the disease. Doses are taken as two inhalations one time per day. Daily doses should be separated by at least 24 hours.

Not everyone can safely take Spiriva. Healthcare providers will not prescribe Spiriva to anyone who has had an allergic reaction to its active ingredient, tiotropium, or a similar drug called ipratropium. Additionally, the capsules contain milk proteins, so people with severe milk allergies should not use this drug.

People with narrow-angle glaucoma, an enlarged prostate, urinary blockage (such as bladder-neck obstruction), or urinary retention might experience worsening of these problems when taking Spiriva. 

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Spiriva Handihaler dosage for COPD

Chronic obstructive pulmonary disease (COPD) is a lung condition that describes two distinct lung diseases: emphysema and chronic bronchitis. Both are common lung diseases affecting about 4.3% of Americans. Most of those affected are older adults, but chronic bronchitis can occur in young adults and children.

Emphysema damages the lung’s air sacs, which are small, balloon-shaped parts of the lung where air is exchanged between the lungs and the blood and vice versa. Chronic bronchitis involves swelling of the air passage, and tubes called the bronchi that pass air into and out of the lungs. Although the symptoms can be different, healthcare professionals manage both conditions with the same treatments: long-acting and short-acting bronchodilators, inhaled corticosteroids, lung rehabilitation, and lifestyle changes. Both bronchodilators and corticosteroids help to open the airways. Bronchodilators relax the muscles in the air passages. Short-acting bronchodilators like albuterol are used for severe breathing problems during a COPD exacerbation. Corticosteroids reduce swelling that narrows the airways.

Spiriva Handihaler contains tiotropium bromide inhalation powder, a long-acting bronchodilator. It belongs to a class of drugs called anticholinergics. They work by blocking nerves that tighten muscles in the air passages. The air passages then widen, allowing more air to pass into and out of the lungs. This generally improves breathing, but it also helps prevent airway closure during an attack. 

Spiriva Handihaler is intended as a long-term maintenance treatment. It should be taken once daily. It will not work as a rescue inhaler when breathing suddenly becomes difficult. 

The Handihaler is not a metered inhaler. For each dose, the powder, in the form of a capsule, has to be put into the Handihaler. It is considered a passive inhaler, so the patient has to pull all the powder from the inhaler into the lungs by breathing deeply. People who can’t use the Handihaler have the option of using the spray inhaler version called Spiriva Respimat.

A full dose consists of two inhalations of the powder.

• Standard dosage for COPD: One 18 mcg capsule (two inhalations) once daily

• Maximum dosage for COPD: One 18 mcg capsule (two inhalations) once daily

Spiriva Handihaler dosage for children

The FDA has not approved the use of Spiriva Handihaler for use in children younger than 18 years of age. 

Spiriva Handihaler dosage restrictions

Healthcare providers do not modify dosages for people with hepatic impairment, kidney problems, or any other medical condition. However, doctors are advised to monitor people with moderate to severe renal impairment for side effects.

How to take Spiriva Handihaler

Before starting Spiriva Handihaler, you should know two things. It’s a passive inhaler. That means you do all the work bringing the dose into your lungs. The second is that dry powder inhalation is more complicated than spray inhalers. With more steps involved, there are more opportunities to make a mistake. Therefore, it is important to fully understand how to properly take a dose before you start this medicine. 

Here are some general instructions. They should not serve as a substitute for the Instructions for Use included with the medicine or any help you can get from a healthcare provider or pharmacist:

• Take this medicine as instructed.

• Please read the Patient Information sheet and the Instructions for Use before using this medicine the first time.

• A healthcare provider will demonstrate how to use the Handihaler.

• How to use Spiriva Handihaler:

  • Spiriva Handihaler includes an inhalation device and separate capsules.

  • The capsules each contain one dose of Spiriva.

  • Do not swallow the capsules.

  • The capsules fit inside the inhaler. Once properly placed and pierced, you can use the inhaler to breathe in a dose.

• Preparing a dose:

  • First, open the Handihaler by removing the dust cap and opening the mouthpiece. The chamber should be accessible.

  • Remove one capsule blister from the blister pack.

  • If more than one capsule is exposed to the air, throw away the capsule you are not going to use. It cannot be used for the next dose.

  • Pull back the foil to uncover the entire capsule. Do not push the capsule through the foil.

  • Remove the capsule gently.

  • Place it in the center of the Handihaler.

  • Close the mouthpiece.

  • Push the green button all the way in. This will create holes in the capsule, allowing you to breathe in the powder inside.

  • Do not push the green button again.

  • Do not shake the Handihaler.

• Taking a dose:

  • One dose is two inhalations from the Handihaler.

  • Hold your head upright.

  • With the Handihaler away from your face, breathe out completely using your mouth.

  • Immediately put the mouthpiece in your mouth with the Handihaler horizontal to your face. Do not cover the air vents.

  • Close your lips around the mouthpiece.

  • Breathe in deeply.

  • When done, take the Handihaler out of your mouth and hold your breath for a few seconds.

  • Breathe out.

  • Repeat the process a second time.

  • Throw away the capsule remains by opening the mouthpiece and tipping them out. Do not touch what’s left of the capsule.

• Store unopened Spiriva capsules in their original package at room temperature in a dry place away from heat and cold.

• Do not freeze the capsule.

• Never store capsules in the inhaler.

Spiriva Handihaler dosage FAQs

How long does it take Spiriva Handihaler to work?

Spiriva should start making breathing easier on the first day. However, healthcare providers use Spiriva as a maintenance treatment that reduces attacks and slows the progress of the disease. In clinical studies, people did not experience the full effects of Spiriva for a few weeks to two months. 

How long does Spiriva Handihaler stay in your system?

In people who use Spiriva long enough to achieve a steady state of drug concentrations in the body, the half-life of the tiotropium is about 25 hours. At that rate, the body will completely clear the last dose of Spiriva in about five days.

What happens if I miss a dose of Spiriva Handihaler?

Take a missed dose as soon as you remember. Then wait 24 hours before taking the next dose.

How long can you take Spiriva Handihaler?

Spiriva Handihaler is a long-term treatment that can be used for as long as it works without causing problems. If necessary, the treatment period could last for years. In clinical trials, treatment lasted six months and 12 months. Over that time, researchers did not discover any side effects due to long-term use.

How do I stop taking Spiriva Handihaler?

Do not stop taking Spiriva Handihaler doses until you’ve consulted with your healthcare provider.. Stopping the drug will not cause withdrawal effects, but lung function may decline unless a suitable replacement is in place.

A healthcare provider may stop Spiriva if it doesn’t work or worsens certain medical conditions. People can also have allergic reactions—usually immediate hypersensitivity reactions—that will require stopping the drug immediately. In those cases, the prescriber can turn to other long-acting bronchodilators. One alternative is a drug like tiotropium called ipratropium. The more likely treatment options are drugs called long-acting beta-agonists or LABAs. These are some of the most prescribed drugs in COPD treatment and are often combined with inhaled corticosteroids in a single inhaler.

What is the maximum dosage for Spiriva Handihaler?

The recommended dosage for Spiriva Handihaler is the maximum dosage: one daily inhalation of an 18 mcg capsule. Do not take more than two doses in a 24-hour period.

Can you overdose on Spiriva Handihaler?

Do not take more than the recommended dose. If too much Spiriva is taken, call your healthcare provider or a poison control center. Taking more than one dose is likely to worsen side effects like dry mouth. Extreme overdoses are rare but require emergency treatment.

What interacts with Spiriva Handihaler?

Spiriva Handihaler has few significant drug interactions other than drugs similar to tiotropium called anticholinergics. Many of these drugs are bronchodilators that treat COPD. Ipratropium, another COPD treatment, is contraindicated for use with tiotropium. 

Some anticholinergics treat overactive bladders, like oxybutynin. Others are eye drops used to dilate pupils, such as atropine. Tell any healthcare provider who treats you—particularly eye doctors or optometrists—that you’re taking Spiriva so they don’t give you another drug that will worsen the anticholinergic effects. 

Is it safe to take Spiriva Handihaler during pregnancy?

Tell your healthcare provider if you are pregnant or planning to become pregnant. Healthcare professionals do not know if Spiriva Handihaler can cause problems during a pregnancy or harm a fetus. Animal studies suggest that it doesn’t, but talk to your healthcare provider for medical advice about the risks.

Is it safe to take Spiriva Handihaler while breastfeeding?

Healthcare providers believe that Spiriva is safe to take while breastfeeding because not much of the drug enters the mother’s system. It is unknown if tiotropium is present in breast milk or affects a nursing baby. If a baby swallows tiotropium, only a small amount enters the bloodstream. 

What side effects can be expected?

The most common side effect of Spiriva Handihaler is upper respiratory tract infections. Other common adverse effects include dry mouth and sinus infections (sinusitis). Some possible but less common adverse reactions include sore throat, chest pain, urinary tract infection, stomach upset, runny nose (rhinitis), constipation, abdominal discomfort, increased heart rate, and blurred vision. 

Sources

• Chronic bronchitis in children and adults: definitions, pathophysiology, prevalence, risk factors, and consequences, Journal of Clinical Medicine

• Chronic obstructive pulmonary disease (COPD), Centers for Disease Control 

• Spiriva Handihaler drug summary, Prescriber’s Digital Reference (PDR)

• Spiriva Handihaler tiotropium bromide prescribing information, DailyMed (NIH National Library of Medicine)

• Spiriva Respimat, Boehringer Ingelheim