Stiolto Respimat dosage, forms, and strengths

Stiolto Respimat is a prescription-only treatment for chronic obstructive pulmonary disease (COPD), a group of lung diseases that includes chronic bronchitis and emphysema. The first line of treatment to prevent COPD exacerbations is to take a daily long-acting muscarinic antagonist (LAMA) with a long-acting beta-2 agonist (LABA). Stiolto Respimat combines two medications, a LAMA, tiotropium bromide or Spiriva Respimat, and a LABA, olodaterol or Striverdi Respimat, which work together to relax and widen the airways in the lung. Only one dose per day is required.

Stiolto Respimat forms and strengths

Stiolto Respimat comes as a metered soft mist inhaler.

• Metered dose inhaler: 2.5 mcg tiotropium/2.5 mcg olodaterol per actuation

Stiolto Respimat dosage for adults

Stiolto Respimat is approved by the U.S. Food and Drug Administration (FDA) as a maintenance treatment for COPD, not as a rescue inhaler or as a treatment for asthma. It combines two bronchodilators in each dose. Doses should be taken once per day at the same time each day.

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Stiolto Respimat dosage for COPD

Stiolto Respimat is a maintenance treatment for COPD. This means that the drug does not help with acute episodes of COPD or bronchospasm, but rather prevents them from happening. In addition, daily Stiolto use can improve lung function by decreasing the breathing problems people typically experience throughout the day, such as shortness of breath or wheezing. Both drugs in Stiolto Respimat—a long-acting anticholinergic (LAMA) and a long-acting beta-agonist (LABAL)—are considered the first-line treatment for preventing COPD exacerbations, depending on the severity of the condition. 

• Standard Stiolto Respimat dosage for the maintenance treatment of COPD: 2 puffs taken once per day at the same time each day (4 mcg/4 mcg per day) 

Stiolto Respimat dosage for children

Stiolto Respimat is not FDA-approved for use in children. COPD primarily affects adults, so Stiolto Respimat has not been tested in children to see if it is safe and effective.

Stiolto Respimatdosage restrictions

No dosage adjustments are required for people with liver disease or kidney disease. However, healthcare providers will need to monitor people with moderate to severe kidney disease in case they experience side effects, such as urinary retention

Stiolto Respimatdosage for pets

Animal studies with the combination drugs in Stiolto Respimat have not been done. However, there have been studies with each drug individually. Inhalation aerosols and inhalation sprays similar to Stiolto Respimat are used in veterinary medicine to treat chronic bronchitis in dogs and cats. Treatments include LAMA and LABAs like the drugs found in Stiolto. Soft mist inhalers such as the Respimat inhalation device can be used in dogs and cats with the proper spacer. However, Stiolto Respitmat is a premium-priced brand-name drug, so veterinarians may default to less expensive generic medications like ipratropium. There are no published Stiolto Respimat dosages for dogs or cats, so dosages may vary if a veterinarian prescribes Stiolto.

How to take Stiolto Respimat

The Respimat inhaler device is a soft mist inhaler. In many ways, it’s similar to an aerosol inhaler and has to be primed before use. Doses are sprayed by pressing a button and taken in with a deep breath. There are, however, a few extra steps needed. Here is how to prepare the inhaler, care for the inhaler, and use the inhaler. 

• Use the medication as directed. Do not use more than prescribed.

• Take only one dose per day, which consists of two puffs.

• Take doses at the same time each day.

• Do not take more than one dose every 24 hours.

• The inhaler device must be advanced by one dose to work. That will require turning the cartridge chamber one-half turn before taking a dose.

BEFORE THE FIRST USE

• Read the Instructions for use included with the medicine.

• Know the various parts of the inhaler, including the dose indicator.

• The dose indicator is an arrow next to the inhaler's green and red scale.

  • The cartridge is almost empty when the dose indicator hits the red area.

  • When it hits the top of the red area, the cartridge is out of medicine. 

• Remove the clear base by pressing the safety catch and pulling it off.

• Before using it for the first time, write the discard date on the cartridge holder.

• Insert the cartridge and then complete insertion by pressing the bottom against a solid surface. When the cartridge is completely inserted, it should click.

• Replace the base. It is fully attached when you hear a click.

• Before using the inhaler, it must be primed.

  • With the cap on, turn the base toward the arrows for one-half turn. The base should click when finished.

  • Remove the cap.

  • Point the mouthpiece away from yourself and press the dose button.

  • If no mist comes out, repeat the process by closing the cap, turning the base, removing the cap, and then pressing the dose button with the inhaler pointed away from you.

  • When a mist does come out, repeat the process three more times.

  • The inhaler is primed and ready to use.

• If the inhaler isn’t used for three days, you must re-prime it by turning the base and releasing one dose while it is pointed away from you.

• If the inhaler remains unused for 21 days, you need to repeat the entire priming process by releasing four mists from the inhaler.

TAKING A DOSE

• TURN

  • With the cap closed, turn the base one half-turn until it clicks. This prepares the dose.

• OPEN

  • Open the cap.

• PRESS

  • Breathe out of your mouth.

  • Place the mouthpiece in your mouth and form a tight seal around it with your lips.

  • Do not cover the air vents.

  • Start taking a deep breath and squeeze the dose button while breathing in.

  • Hold your breath for up to ten seconds.

  • Take a second puff in the same way.

MANAGING YOUR INHALER

• Clean the mouthpiece and the metal part inside the mouthpiece once weekly with a moist cloth or tissue. 

• Order a new inhaler when the dose indicator is in the red zone or almost empty.

• The base will not turn when the dose indicator hits “0.”

• Throw away the inhaler when the dose indicator reads “0” or three months after inserting the cartridge.

• Store the inhaler at room temperature. Do not freeze either the inhaler or the cartridge.

Stiolto Respimat dosage FAQs

How long does it take Stiolto to work?

People taking Stiolto Respimat usually experience improved lung function within five minutes of taking a dose and provides 24 hours of symptom control. However, Stiolto Respimat is intended for long-term use to prevent and moderate COPD symptoms, so these goals won’t be evident until several months of use.

How long does Stiolto stay in your system?

The effects of a Stiolto Respimat dose typically last about 24 hours. About one-third of the dose will enter the bloodstream. That includes both drugs. They have long half-lives in the body—25 to 45 hours—so it could take about a week to clear the system of these drugs completely.

What happens if I miss a dose of Stiolto?

If you miss a dose, take it as soon as it is remembered. However, no more than one dose should be taken every 24 hours. So, if you take a missed dose, the next dose must be taken simultaneously the next day.

How long can you take Stiolto?

Stiolto Respimat is a long-term maintenance treatment for COPD. Healthcare providers prescribe it as long as it controls COPD symptoms and does not cause too many side effects. In year-long clinical trials, no side effects due to long-term use were reported.

How do I stop taking Stiolto?

Stiolto Respimat can be stopped at any time because discontinuing the medication will not cause withdrawal symptoms healthcare providers should prescribe medications similar to Stiolto Respimat as a replacement so breathing problems and COPD exacerbations do not get worse. To avoid that, talk to a healthcare provider if you want to stop taking Stiolto Respimat. However, if you have an allergic reaction, such as mouth or lip swelling, itching, or anaphylaxis, stop taking the medication, get medical help, and talk to the doctor about switching to a different drug.

What is the maximum dosage for Stiolto?

The maximum dose of Stiolto Respimat is two puffs once every 24 hours.

Can you overdose on Stiolto?

Do not exceed the recommended dose. Do not take more than one dose every 24 hours. Call a healthcare professional or go to an emergency room if you have taken too much. Symptoms of an overdose might include rapid heart rate, chest pain, irregular heartbeats, palpitations, dry mouth, headache, and muscle spasms.

What interacts with Stiolto?

About one-third of each Stiolto Respimat dose gets into the bloodstream, so some drugs might cause problems when taken with Stiolto Respimat. For this reason, make sure the prescriber knows about all prescription drugs, over-the-counter medications, vitamins, or supplements that are taken regularly, especially the following:

• Short-acting beta-agonists such as albuterol

• Other types of anticholinergic drugs

• Atropine

• Diuretics

• Adrenergic drugs 

• Tricyclic antidepressants

• Monoamine oxidase inhibitors (MAOIs)

• Beta blockers

What happens when you mix Stiolto and alcohol?

There are no recorded drug interactions between Stiolto Respimat and alcohol.

Is it safe to take Stiolto during pregnancy?

Healthcare professionals are not sure if Stiolto Respimat is safe to take during pregnancy, but animal studies suggest that both active ingredients in the medication are not associated with birth defects. Women and their doctors will decide whether Stiolto Respimat is the right therapy during pregnancy.

Is it safe to take Stiolto while breastfeeding?

Stiolto Respimat has not been studied in breastfeeding women, but animal studies suggest that both tiotropium and olodaterol may be present in breast milk. There are no studies on possible side effects in a nursing infant. Women should ask the prescriber for medical advice about breastfeeding while using Stiolto.

What should I know about the side effects of Stiolto?

The most common side effects of Stiolto Respimat are nasopharyngitis (runny nose and sore throat), cough, and back pain. It may also cause urination problems such as urinary retention

What should I know about the risks of using Stiolto?

Some of the less common but more serious side effects include:

• Worsening breathing problems (bronchospasm)

• High blood pressure

• High blood sugar (hyperglycemia)

• Low potassium (hypokalemia)

• Narrow-angle glaucoma

• Irregular heart rhythms 

To avoid these adverse effects, make sure the healthcare provider knows about all past and presentmedical conditions.

Who should not use Stiolto Respimat?

Stiolto Respimat should never be used to treat asthma. Without the concomitant use of an inhaled corticosteroid, it could cause serious or even fatal breathing problems. People allergic to tiotropium, olodaterol, or any ingredients in Stiolto Respimat should also never use Stiolto. People who are experiencing acute deterioration of COPD should not start Stiolto Respimat.

Sources

• 2024 Gold Report, Global Initiative for Chronic Obstructive Lung Disease

• Stiolto, Boehringer Ingelheim Pharmaceuticals

• Stiolto HCP, Boehringer Ingelheim Pharmaceuticals

• Stiolto Respimat tiotropium bromide and olodaterol spray prescribing information, DailyMed