Safety, tolerability and risk benefit analysis of tiotropium in COPD

Abstract

COPD is a chronic disease and, like many other chronic diseases, there is no treatment to reverse the severity of the disease except for lung transplant. To date, no inhaled medications have been shown to improve survival. Tiotropium bromide is a long-acting inhaled anticholinergic drug for the treatment of COPD that can improve lung function, reduce symptoms and exacerbations, and improve quality of life with once-daily dosing. It was initially approved and marketed in several countries in Europe in 2002 and then approved in the US in 2004. Tiotropium is generally well tolerated with dry mouth being the main adverse effect. Other adverse effects include constipation, tachycardia, blurred vision, urinary retention and increased intraocular pressure. Despite the recently raised concerns about an excess risk of cardiovascular adverse events with inhaled anticholinergic agents, the risk/benefi t ratio of tiotropium appears still favorable given the favorable safety profi le demonstrated in the UPLIFT study. However, caution should be advised in patients at high risk for cardiovascular disease given the paucity of data in such patients.

Optimizing safety of COPD treatments: role of the nurse practitioner

“…Adverse effects associated with tiotropium are similar to those observed with ipratropium, with the most common side effect being dry mouth (Table 2). 52,63 Again, tiotropium should be used with caution in patients with glaucoma or prostatic hyperplasia.…”

In Vivo Pharmacological Characterization of TD-4208, a Novel Lung-Selective Inhaled Muscarinic Antagonist with Sustained Bronchoprotective Effect in Experimental Animal Models

“…In several clinical trials, tiotropium has been shown to improve lung function, reduce the frequency of exacerbations, and enhance quality-of-life scores of patients with COPD (Casaburi et al, 2000(Casaburi et al, , 2002Vincken et al, 2002;Tashkin et al, 2008). Although tiotropium is regarded as effective and generally safe (Barr et al, 2006;Oba et al, 2008;Tashkin et al, 2008), its side-effect profile is undesirable for some patients. For example, a meta-analysis of the adverse effects from several clinical trials indicated a 16% incidence of dry mouth, which was the most common adverse event in patients treated with tiotropium (Kesten et al, 2006(Kesten et al, , 2009.…”

Possible side effects of drugs in elderly patients with chronic obstructive pulmonary disease and comorbidity

“…В повторном анализе ис-следований, включенных в упомянутый метаанализ [25], Y. Oba и соавт. [27] с учетом результатов РКИ UPLIFT устранили все ошибки и недостатки этого метаанализа. Авторы установили, что комбинированный риск указанных исходов у пациентов, прини-мающих тиотропий, не отличался от такового у пациентов кон-трольной группы (ОР 1,0; р=0,97).…”