Not for Acute Use
SPIRIVA HandiHaler is intended as a once-daily maintenance treatment for COPD and is not indicated
for the initial treatment of acute episodes of bronchospasm (i.e., rescue therapy).
Immediate Hypersensitivity Reactions
Immediate hypersensitivity reactions, including angioedema (including swelling of the lips, tongue,
or throat), itching, or rash may occur after administration of SPIRIVA HandiHaler. If such a reaction
occurs, therapy with SPIRIVA HandiHaler should be stopped at once and alternative treatments should be
considered. Given the similar structural formula of atropine to tiotropium, patients with a history of
hypersensitivity reactions to atropine should be closely monitored for similar hypersensitivity reactions
to SPIRIVA HandiHaler. In addition, SPIRIVA HandiHaler should be used with caution in patients with severe
hypersensitivity to milk proteins.
Paradoxical Bronchospasm
Inhaled medicines, including SPIRIVA HandiHaler, may cause paradoxical bronchospasm. If this occurs,
treatment with SPIRIVA HandiHaler should be stopped and other treatments considered.
Worsening of Narrow-Angle Glaucoma
SPIRIVA HandiHaler should be used with caution in patients with narrow-angle glaucoma. Prescribers
and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (e.g., eye pain
or discomfort, blurred vision, visual halos or colored images in association with red eyes from
conjunctival congestion and corneal edema). Instruct patients to consult a physician immediately
should any of these signs or symptoms develop.
Worsening of Urinary Retention
SPIRIVA HandiHaler should be used with caution in patients with urinary retention. Prescribers and
patients should be alert for signs and symptoms of prostatic hyperplasia or bladder-neck obstruction
(e.g., difficulty passing urine, painful urination). Instruct patients to consult a physician immediately
should any of these signs or symptoms develop.
Renal Impairment
As a predominantly renally excreted drug, patients with moderate to severe renal impairment (creatinine
clearance of ≤50 mL/min) treated with SPIRIVA HandiHaler should be monitored closely for anticholinergic
side effects [see Clinical Pharmacology].