Tiotropium Side Effects and Precautions

Several organ systems and functions are under the control of the parasympathetic nervous system and thus can be affected by anticholinergic agents. Possible Tiotropium side effects attributable to systemic anticholinergic effects include dry mouth, dry throat, increase heart rate, glaucoma, blurred vision, urinary difficulty, urinary retention, and constipation. Spiriva is an infamous inhaler that contains tiotropium. 

In addition, upper airway irritant phenomena were observed in patients receiving tiotropium bromide. An increased incidence of dry mouth and constipation may occur with increasing age.

The most common anticholinergic Tiotropium side effects reported by COPD patients were dry mouth which was mild in the majority of cases. In general, the dry mouth had onset between 3-5 weeks which resolved while patients continued to receive tiotropium bromide.

The other reported side effects are diarrhea, tonsillitis, hypertension, abdominal pain, insomnia, dehydration, angioedema, arthralgia, pain in extremity, muscle spasms, chest pain, hepatic function, liver function test abnormal, atrial fibrillation, glossitis, tachycardia, pharyngitis, cough, sinusitis, palpitations, orophryngeal candidiasis, dizziness, dysphonia, pruritus, dysphagia, rash, gingivitis, intestinal obstruction includes ileus paralytic, joint swelling, dysuria, laryngitis, dry skin, angioedema, skin infection, and skin ulcer.


Tiotropium should not be used for the initial treatment of acute episodes of bronchospasm, i.e rescue therapy.

Immediate hypersensitivity reactions may occur after administration of tiotropium bromide inhalation powder. As with other anticholinergic drugs, tiotropium bromide should be used with caution in patients with narrow-angle glaucoma, prostatic hyperplasia or bladder neck obstruction.

Inhaled medicines may cause inhalation-induced bronchospasm. Patients should stop using Tiotropium and consult a physician immediately when signs and symptoms of narrow-angle glaucoma appear. Dry mouth, which has been observed with anti-cholinergic treatment, in the long term may be associated with dental caries. Tiotropium may not be used more frequently than once daily.

Patients with moderate to severe renal impairment treated with Tiotropium, their creatinine clearance should be monitored closely for anticholinergic side effects.

Drug Interactions

There is a potential for an additive interaction with concomitantly used anticholinergic mediations. Therefore, avoid coadminister of Tiotropium with other anticholinergic-containing drugs as this may lead to an increase in anticholinergic adverse effects.


Pregnancy Category C: No studies have been done on Tiotropium, therefore it should only be used after doctor’s advice.


It is not known that the Tiotropium excreted in human milk, but because many drugs excreted in breast milk, so caution should be exercised while administering Tiotropium to a nursing woman.