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# Tus%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520qd (Tiotropium)
## Overview
Tiotropium is a long-acting anticholinergic bronchodilator used for the management of bronchospasm. It is administered via inhalation.
## Primary Indications
* Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD).
* Long-term maintenance treatment of asthma in patients aged 12 years and older.
## Adult Dosing
* **COPD:** 18 mcg inhaled once daily using a HandiHaler device.
* **Asthma:** 18 mcg inhaled once daily using a HandiHaler device.
## Pediatric Dosing
* **Asthma:** Approved for patients 12 years and older at a dose of 18 mcg inhaled once daily. Safety and efficacy in younger children are not established.
## Dose Adjustments
No dose adjustments are typically required for hepatic or renal impairment, though caution may be advised in severe renal impairment.
## Contraindications
* Hypersensitivity to tiotropium, ipratropium, or any component of the formulation.
* Acute narrow-angle glaucoma.
* Prostatic hyperplasia or bladder-neck obstruction.
## Adverse Effects
* Dry mouth
* Hoarseness
* Constipation
* Urinary retention
* Blurred vision
* Dizziness
* Cough
* Paradoxical bronchospasm
## Key Drug Interactions
* **Anticholinergics:** Additive effects with other anticholinergic medications (e.g., ipratropium, benztropine) may increase adverse effects.
* **Beta-agonists:** The combination with long-acting beta-agonists (LABAs) for asthma maintenance is generally well-tolerated.
## Monitoring
* Monitor for signs and symptoms of anticholinergic adverse effects (e.g., urinary retention, glaucoma exacerbation).
* Assess for paradoxical bronchospasm.
* For asthma patients, monitor for improvement in symptoms and lung function.
## Clinical Pearls
* Tiotropium is for maintenance therapy only and not for acute relief of bronchospasm.
* Ensure proper inhalation technique with the HandiHaler device.
* Patients with severe renal impairment may accumulate tiotropium; use with caution.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before making clinical decisions.*
