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U.S. Department of Health and Human Services

Safety

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Spiriva HandiHaler (tiotropium bromide) inhalation powder

Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) – December 2009

 

Summary View

 

CONTRAINDICATIONS 

  • Spiriva HandiHaler is contraindicated in patients with a hypersensitivity to ipratropium or tiotropium. In clinical trials and post-marketing experience with SPIRIVA HandiHaler, immediate hypersensitivity reactions, including angioedema (including swelling of the lips, tongue, or throat), itching, or rash have been reported.

WARNINGS and PRECAUTIONS

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.
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. 

USE IN SPECIFIC POPULATIONS

Pregnancy
  • There are no adequate and well-controlled studies in pregnant women. Spiriva HandiHaler should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • No evidence of structural alterations was observed in rats and rabbits at inhalation tiotropium doses of up to approximately 660 and 6 times the recommended human daily inhalation dose (RHDID) on a mg/m2 basis, respectively. However, in rats, tiotropium caused fetal resorption, litter loss, decreases in the number of live pups at birth and the mean pup weights, and a delay in pup sexual maturation at inhalation tiotropium doses of approximately 35 times the RHDID on a mg/m2 basis. In rabbits, tiotropium caused an increase in post-implantation loss at an inhalation dose of approximately 360 times the RHDID on a mg/m2 basis). Such effects were not observed at inhalation doses of approximately 4 and 80 times the RHDID on a mg/m2 basis, respectively. These dose multiples may be over-estimated due to difficulties in measuring deposited doses in animal inhalation studies.