Braltus 10microgram inhalation powder capsules with Zonda inhaler (Teva UK Ltd) 30 capsule

Type Dry powder inhaler (DPI)
Medicine Tiotropium bromide 10microgram inhalation powder capsules with device
Activation mechanism Breath actuated
Dose counter No dose counter
Price £25.80 / 30 days
(based on 1 puffs / day)
Licences
  • COPD Licence

Training material

Pathways

The use of each medicine included in Right Breathe has been considered in relation to international, national, and regional prescribing pathways. The pathway points at which this medicine is considered a viable prescribing option are included below. If you wish to view the entire pathway, click on its heading, from where you can also access all the prescribing options for each pathway and each pathway point.

Prescribing

Detailed prescribing information is provided below. This content has not been generated by the RightBreathe team, but has been integrated from a 3rd party solution: Multilex (provided by FirstDataBank). Use of this prescribing content is subject to the FirstDataBank disclaimer, which is set out in the "About" section of RightBreathe.

As RightBreathe is a bespoke decision support tool, it covers each and every individual known inhaler option on the UK market to a high level of specificity. Multilex, as a more general resource, does not offer the same level of specificity. There are therefore a small number of medicines for which there are discrepancies between RightBreathe and Multilex content, most notably in relation to licensed particulars and associated licensed doses.

Given the high level of specificity the RightBreathe team work to, details of the individual inhaler licence are most likely to be summarised accurately in the content provided at the top of this page, rather than in the Multilex content below. Where there is ambiguity, users may also wish to refer to individual summaries of product characteristics prior to prescribing.

Dosing

Chronic obstructive pulmonary disease

Type Age Range Dose Licensed
Maintenance From 18 years 1 dose - ONCE a DAY - inhalation - using a metered dose device

Safety Advice Warnings

Adverse effects (report/action)

  • Drug induced bronchospasm may occur
  • Prolonged treatment may lead to dental caries

Advice concerning formulation

  • Not all available brands are recommended for all age groups
  • Not all presentations are licensed for all indications

Advice on Administration

  • Avoid contact with eyes

Advice on possible excipients

  • Some formulations contain lactose

Discontinue due to test or exam

  • Discontinue if paradoxical bronchospasm occurs

Patient Counselling

  • Advise ability to drive/operate machinery may be affected by side effects
  • Advise patient not to exceed stated dose
  • Advise patient to report any blurred vision or any other eye symptoms
  • Advise patient to report new or worsening signs of cardiac failure
  • Asthma: Advise patients benefit of therapy is apparent after several doses
  • Ensure patient has a fast acting bronchodilator available
  • Patient should seek medical advice if usual relief is diminished

Pre-treatment points to consider

  • Not to be used as the sole or main treatment for severe or unstable asthma

Recommended monitoring

  • Check patient is using correct inhaler technique
  • Monitor closely patient at risk of cardiovascular disorders

Safety/advice in other condition

  • Not to be used to relieve an acute asthmatic attack

Drug Interactions

With Risk Severity
AMANTADINE Antimuscarinic side effects may be increased Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ANTIHISTAMINES - SEDATIVE Antimuscarinic side effects may be increased Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CODEINE Antimuscarinic side effects may be increased/risk of paralytic ileus Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CYCLIZINE (IN COMBINATION WITH STRONG OPIOIDS) Antimuscarinic side effects may be increased Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DISOPYRAMIDE Antimuscarinic side effects may be increased Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MAOIS Antimuscarinic side effects may be increased Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
NEFOPAM Antimuscarinic side effects may be increased Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
TRICYCLIC ANTIDEPRESSANTS Antimuscarinic side effects may be increased Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
TRICYCLIC ANTIDEPRESSANTS AND PHENOTHIAZINES (COMBINED PRODUCT) Antimuscarinic side effects may be increased Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AMISULPRIDE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ARIPIPRAZOLE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BENPERIDOL Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
CLOZAPINE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
DROPERIDOL Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
FLUSPIRILINE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
HALOPERIDOL Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
LOXAPINE (INHALED) Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
LOXAPINE (ORAL) Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
MEMANTINE effect may be increased by Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
OLANZAPINE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
OXYPERTINE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
PALIPERIDONE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
PHENOTHIAZINES Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
PIMOZIDE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
QUETIAPINE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
REMOXIPRIDE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
RISPERIDONE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
SERTINDOLE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
SULPIRIDE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
TRIFLUPERIDOL Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ZIPRASIDONE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ZOTEPINE Antimuscarinic side effects may be increased Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.

Precautions

  • Benign prostatic hyperplasia
  • Bladder outflow obstruction
  • Breastfeeding
  • Cardiac arrhythmias
  • Children aged 6 to 18 years
  • Galactosaemia
  • Glucose-galactose malabsorption syndrome
  • Lactose intolerance
  • Narrow angle glaucoma
  • New York Heart Association class III failure
  • New York Heart Association class IV failure
  • Pregnancy
  • Renal impairment - creatinine clearance below 50ml/minute
  • Within 6 months of a myocardial infarction

Contraindications

  • Children under 6 years
  • Cystic fibrosis

Side Effects

  • Anaphylactic reaction
  • Angioneurotic oedema
  • Atrial fibrillation
  • Blurred vision
  • Bronchospasm
  • Candidiasis (mouth or throat)
  • Conjunctival vascular congestion
  • Constipation
  • Corneal oedema
  • Cough
  • Dehydration
  • Dizziness
  • Dry mouth
  • Dry skin
  • Dysphagia
  • Dysphonia
  • Dysuria
  • Epistaxis
  • Eye pain
  • Gastroesophageal reflux disease
  • Gingivitis
  • Glaucoma
  • Glossitis
  • Headache
  • Hypersensitivity reactions
  • Increase in dental caries
  • Increased intra-ocular pressure
  • Insomnia
  • Intestinal obstruction
  • Joint swelling
  • Laryngitis
  • Nausea
  • Palpitations
  • Paralytic ileus
  • Pharyngitis
  • Pruritus
  • Rash
  • Sinusitis
  • Skin infection
  • Skin ulcer
  • Stomatitis
  • Supraventricular tachycardia
  • Tachycardia
  • Taste disturbances
  • Urinary retention
  • Urinary tract infections
  • Urticaria