Tiotropium is the long-acting bronchodilator at the center of most COPD treatment plans. In the US it is best known as Spiriva, made by Boehringer Ingelheim. In India, Cipla sells it as Tiova, in both capsule and aerosol form. If you are living with COPD and paying for a once-daily inhaler month after month, the cost difference can be large, so it pays to understand how the products compare.
Tiova vs Spiriva at a glance
| Tiova | Spiriva | |
|---|---|---|
| Active ingredient | Tiotropium bromide | Tiotropium bromide |
| Maker | Cipla, India | Boehringer Ingelheim |
| Capsule form | Tiova Rotacaps 18 mcg, used in a Rotahaler | Spiriva HandiHaler 18 mcg capsules |
| Spray form | Tiova Inhaler, 9 mcg per puff, 2 puffs once daily | Spiriva Respimat 2.5 mcg per puff, 2 puffs once daily for COPD |
| How often | Once a day | Once a day |
| Rescue inhaler? | No | No |
What tiotropium does
Tiotropium is a long-acting muscarinic antagonist, or LAMA. It blocks acetylcholine, the nerve signal that tightens the muscle around the airways, and its effect lasts a full 24 hours. Taken every day, it makes breathing easier, improves exercise tolerance and, importantly, reduces COPD flare-ups (exacerbations) and the hospital visits that come with them. Large long-term trials have confirmed these benefits.
It does not work fast enough to treat sudden breathlessness. Keep a quick-acting reliever such as albuterol for that, and read our inhaler types guide to see how relievers and maintenance inhalers differ.
Comparing the devices
Capsule inhalers. Tiova Rotacaps contain 18 mcg of tiotropium powder per capsule, the same labeled dose as a Spiriva HandiHaler capsule, and Tiotrop Rotacaps are another capsule option. You load one capsule into the device, pierce it and breathe the powder in. Use each capsule in the device it was designed for, and ask a pharmacist if you are unsure whether your inhaler device suits your capsules.
Spray inhalers. The Tiova Inhaler is a pressurized aerosol that gives 9 mcg per puff; the usual dose is 2 puffs once a day. Spiriva Respimat is a different “soft mist” device with a much smaller labeled dose (2 puffs of 2.5 mcg) because the mist reaches the lungs more efficiently. The numbers are not interchangeable, so never convert between devices on your own.
To see every tiotropium option we carry, with prices, visit our generic Spiriva page.
How to use a tiotropium capsule inhaler
- Peel open one blister just before use and take out one capsule. Never swallow the capsule.
- Place it in the chamber and close the device. Pierce or twist as the instructions describe.
- Breathe out fully, away from the mouthpiece.
- Seal your lips around the mouthpiece and breathe in deeply. You should hear or feel the capsule rattle as the powder is released.
- Hold your breath for as long as is comfortable, up to 10 seconds.
- Breathe in a second time from the same capsule to empty it, then throw it away.
Keep capsules in their blister until the moment you need them; humidity spoils the powder. Store them at room temperature, below 77°F (25°C), and never leave them in a hot car.
Side effects and precautions
Dry mouth is the most common side effect and usually mild. Others include constipation, sore throat, sinus congestion and, rarely, a fast heartbeat. Because tiotropium is an anticholinergic, it can also:
- Worsen urinary retention in men with an enlarged prostate. Report difficulty passing urine or a weak stream.
- Trigger narrow-angle glaucoma. Eye pain, blurred vision, halos around lights or red eyes need urgent attention. Avoid getting the powder or spray in your eyes.
- Build up in kidney disease. People with moderate to severe kidney impairment should be monitored.
Do not use tiotropium with other long-acting anticholinergic inhalers such as umeclidinium, aclidinium or glycopyrrolate, and check with your doctor before using ipratropium at the same time. Stop and get help if breathing gets worse straight after a dose or if you notice swelling of the lips, face or tongue. People with a milk-protein allergy should check the capsule ingredients, since dry-powder capsules often contain lactose.
Getting more from COPD treatment
Medicine is only part of COPD care. These steps make a measurable difference:
- Stop smoking. It is the single most effective way to slow COPD. Free help is available at 1-800-QUIT-NOW in the US.
- Stay up to date with vaccines: flu every year, pneumococcal, COVID-19 and, for older adults, RSV.
- Ask about pulmonary rehabilitation, a supervised exercise and education program that improves breathlessness and stamina.
- Have a written flare-up plan so you know when to start rescue medicines and when to call your doctor.
If tiotropium alone is not enough, doctors often add a long-acting beta-agonist. Duova Rotacaps combine tiotropium with formoterol in one capsule. Browse the full COPD range for other options.
Frequently asked questions
Is Tiova the same as Spiriva?
Both contain tiotropium bromide, and Tiova Rotacaps have the same 18 mcg capsule dose as the HandiHaler. The maker, the devices and the regulatory approval differ.
What time of day should I take tiotropium?
Any time, as long as it is the same time each day. Many people pair it with brushing their teeth in the morning.
Can tiotropium be used for asthma?
Spiriva Respimat is approved in the US as an add-on maintenance treatment for asthma from age 6. Capsule forms are used mainly for COPD. Ask your doctor which applies to you.
What if I miss a dose?
Take it as soon as you remember, but never take two doses in 24 hours.
This article gives general information and does not replace advice from your doctor. If you are too breathless to speak in full sentences, call 911.
Shop the products in this article
Browse all Generic Spiriva (Tiotropium) products →
Prescription medicines: check with your doctor or pharmacist that a treatment is right for you before ordering.
