Generic Spiriva (Tiotropium)

Generic Spiriva means tiotropium, a long-acting muscarinic antagonist (LAMA) inhaled once a day to keep the airways open in chronic obstructive pulmonary disease (COPD). The Indian brands in this hub, Tiova and Tiotrop, contain the same active ingredient as Boehringer Ingelheim's Spiriva and are made and licensed in India. Tiova Rotacaps share the 18 mcg capsule strength of the Spiriva HandiHaler, while the Tiova Inhaler is a different device whose puffs do not convert to Spiriva Respimat.

How does tiotropium work in COPD?

Tiotropium blocks muscarinic (M3) receptors on airway muscle, so the muscle relaxes and the airways stay wider. In the US label for the Spiriva HandiHaler, better lung function lasted 24 hours after a single dose, which is why one dose a day is enough. Tiotropium is used for long-term maintenance and to reduce COPD flare-ups. It is not a rescue medicine and will not relieve a sudden attack of breathlessness.

Is Tiova the same as Spiriva?

They share the active ingredient, but not the maker, the device or the regulator. Spiriva comes as HandiHaler capsules and the Respimat soft-mist spray, and Cipla sells a capsule and an aerosol inhaler of its own.

The capsule pair is the closest match: Tiova Rotacaps and the HandiHaler carry the same labeled amount of tiotropium per capsule. A different device can still deliver a slightly different amount to the lungs, so treat them as close equivalents, not identical products. The inhalers are another story. The Spiriva Respimat label sets a full COPD dose at two puffs of 2.5 mcg, while the Tiova Inhaler is a conventional aerosol at 9 mcg per puff. Each device is labeled on its own terms, so the doses are not interchangeable. For a closer side-by-side look, read our Tiova vs Spiriva comparison.

Is there an FDA-approved generic Spiriva in the US?

Yes, for the capsule form. Lupin sells tiotropium bromide inhalation powder approved through the FDA's generic drug pathway. Each capsule holds 18 mcg, taken as two inhalations once a day, and the capsules are labeled for use only with Lupin's own LupinHaler device. Brand-name Spiriva can cost several hundred dollars a month without insurance, which is why many people also compare the Indian versions below.

Generic Spiriva products in this hub

Rotacaps need a capsule device. If you do not already have one, the Rotahaler inhalation device is listed separately from $4. Prices can change, and shipping to the USA is free on orders of $199 or more.

How do you choose between capsules and an inhaler?

• Coming from Spiriva HandiHaler: capsules are the natural fit, because the strength and once-daily routine are the same. Ask your doctor to confirm the switch.
• Coming from Spiriva Respimat: no product here is a direct equivalent, so let your doctor choose the product and number of inhalations.
• Breathing and coordination: capsule devices are powered by your own deep breath, while an aerosol needs you to press the canister and breathe in at the same moment. Your doctor can check which technique suits you.
• Still breathless on tiotropium alone: doctors may add a long-acting beta-agonist. Combination capsules such as Duova Rotacaps (tiotropium with formoterol) replace single tiotropium; they are not taken alongside it.

How do you use tiotropium capsules correctly?

1. Use one capsule once a day, at about the same time each day.
2. Keep capsules in their blister until right before use, and never store one inside the device. If you open a blister by mistake, throw that capsule away.
3. Load the capsule into its own device: Spiriva capsules go only in the HandiHaler, and Rotacaps go in a Rotahaler, following the device leaflet.
4. Breathe out fully, away from the mouthpiece.
5. Seal your lips around the mouthpiece and breathe in deeply until your lungs are full. Hold your breath for a few seconds, then breathe normally.
6. Breathe in a second time from the same capsule to empty it, then throw away the shell.
7. Never swallow a capsule, and keep the powder out of your eyes.

With the Tiova Inhaler, follow the leaflet for shaking and priming, then press the canister as you start a slow, deep breath. Keep a separate rescue inhaler, such as albuterol (salbutamol) in the Asthalin Inhaler, for sudden symptoms, because tiotropium does not act fast enough for that.

What side effects can tiotropium cause?

Dry mouth is the most common. In the HandiHaler's one-year placebo-controlled trials it affected 16% of people taking tiotropium, compared with 3% on placebo. Other frequent effects include sore throat, sinus and upper respiratory infections, constipation, indigestion and urinary tract infections. MedlinePlus also lists nosebleeds, stomach pain and painful white patches in the mouth.

Get medical help quickly if you notice:

• eye pain, blurred vision, halos or colored images, or red eyes, which can signal acute narrow-angle glaucoma
• difficulty or pain passing urine
• wheezing or breathlessness that gets worse right after a dose (paradoxical bronchospasm)
• swelling of the face, lips or throat, hives or a rash

Who should not use tiotropium?

Do not use it if you are allergic to tiotropium or ipratropium. Talk to your doctor first if you have:

• an allergy to atropine-type medicines, or a severe milk-protein allergy (the capsule powder is blended with lactose, which may contain milk proteins)
• narrow-angle glaucoma
• an enlarged prostate, bladder-neck obstruction or trouble passing urine
• moderate or severe kidney disease, which calls for closer watch for side effects
• an irregular heartbeat
• pregnancy or breastfeeding, because safety data are limited

Avoid combining tiotropium with other anticholinergic medicines unless your doctor has planned it. That includes ipratropium products such as Ipravent and Duolin, and inhalers that already contain tiotropium, such as Duova and Triohale. For other maintenance options, browse our COPD medicines.

Frequently asked questions

Is Tiova a generic version of Spiriva?

Tiova contains the same active ingredient, tiotropium; it is an Indian brand made by Cipla.

Can I swap Spiriva Respimat for the Tiova Inhaler?

Not puff for puff. The two devices are labeled in different strengths and deliver the drug differently, so ask your doctor to set the new dose.

What if I miss a dose?

Take it when you remember, unless your next dose is nearly due; in that case, skip the missed one. Never take more than one dose in 24 hours.

Can tiotropium be used for asthma?

In the US, only Spiriva Respimat 1.25 mcg is approved for asthma, as long-term maintenance for people aged 6 and older. The capsule forms are labeled for COPD, so asthma use should be set up by your doctor.

This article gives general information and does not replace advice from your doctor or pharmacist. Tiotropium is a prescription medicine for use under a doctor's care. Seek emergency care if your breathing suddenly gets worse.