Counselling Points for Spiolto Respimat (Tiotropium 2.5 mcg / Olodaterol 2.5 mcg Inhalation)

 Usage

Ø  Warn patient not to exceed maximum recommended dose (2 inhalations/ day).²

Ø  If SPIOLTO RESPIMAT has NOT been used for more than 7 days, release one puff towards the ground.¹

Ø  If SPIOLTO RESPIMAT has NOT been used for more than 21 days, prime until a cloud is visible.¹

Ø  When the dose indicator enters the red area of the scale, approximately medication for 7 days left (14 puffs).¹

Ø  Once the dose indicator reaches the end of the red scale, no more doses can be release.¹

Ø  SPIOLTO RESPIMAT should be discarded three months after have prepared for first use, even if it has not been used or used at all.¹

 

Special warnings/ Precautions

v NOT indicated for treatment of acute episodes of bronchospasm / exacerbation, i.e. NOT as rescue therapy.^1-3

v Patients should be advised that dizziness and blurred vision have been reported with the use of SPIOLTO RESPIMAT. Caution should be recommended when driving a car or operating machinery.^1,3

v Avoid activities requiring mental alertness or coordination until drug effects are realized.²

v Side effects may include nasopharyngitis, epistaxis, pharyngitis, sinusitis, cough, back pain, rash, constipation, urinary retention or dry mouth.²

v Dry mouth, which has been observed with anti-cholinergic treatment, may in the long term be associated with dental caries.^1,3

v Avoid getting spray into the eyes:

o  As this may result in precipitation or worsening of narrow-angle glaucoma, eye pain or discomfort, temporary blurring of vision.¹

o  Should this occur, immediately flush your eyes with cold tap water for several minutes, stop using Spiolto Respimat and immediately consult your doctor for further advice.⁴

o  Eye symptoms may be accompanied by headache, nausea or vomiting.⁴

v Warn patient to report symptoms of paradoxical bronchospasm, worsening COPD, or decreased efficacy of the drug.²

v Stop using Spiolto Respimat and tell your doctor immediately if you get sudden tightness of the chest, coughing, wheezing or breathlessness immediately after using the Spiolto Respimat.⁴

v Tell your doctor as soon as possible if you notice any symptoms of hypokalaemia (low level of potassium in blood), such as muscle spasm, muscle weakness or abnormal heart rhythm.⁴

v If you are a smoker, you should stop smoking - unless you are on medication such as warfarin or theophylline, where you may need to discuss your intention to reduce / stop smoking with your doctor first.⁴

A good example of patient’s information leaflet with diagrams is available from the following website: https://www.medsafe.govt.nz/Consumers/cmi/s/spioltorespimat.pdf  

Cleaning

·      Clean the mouthpiece including the metal part inside the mouthpiece with a damp cloth or tissue only, at least once a week. Make sure no water entry into internal part(s) of the inhaler. ⁴

·      It is important to keep your inhaler clean and dry. It may not work as well if it gets dirty.⁴

 

References:

1.       Product leaflet, Spiolto Respimat Inhalation Solution 2.5 mcg / 2.5 mcg per actuation [Revised 20 Mac 2017]

2.       Micromedex, version 2.5b851: Tiotropium 2.5 mcg & Olodaterol 2.5 mcg

3.       MIMSGATEAWAY [online]: Spiolto Respimat

4.       https://www.medsafe.govt.nz/Consumers/cmi/s/spioltorespimat.pdf  

All info are accessed on 26 Oct 2020

Prepared by Syahmi ; Edited by J. Ho on 26 Oct 2020