When Spiriva was released, the official statement was that Ipratropium might compete with Tiotropium and, being less potent, decrease its benefit. The trials were done comparing the two but no add-on effect was measured. The PI actually states: "However, the co-administration of SPIRIVA with other anticholinergic-containing drugs (e.g., ipratropium) has not been studied and is therefore not recommended."
Our pharmacy interpreted that all Pts started on Spiriva should have Atrovent discontinued and Combivent switched to albuterol. How have you handled this?
Subscribe to:
Post Comments (Atom)
6 comments - CLICK HERE to read & add your own!:
I stop the atrovent an combivent and add prn albuterol.
I've done the same...I stop the Atrovent and substitute albuterol for the Combivent.
I have looked on PubMed and there is no trial/experiment showing a true antagonistic competitive effect. It seems that Atrovent dettachs itself from the receptor so fast it shouldn't really interfere with the Spiriva.
I think the issue is that tiotropium has such a long 1/2 life for blocking the M1 and M3 receptors, that intermittant treatment with atrovent MAY (theoretically), compete with the tiotropium and reduce the efficacy of tiotropium.
Regarding ipratroprium wearing off fast, metabolic studies in healthy volunteers show an average elimination half-life of 3.5 hours (range 1.5 to 4 hours). For some patients using a lot of ipratroprium, degrading the responses of expensive medications would be a consideration.
test
Post a Commenttest post a comment