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Tiotropium/Formoterol/ Ciclesonide

Tiotropium/Formoterol/ Ciclesonide

Tiotropium/Formoterol/ Ciclesonide

Tiotropium Bromide, A Long-Acting Quaternary Ammonium Antimuscarinic, Is Structurally Related To Ipratropium. It Is A Nonselective Competitive Antagonist Of Muscarinic (M1-M5) Receptors And Causes Bronchodilation By Inhibiting The Actions Of Acetylcholine And Other Cholinergic Stimuli At M3 Receptors In The Smooth Muscle Of The Respiratory Tract. Absorption: Bioavailability 20% (Lungs). Distribution: Protein-Binding: 72%. Metabolism: Undergoes Some Metabolism By Non-Enzymatic Cleavage And By Cytochrome P450 Isoenzymes CYP2D6 And CYP3A4. Excretion: Excreted Largely Unchanged In Urine. Terminal Half-Life: 5-6 Days.

How ciclesonide + formoterol + tiotropium works

This is a combination of three medicines: Ciclesonide, formoterol and tiotropium. Ciclesonide is a corticosteroid. It acts by stopping the release of certain natural substances in body that are responsible for inflammation of the airways. Formoterol is a bronchodilator, while tiotropium is an anticholinergic. They work by relaxing the muscles in the airways and widen the airways. Together, they make breathing easier.

Common side effects of ciclesonide + formoterol + tiotropium

Nausea, Vomiting, Dryness in mouth, Fungal infection of mouth, Respiratory tract infection, Pharyngitis, Bronchitis (inflammation of the airways), Cough, Sore throat, Hoarseness of voice, Headache, Musculoskeletal (bone, muscle or joint) pain

How to use

Acute bronchospasm, reversible airways obstruction in bronchial asthma and chronic obstructive pulmonary disease (COPD): Inhalation: As inhalation capsule 12 mcg twice daily, up to 24 mcg twice daily in severe cases. As dry powder inhaler: 6 or 12 mcg 1-2 times/day, up to to 24 mcg twice daily in sever cases. As metered doses from aerosol inhaler: 12 or 24 mcg twice daily. As nebuliser: 20 mcg twice daily. Prevention of exercise-induced bronchospasm Inhalation: As metered doses from aerosol inhaler 6 or 12 mcg at least 15 minutes before exercise.


Should be taken in patients having:

• Hypersensitivity

• Thyrotoxicosis

• Severe cardiac disorders (ischaemic heart disease, tachyarrhythmias or severe heart burn)

• Prolonged QT-interval diabetes

Side Effects

Report to the physician immediately if the patients are having any of these following symptoms:

  • Tremor
  • Headache
  • Tiredness
  • Restlessness
  • Dizziness
  • Dry mouth
  • Palpitation
  • Tachycardia
  • Muscle cramps
  • Nausea


Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Drug Interactions

Information to be updated soon.


If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Lab and/or medical tests (such as lung function tests) should be done while you are using this medication. Keep all medical and lab appointments.

 Avoid substances that can worsen breathing problems by causing irritation or allergic reaction, such as smoke, pollen, pet dander, dust, and mold.

If you are using this medication to treat asthma, learn to use a peak flow meter, use it daily, and promptly report worsening breathing problems (such as readings in the yellow/red range, increased use of quick-relief inhalers).

Because the flu virus can worsen breathing problems, ask your doctor or pharmacist if you should have a flu shot every year.

Missed Dose

If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.


Store at room temperature away from light and moisture. Do not freeze. Do not store in the bathroom. The inhaler should be thrown away when it becomes locked (which means that all the medication is used up) or 3 months after putting the cartridge in the inhaler, even if there is medication left in the cartridge. Keep all medications away from children and pets.


Inhalation cap: Prior to dispensing: Store between 2°C-8°C. After dispensing: Store between 20°C-25°C.

Solution for nebulisation: Prior to dispensing: Store between 2°C-8°C. After dispensing: Store between 2°C-25°C.


Formoterol (12 μg) enhances mucus clearance in patients with mild to moderate COPD when given as a single dose, and may do so when given for 14 days. Studies of longer duration would be needed in order to assess the effects of the study drugs on mucus clearance when they are used for long-term maintenance therapy.