Tiotropium Bromide 18mcg inhalation powder capsules

Q: I have a prescription for Tiotropium bromide 18mcg inhalation powder capsules. We usually supply Spiriva® powder capsules but our PMR is suggesting a product called Tiogiva® 18mcg inhalation powder capsules. Can we supply these ones?

A: Tiogiva® 18mcg inhalation powder capsules are a recently launched product made by Glenmark Pharmaceuticals.

It has bioequivalence with Spiriva® powder capsules and delivers a dose that is equivalent to 10mcg of tiotropium.

Its licensed indication is as a maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease (COPD)

The capsules have their own inhalation device and are available as a complete pack with device or a refill pack of capsules alone. The capsules should only be used with the Tiogiva® inhaler device, as they are not compatible with the Spiriva Handihaler®.

Pricing

The current Drug Tariff price (June 2021) for tiotropium bromide 18mcg inhalation powder capsules is based on Spiriva®. Whilst currently pharmacists will not be out of pocket by supplying Spiriva® against a generic prescription, it would be reasonable to assume that the tariff price will be corrected to reflect the availability of generic versions.

Product

List Price (June 2021)

Spiriva® 18mcg inhalation powder capsules + device

£34.87

Spiriva® 18mcg inhalation powder capules refill pack

£33.50

Tiogiva® 18mcg inhalation powder capsules + device

£22.67

Tiogiva® 18mcg inhalation powder capsules refill pack

£21.78

Advice for Pharmacy teams

Pharmacists should ensure that patients:

  • agree to a switch in their inhaler device
  • are counselled on the correct use of the new device
  • are counselled on potential taste differences

Prescribers should be advised that where they or their patients have a specific preference for one particular brand this should be specified on the prescription to ensure correct supply.

In the absence of a specific product being prescribed then either of the products could be supplied but pharmacists would need to ensure that patients are supplied with a complete pack of device and inhalation powder capsules initially.

In the interests of consistency and patient adherence to the prescribed treatment the same inhaler device should be supplied each time. A record should be made on the patient’s PMR of the correct device to supply.

Pharmacy support pack

There is another tiotropium bromide capsule product (Braltus®) that can be prescribed but this is listed as 10mcg inhalation powder capsules so although Tiogiva® inhalation powder capsules deliver this dose they cannot be dispensed for prescriptions for tiotropium bromide 10mcg inhalation powder capsules.