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Spiriva (Tiotropium) Side Effects & Memory Problems

Tiotropium, the active ingredient in Spiriva, is an anticholinergic compound. Anticholinergic drugs can cause dry mouth, connstipation and mental fogginess.

You may have seen commercials of a person with an elephant sitting on her chest. Here’s a link in case you may have missed them. It’s a clever marketing strategy to reinforce the idea that a serious breathing problem like chronic bronchitis, COPD or emphysema can feel like an elephant weighing you down. But that image of the elephant might distract you from the voice-over announcer’s long list of side effects.

Here is a Spiriva question from Mimi, a visitor to our website:

Q. My elderly mother was prescribed a number of medications to treat her COPD [chronic obstructive pulmonary disease]. She developed many symptoms though a couple were attributed to other causes… the red/blue hot leg being one, memory problems, terrible weakness and edema. She had been alert, active and mentally bright up until she started taking Spiriva, prednisone and other inhaled meds.

She kept having episodes that looked like heart attacks, yet weren’t. She kept being taken to the hospital for treatment. It was a terrible way for her to end her life in her 93rd year. She’d been so healthy until she started taking those meds. We were told there were no other treatments.

I honestly think that when she died suddenly one night it was because of a pulmonary embolism. Her primary care doctor thinks so too. Now I read that that can be caused by corticosteroids. Her mother and her aunt all lived to a ripe old ages [98, 102] almost disease free until the end. I think Mom might have lived longer and healthier without all the treatments.

A. Tiotropium, the active ingredient in Spiriva, is considered a strong anticholinergic medication. That means it affects the activity of the neurochemical acetylcholine. Although there is no mention in the official Spiriva prescribing information about cognitive dysfunction, drugs that have anticholinergic activity can cause confusion, mental fogginess or even memory problems. Another classic complication is constipation.

The commercials on television do not mention anything about mental fogginess. They do say the following, though:

“Tell your doctor if you have kidney problems, glaucoma, trouble urinating or an enlarged prostate. These may worsen with Spiriva…Stop taking Spiriva and seek immediate medical help if your breathing suddenly worsens, your throat or tongue swells, you get hives, vision changes or eye pain, or problems passing urine. Other side effects include dry mouth and constipation.”

 Other side effects of Spiriva include:


  • Dry Mouth
  • Severe constipation
  • Upper respiratory tract infection, sore throat, cold symptoms, sinus infection
  • Worsened breathing problems, bronchospasm
  • Chest pain, irregular heart rhythms, palpitations
  • Digestive tract distress, heartburn, stomach pain, reflux
  • Headache
  • Depression, difficulty sleeping
  • Fluid retention
  • Arthritis or joint pain, muscle pain (myalgia)
  • Nose bleeds, runny nose
  • Dehydration, dry skin
  • Difficulty urinating, urinary retention
  • Severe allergic reaction, hives, itching, rash, swelling of tongue, throat or lips
  • Visual problems, glaucoma, cataracts
  • Yeast infections in mouth and throat, mouth ulcers, hoarseness
  • Voice changes
  • Cholesterol elevation

Tiotropium is an Anticholinergic Drug:

Okay, so what does it mean when a medication has strong anticholinergic activity? Acetylcholine is a critical neurochemical that affects your entire body. Without this chemical you could not lift a pencil, blink or think. It is crucial inside the brain as well as outside the brain. When drugs interfere with the normal activity of acetylcholine, we call them anticholinergic. You can learn more about this critical process and other anticholinergic drugs at this link:

Where Can I Find A List of Anticholinergic Drugs?

What are common symptoms of anticholinergic activity? Dry mouth is a classic tip off. Acetylcholine is essential to keep mucus membranes functioning normally. When the effects of acetylcholine are blocked, secretions are reduced and body parts get dry. That’s why people complain of dry skin, dry mouth, dry eyes, blurred vision, dehydration, constipation and urinary retention. That last one means that people may have trouble urinating or emptying their bladder completely.

Go back and read the symptoms listed for Spiriva during the video advertisement. To make it easy here are a couple of key ones: “problems passing urine,” “dry mouth,” and “constipation.” By the way, anticholinergic drugs can make glaucoma worse, hence the warning:

“Tell your doctor if you have kidney problems, glaucoma, trouble urinating or an enlarged prostate. These may worsen with Spiriva…”

Who Cares?

Why should anyone care if a medicine is considered anticholinergic? Besides the side effects mentioned above, there are concerns that anticholinergic drugs may impact cognitive function. An article in Geriatrics & Gerontology International (April, 2017) described it this way:

“The use of anticholinergic drugs had been strongly linked to adverse health outcomes among older adults, especially in cognitive impairment or dementia. The present study aimed to evaluate the cognitive decline related to the use of anticholinergicdrugs among older men living in the veterans’ homes in Taiwan.”

The authors concluded:

“Exposure to anticholinergic drugs significantly increased the risk for short-term cognitive decline among older men, and the adverse effects remained similar when antipsychotics were excluded for analysis. A further intervention study is required to evaluate whether reducing anticholinergic burden might improve cognitive function among older adults.”

Another article in the journal Aging Clinical and Experimental Research (Feb. 2016) summarizes the situation this way:

“The use of medication with anticholinergic properties is widespread among older subjects. Many drugs of common use such as antispasmodics, bronchodilators, antiarrhythmics, antihistamines, anti-hypertensive drugs, antiparkinson agents, skeletal muscle relaxants, and psychotropic drugs have been demonstrated to have an anticholinergic activity. The most frequent adverse effects are dry mouth, nausea, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia and neurologic impairment such as confusion, agitation and coma.”

The authors conclude conclude:

“Overall, minimizing anticholinergic burden should always be encouraged in clinical practice to improve short-term memory, confusion and delirium, quality of life and daily functioning.”

No one should ever stop any medication with careful consultation with the prescribing physician. That includes Spiriva!

Stories from Visitors:

Other visitors to our website have shared the following concerns:

A self-described “Old Fart in Florida” asks:

“Anyone have any of the dry mouth, dry lips, sore tongue problems using a Spiriva inhaler?”

Anonymous notes:

“I also have a problem with urine retention, and when this happens I reduce Spiriva to every other day and it seems to clear up.  I take Symbicort – 1 puff 2 x a day (child’s dose) which has worked very well for me.”

M.F.C. also wonders about urinary retention:

“I have been diagnosed with COPD. I was using Spiriva for about 6-8 weeks when I developed a urine retention problem.The Spiriva did help the breathing problem but the side effects were more than I could tolerate.  I am now on Advair 100/50 and I truly believe that is also causing side effects that are troublesome.  I am waiting to see a pulmonologist but can’t get an appt. till Dec.  The Advair does help the breathing but the side effects concern me.”

Spiriva and Cardiovascular Complications:

One of the most controversial issues around Spiriva (tiotropium) (and other long-acting bronchodilators) has to do with cardiovascular risks. An epidemiological study from Canada suggested that when older patients start taking such medications, they increased their risk of trips to an emergency department or hospitalization due to cardiovascular causes. This study reignites a controversy about the cardiovascular safety of these drugs for COPD patients. Here is a commentary that puts this whole issue into perspective.

An article in the International Journal of Chronic Obstructive Pulmonary Disease (Nov. 25, 2016) discusses LAMAs and LABAs. A LAMA is a long-acting muscarinic antagonist. That’s doctorspeak for an anticholineric drug like tiotropium. A LABA is a long-acting beta agonist. That means it is a bronchodilator like salmeterol or formoterol. Here is what the authors say about cardiovascular complications:

“Due to their mechanisms of action, both LAMAs and LABAs have the potential to cause cardiac-related adverse events (AEs). LAMAs suppress parasympathetic control of heart rate (HR) and LABAs stimulate sympathetic control of HR. These effects serve to raise HR with the potential to cause cardiac arrhythmias, myocardial infarction (MI), stroke, and sudden death in susceptible patients.”

The authors strongly argue for additional studies to determine the cardiovascular safety of LAMAs and LABAs. In fact they are undertaking just such a study, but results won’t be known for some time.

In the Meantime:

Until this confusion is resolved, physicians and patients will need to be vigilant for any symptoms that might suggest heart or other vascular complications.

Should you wish to learn more about a different approach to COPD and asthma, you may find the book by David Hahn, MD, MPH, of interest. It is titled: “A Cure for Asthma: What Your Doctor Isn’t Telling You–And Why.” What is fascinating about Dr. Hahn’s book is that it discusses in detail the use of antibiotics for helping overcome asthma symtpoms. The same antibiotic he reviews, azithromycin, has been tested in the treatment of COPD. An article in the New England Journal of Medicine (Aug. 25, 2011) concluded:

“Among selected subjects with COPD, azithromycin taken daily for 1 year, when added to usual treatment, decreased the frequency of exacerbations and improved quality of life but caused hearing decrements in a small percentage of subjects.”

Should you be interested in more information about the use of antibiotics in the treatment of asthma, we think Dr. Hahn’s book is valuable. We are proud to be publishing this ground-breaking book. If you know someone with asthma, please let him or her know about this important information. Here is a link to more information about Dr. Hahn’s provocative book. If you want to go straight to the shopping cart, here is the link.

Remember, no one should ever stop any medication without careful communication with the prescribing physician. That is especially true for life-threatening conditions like asthma or COPD.

To learn more about anticholinergic drugs, here is a link:

Where Can I Find a List of Anticholinergic Drugs?

Share your own experiences with Spiriva below. Has it worked well for your COPD symptoms? Have you had to contend with side effects? Let us and other visitors to this website know how you have made out with this medication.

Revised: 9-21-17

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I had been using Spiriva for about 5 years when realized my insomnia was getting worse. Would go to sleep fine, but woke many times and quite often was up 2-3 hours in the middle of the night. Saw that something about Spiriva might be a problem so stopped it. Started sleeping like a baby. For about 4 months have used it only once every 5-6 days and have realized something else: I no longer have any GERD problems OR chest pains (Costochondritis). When I do use it, the 2nd or 3rd night afterward I plan on not sleeping well. My TMJ issues have calmed down also.

I was prescribed Spirit by my allergist to replace Advair for my allergent asthma in August of 2017. Nearly immediately, I began having sinus problems, INCREASED difficulty breathing, a cough, and my voice became very hoarse. Initially, I thought it was my fall (seasonal) allergies but when it continued, I thought it was just a very, very bad viral cold. Why I let it go one for 6 months is anyone’s guess, but I did and went to my PCP who told me to stop using it immediately. He was particularly concerned with my severely hoarse throat (probably because he could definitely hear that) and sent me to a Ear/Nose/Throat specialist to make sure no permanent damage had been done.

I was never told by my allergist that I should thoroughly rinse my mouth immediately after using although she had emphasized I do that when I was on Advair. Should I have read the small print insert? Yes, but I didn’t and wow, did I suffer. Thankfully, no permanent damage, but be careful with this drug.

My problems with Spiriva after 1 year: Immense weight gain, left side pain below ribs in my back, memory problems, my arthritis aches more, dry mouth (teeth are loosening up), terribly dry skin even though I drink 4 – 16 oz glasses of water daily. Now I have started with pain in my heart area off and on, and now I know why (reading this column). But will still have it checked out. Once I stopped Spiriva Handihaler I’ve been dropping weight steadily, no pain, no dry mouth, and memory sharpness is returning. I am on oxygen and a CPAP whenever I lie down, and my readings have not been any different since stopping Spiriva. I have been on ProAir for 10 years with no problems. Can’t take Advair as I have an allergic reaction to it. Have you ever noticed 2 -3 empty capsules in your box? Drove me nuts.

I took Spiriva for less than two months. It helped my breathing, but by week 7 I was overheating at night. This wasn’t a hot flush or night sweat. It was incredibly severe. It also caused frequent urination and sleeplessness, aside from the dry mouth etc.. I had to stop.

It was great for the first week. Then the fast heart beat started and my fog and joint pain worsened. I started having vivid night mares on top of it. It seems to have magnified my list of problems. Now, I only use it when its absolutely necessary and only 3 days at a time.

I have asthma, was prescribed Spiriva. I was hospitalized with cardiac arrythmia. My allergist attributed this to Spiriva and reduced the frequency to 3 times a week which prevented recurrence of arrhythmia. I continue to have a dry mouth and dry eyes requiring prescription eye drops. Your column suggests less Spiriva may be warranted.

It truly amazes me that the FDA approves these drugs, and then doctors prescribe them. Also, I hate all the ads for drugs. Yes, they do give a list of possible side effects that are spoken so quickly and softly it’s difficult for someone with good hearing to pick everything up.

I briefly tried taking a generic antidepressant, and the side effects were pretty intense. My doctor kept saying they’d most likely go away in a week or two. Are you kidding me?!

There’s something awfully irresponsible in the way people are medicated. I understand that there are conditions that allow no choice, but most of the time, I think there are alternatives or maybe we just have to accept the fact that not everything is “curable” with the drugs we currently have.

Meanwhile, the price of drugs keeps rising while companies put out garbage.

i have copd from welding and smoking,i was ok till i took spiriva powder for 12 months,gave it up for 5 months then had lung infection and antibiotics and spiriva again,then all of a sudden spirive took my breath away,tried spiriva respimat twice,ended in emergency on morphine for pain twice,used atrovent and flutiform effectively ,virtually living on augmentum 1000mg,doxycyllin 100 mg daily,ended up hospital with pneumonia for 8 days ,iv anti biotics ,came out really good for 2 weeks then lost my breath again for last month and cant work it out.

Leah N. I have been on Spiriva for about 12 yrs.I have mild bronchitis.For the past couple months i have noticed after taking spiriva i have an ache in my throat & short of breath.Recently i had heart flutter which lasted for 20 min.Never happen to me before.I want to stop the spiriva & wondering if it is safe to do so.As i mentioned i only have mild bronchitis.

I was given a spiriva prescription today and just inhaled my first dose. I feel some clearing in lungs but some blurred vision and shakiness in my legs which prompted me to find this page. After reading it I am very tempted to stop after one dose. My doc says I y have a small symptom of emphazima. I wonder what percentage of users get bad side effects?

I was a smoker for 50 years and was diagnosed with COPD nearly 30 years ago. Didn’t take that serious and continued smoked up until 10 years ago. However I took no medications for it until I ended up in the hospital with pneumonia 6 years ago. The problem with COPD is that doctors treat it like asthma and give you albuterol when you are having breathing problems (with a cold or flu) this CAUSES your heart to race and then they get all into giving you heart medicine when all you need is the comfort of oxygen.

I now have it in my medical records that I do not want albuterol. The doctors at the hospital nearly killed me with all of their heart drugs and the albuterol. Now I have oxygen at home and will probably never need to go to the hospital again when I feel I can’t breathe. I now take Spiriva but after reading all of this I am going to discuss it with my Dr. I am so sick of having dry skin (yuck) but didn’t know what was causing it.

I guess what I am saying here is that from my point of view you don’t need medication for every diagnoses of COPD. Wait until you can’t walk a block without stopping and have oxygen available when you need it. Everyone should have an oximeter with them at all times. Talk with your doctor about this.

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