A STIOLTO RESPIMAT inhaler spraying a mist

Starting STIOLTO RESPIMAT with 
ease

STIOLTO RESPIMAT: 3 simple steps for daily use1

After preparing the RESPIMAT® inhaler for the first time, patients can remember the steps for daily use with TOP (Turn, Open, Press)

A STIOLTO RESPIMAT inhaler with an arrow showing the turning action
A STIOLTO RESPIMAT inhaler with an arrow showing the opening action
A STIOLTO RESPIMAT inhaler with an arrow showing the pressing action

Help patients quickly learn how to make STIOLTO RESPIMAT part of their daily routine

Watch the RESPIMAT Quick Start video, which teaches patients how to prepare and use their inhaler

(0:00-0:16)   

Hi, I'm Sarah, a healthcare professional, and today I will be helping a patient like you learn how to prepare and use the RESPIMAT® inhaler. In order to feel confident that it's helping deliver the medicine your doctor prescribed, it's important to familiarize yourself with the RESPIMAT inhaler and how to use it properly.   

(0:17-0:38)   

The RESPIMAT inhaler delivers a soft mist that eases the effort to inhale your medicine. This instructional video has been created to help you get the most from your treatment through proper inhaler use. Each month, when you refill your prescription and receive your new RESPIMAT inhaler, you can watch this video to ensure you're doing the steps correctly and get the full benefit of your treatment.   

(0:39-0:52)   

Today I'll be working with Henry, a patient like you. This is his first time using the RESPIMAT inhaler. We will be going through the steps of using the RESPIMAT inhaler together so he can become familiar and feel comfortable using it as part of his treatment plan.   

(0:53-1:33)   

I tell Henry that I'm going to help him assemble and prime his inhaler. This will be presented in 4 sections: Label your “discard by” date; load your medication; prepare your inhaler; and spray 4 mists. Then, I'm going to educate Henry on using his inhaler every day using the TOP method. Henry looks intimidated, but I assure him that he has nothing to worry about. Like anything new, once you become familiar with the process, you will feel more comfortable, and be able to do the steps on your own. I remind him he can always refer to this instructional video as a refresher to ensure he is preparing and using his RESPIMAT inhaler correctly.   

(1:34-1:42)   

First, let's take a look at the components of the RESPIMAT inhaler. Depending on what your doctor prescribed, your inhaler cap may be a different color.   

(1:47-2:12)   

Before we go into detail about how to use the RESPIMAT inhaler, it's important for Henry and you to become familiar with the RESPIMAT inhaler components or parts. There are two main components: the inhaler, which consists of the cap, mouthpiece, air vent, dose-release button, safety catch button, and the clear base with the piercing element; and then the cartridge that holds the medication that fits inside.   

(2:13-2:45)   

The safety catch button along the side allows the clear base to separate from the top of the inhaler. Pushing up on the cap’s opening tab reveals the mouthpiece. Along the sides of the mouthpiece are two air vents. Be sure not to cover these when using the inhaler. The medicine is discharged as a soft mist from the medication cartridge when the dose-release button is pressed. A dose indicator on the side of the inhaler shows about how many doses are left. When the indicator points to the red area, it's time to prepare your next inhaler.   

(2:46-2:50)   

How do you assemble the RESPIMAT inhaler? We'll cover that next.   

(2:55-3:22)   

I give Henry a RESPIMAT inhaler and together we go through the steps to assemble it. First, press the gray safety catch button, then with the other hand, pull down on the clear base. This lets the two pieces come apart. I point out the piercing element and remind Henry to be careful not to touch it. Next, we write the “discard by” date on the label. Once the medicine is put into the inhaler, it is good for 3 months. So, the discard date is 3 months from today's date.   

(3:23-3:42)   

To load his medication, Henry inserts the narrow end of the cartridge into the inhaler. Placing the inhaler on a flat surface like a table or counter, Henry pushes down firmly until he hears a click. He then replaces the clear base by aligning the notch with the safety catch button and slides them together until they click.   

(3:43-3:45)   

Now the inhaler is ready for priming.   

(3:49-4:31)   

Before it can be used for the first time, the assembled inhaler needs to be primed. I show Henry how to prepare his RESPIMAT inhaler. With the cap closed, I turn the clear base half a turn and hear a click. Next, we push up on the circular opening tab until the cap snaps fully open. With the inhaler pointed toward the ground, we press the dose-release button. We then repeat turn, open, press, with the inhaler pointed toward the ground, until there are 4 mists released from the inhaler. Between each spray, I remind Henry to close the cap and turn the base until he hears a click. The arrows on the label are there as a reminder of the direction the base turns. Henry's inhaler is now ready for daily use.   

(4:32-4:42)   

Feel free to watch this section again and go through the steps one more time if you have any questions. Otherwise, you’re ready to move on to using your RESPIMAT inhaler daily.   

(4:46-5:08)   

To use his RESPIMAT inhaler daily, Henry uses the word “TOP” to remember the steps. That stands for Turn, Open, and Press. For “Turn,” with the cap closed, Henry turns the clear base in the direction of the arrows half a turn until he hears a click. For “Open,” he pushes on the small circular tab until the cap snaps fully open.   

(5:09-5:43)   

“Press” is how he takes the medication. He starts by breathing in and then out slowly and fully to empty his lungs. Placing his lips around the mouthpiece, being careful not to cover the air vents, he points the inhaler at the back of his throat. While taking a slow, deep breath through his mouth, Henry presses the dose-release button. After inhaling his medication, Henry holds his breath for 10 seconds or for as long as comfortable for him. Depending on what medication your doctor has prescribed, you may need to repeat this. Remember to use your medication as directed by your doctor.   

(5:44-5:52)   

When the dose indicator on the side moves into the red area, it's time for Henry to prepare his next inhaler, using the same steps I showed him in the office.   

(5:54-6:16)   

Henry is no longer apprehensive about using his new RESPIMAT inhaler. Now that Henry is home, he might have questions. If so, he can consult the Instructions for Use inside the medication box, speak to his doctor or pharmacist, or call 1-800-542-6257. He can also go to RespimatQuickStart.com for more help.   

(6:17-6:23)   

The RESPIMAT inhaler. For daily use, remember “TOP” for Turn, Open, and Press.

The Quick Start Guide is available here and on the patient site

1 dose = 2 puffs once daily

Make sure patients know the dosing of STIOLTO RESPIMAT. Remind patients not to use more than 2 puffs every 24 hours.

INDICATION for STIOLTO RESPIMAT

STIOLTO® RESPIMAT® (tiotropium bromide and olodaterol) Inhalation Spray is a combination of tiotropium, an anticholinergic, and olodaterol, a long-acting beta2-adrenergic agonist (LABA), indicated for the long-term, once-daily maintenance treatment of patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.

 

Important Limitations of Use

STIOLTO is NOT indicated to treat acute deterioration of COPD and is not indicated to treat asthma.

IMPORTANT SAFETY INFORMATION for STIOLTO RESPIMAT

CONTRAINDICATION

Use of a LABA, including STIOLTO RESPIMAT, without an inhaled corticosteroid (ICS) is contraindicated in patients with asthma.

STIOLTO is contraindicated in patients with hypersensitivity to tiotropium, ipratropium (atropine derivatives), olodaterol, or any component of this product.

In clinical trials and postmarketing experience with tiotropium, immediate hypersensitivity reactions, including angioedema (including swelling of the lips, tongue, or throat), itching, or rash have been reported. Hypersensitivity reactions were also reported in clinical trials with STIOLTO.

 

WARNINGS AND PRECAUTIONS

LABA as monotherapy (without an ICS), for asthma increases the risk of asthma-related death, and in pediatric and adolescent patients, increases the risk of asthma-related hospitalizations.

Do not initiate STIOLTO in patients with acutely deteriorating COPD, which may be a life-threatening condition, or used as rescue therapy for acute symptoms. Acute symptoms should be treated with an inhaled short-acting beta2-agonist.

STIOLTO should not be used more often or at higher doses than recommended, or with other LABAs as an overdose may result.

If immediate hypersensitivity reactions occur, such as urticaria, angioedema, rash, bronchospasm, anaphylaxis, or itching, discontinue STIOLTO at once and consider alternative treatment. Patients with a history of hypersensitivity reactions to atropine or its derivatives should be closely monitored for similar hypersensitivity reactions to STIOLTO.

If paradoxical bronchospasm occurs, discontinue STIOLTO immediately and institute alternative therapy.

STIOLTO can produce a clinically significant cardiovascular effect in some patients, as measured by increases in pulse rate, systolic or diastolic blood pressure, and/or symptoms. If such effects occur, STIOLTO may need to be discontinued.

Use caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, in patients with known or suspected prolongation of the QT interval, and in patients who are unusually responsive to sympathomimetic amines.

Use with caution in patients with narrow-angle glaucoma. Instruct patients to contact a physician immediately if signs or symptoms of acute narrow-angle glaucoma develop.

Use with caution in patients with urinary retention especially in patients with prostatic hyperplasia or bladder-neck obstruction. Instruct patients to consult a physician immediately should any of these signs or symptoms develop.

Patients with moderate to severe renal impairment (creatinine clearance of <60 mL/min) should be monitored closely for anticholinergic side effects.

Be alert to hypokalemia and hyperglycemia.

ADVERSE REACTIONS

The most common adverse reactions with STIOLTO (>3% incidence and higher than an active control) were: nasopharyngitis, 12.4% (11.7%/12.6%), cough, 3.9% (4.4%/3.0%), and back pain, 3.6% (1.8%/3.4%).

DRUG INTERACTIONS
  • Use caution if administering adrenergic drugs because sympathetic effects of olodaterol may be potentiated.

  • Concomitant treatment with xanthine derivatives, steroids, or diuretics may potentiate any hypokalemic effect of olodaterol.

  • Use with caution in patients taking non–potassium-sparing diuretics, as the ECG changes and/or hypokalemia may worsen with concomitant beta-agonists.

  • The action of adrenergic agents on the cardiovascular system may be potentiated by monoamine oxidase inhibitors or tricyclic antidepressants or other drugs known to prolong the QTc interval. Therefore, STIOLTO should be used with extreme caution in patients being treated with these drugs. Use beta-blockers with caution as they not only block the therapeutic effects of beta-agonists, but may produce severe bronchospasm in patients with COPD.

  • Avoid co-administration of STIOLTO with other anticholinergic-containing drugs as this may lead to an increase in anticholinergic adverse effects.  
     

STIOLTO is for oral inhalation only.

The STIOLTO cartridge is only intended for use with the STIOLTO RESPIMAT inhaler.

Inform patients not to spray STIOLTO into the eyes as this may cause blurring of vision and pupil dilation.

CL-STO-100021 6.5.2019

Please see full Prescribing Information, Patient Information, and Instructions for Use for STIOLTO RESPIMAT.

REFERENCE
  1. STIOLTO RESPIMAT [prescribing information]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc; November 2021.