Tiotropium

Oral health effects

• Xerostomia

  Dry mouth is the most common side effect of long-acting inhaled anticholinergics.

  Mechanism: Muscarinic receptor blockade.

  Clinical management: Advise rinsing after inhaler use; reinforce fluoride and hydration.

• Oropharyngeal candidiasis (thrush)

  Oropharyngeal candidiasis occurred in 1-3% of COPD patients (Respimat 5 mcg) and 1-2% of asthma patients (2.5 mcg), more often than with placebo. It is also reported with the HandiHaler. Anticholinergic dry mouth adds to the risk.

  Clinical management: Examine for white or erythematous patches, especially in denture wearers with dry mouth. Refer for antifungal therapy. Advise rinsing after dosing and nightly denture removal and cleaning.

• Mouth irritation (stomatitis, gingivitis, glossitis) and hoarseness

  Dysphonia occurred in 1-3% of COPD patients on Respimat 5 mcg. Gingivitis (<1%), stomatitis (including ulcerative stomatitis), glossitis and mouth ulceration are reported less often in trials and postmarketing.

  Clinical management: Inspect the mucosa and gingiva at recall. Bland rinses and a soft brush for soreness. Manage dry mouth (often the underlying driver), and refer for persistent ulceration or hoarseness.