What is Stiolto Respimat, and how does it work (mechanism of action)?

Stiolto Respimat is a combination of inhaled medications used for treating chronic obstructive pulmonary disease (COPD). It consists of two medications, tiotropium bromide (Spiriva) and olodaterol (Striverdi Respimat).

Tiotropium bromide is an inhaled bronchodilator that enlarges (dilates) airways (bronchi) in the lungs and is used for treating COPD. Tiotropium bromide blocks the effect of acetylcholine on airways (bronchi). Acetylcholine is a chemical that nerves use to communicate with muscle cells. In people with chronic obstructive pulmonary disease, cholinergic nerves going to the lungs cause narrowing of the airways by stimulating muscles surrounding the airways to contract. The "anti-cholinergic" effect of tiotropium blocks the effect of cholinergic nerves, causing the muscles to relax and airways to dilate.

Olodaterol also is an inhaled bronchodilator that relaxes lung airways, improving breathing in people with COPD. Olodaterol is a long acting beta-2 adrenergic agonist (LABA) bronchodilator. Beta-2 agonists are medications that stimulate beta-2 receptors on smooth muscle cells that line the airways, causing these muscle cells to relax, thus, opening airways.

Combining two bronchodilators with different mechanisms of action improves breathing more than either drug alone. Stiolto (Respimat improved breathing better than tiotropium bromide or olodaterol in clinical studies.) The FDA approved Stiolto Respimat on May 26, 2015.

What brand names are available for Stiolto Respimat?

Stiolto Respimat

Is Stiolto Respimat available as a generic drug?


Do I need a prescription for Stiolto Respimat?


What are the side effects of Stiolto Respimat?

Common side effects of Stiolto Respimat are

It also causes

In clinical trials the most frequent serious adverse effects reported were worsening of COPD and pneumonia.

Long-acting beta2-adrenergic agonists such as olodaterol, one of the active ingredients in Stiolto Respimat, increases the risk of asthma-related death.

What is the dosage for Stiolto Respimat?

The recommended dose is 2 oral inhalations once daily at the same time of day.

Which drugs or supplements interact with Stiolto Respimat?

  • Other drugs that affect blood pressure, heart rate, and have similar effects as epinephrine and norepinephrine increase side effects of Stiolto Respimat.
  • Combining Stiolto Respimat with steroids, diuretics, or xanthines, for example, theophylline (Respbid, Slo-Bid, Theo-24) increases the risk of low blood potassium (hypokalemia).
  • Stiolto Respimat should not be used with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, or other drugs that affect heart rhythm because such combinations may increase the risk of abnormal heartbeats.
  • Beta-blockers, for example, propranolol (Inderal, Inderal LA, Innopran XL) may block the effects of olodaterol and may produce bronchospasms in people with COPD.
  • Anticholinergic drugs add to the anticholinergic effects of tiotropium, leading to increased side effects.
  • Ketoconazole (Nizoral, Extina, Xolegel, Kuric) and other drugs that reduce the activity of certain liver enzymes may increase blood levels of olodaterol.


COPD (chronic obstructive pulmonary disease) is the same as adult-onset asthma. See Answer

Is Stiolto Respimat safe to take if I'm pregnant or breastfeeding?

The safety of Stiolto Respimat or any of its components in pregnant women has not been adequately evaluated.

Use of Stiolto Respimat or its components in nursing mothers has not been evaluated.

What else should I know about Stiolto Respimat?

What preparations of Stiolto Respimat are available?

Inhalation Spray: 2.5 mcg tiotropium/2.5 mcg olodaterol per actuation (each inhalation)

How should I keep Stiolto Respimat stored?

Store Stiolto Respimat at room temperature between 59 F and 86 F (15 C to 30 C).


Tiotropium bromide and olodaterol (Stiolto Respimat) is a combination of inhaled medications prescribed to treat (COPD) chronic obstructive pulmonary disease. Side effects, drug interactions, dosing, storage, and pregnancy and breastfeeding information should be reviewed prior to using this drug.

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