Drug interactions
Physostigmine + Tiotropium
Severity: Moderate
Physostigmine and Tiotropium: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Physostigmine inhibits acetylcholinesterase and increases cholinergic activity, which opposes the muscarinic blockade of tiotropium. The effect of each drug may be reduced. Physostigmine can also cause bronchoconstriction and bradycardia.
What this interaction means in plain words
Physostigmine and Tiotropium can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Pharmacodynamic antagonism between cholinesterase inhibition and muscarinic receptor blockade.
What to do
Monitor respiratory status, heart rate and secretions when physostigmine is given to patients using tiotropium. Be prepared to treat bronchospasm or bradycardia.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Tiotropium
Frequently asked questions
Can I take Physostigmine with Tiotropium?
MediHelp rates the interaction as moderate. Physostigmine and Tiotropium can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Physostigmine inhibits acetylcholinesterase and increases cholinergic activity, which opposes the muscarinic blockade of tiotropium. The effect of each drug may be reduced. Physostigmine can also cause bronchoconstriction and bradycardia.
How serious is the interaction between Physostigmine and Tiotropium?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor respiratory status, heart rate and secretions when physostigmine is given to patients using tiotropium. Be prepared to treat bronchospasm or bradycardia.
What other medicines interact with Tiotropium?
MediHelp also lists interactions of Tiotropium with, for example, Glycopyrrolate inhaled, Indacaterol-glycopyrronium, Revefenacin. The full list is on the Tiotropium page.
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