Sirkava (tiotropium 18 mcg): Uses, Dosage & Side Effects
Long-acting anticholinergic bronchodilator for COPD maintenance therapy
Quick facts about Sirkava
Key takeaways about Sirkava
- Once-daily inhaler: One 18 mcg capsule is inhaled once per day, at the same time each day, to provide continuous 24-hour airway protection in COPD
- Not a rescue inhaler: Sirkava does not relieve sudden breathlessness — always carry a fast-acting rescue inhaler (such as salbutamol) for acute symptoms
- Capsules are for inhalation, never swallowed: Each capsule must be placed into the dry powder inhaler device and pierced so the powder can be inhaled into the lungs
- Avoid contact with the eyes: Powder reaching the eyes may trigger or worsen narrow-angle glaucoma — seek eye care urgently if you develop eye pain, halos around lights, or blurred vision
- Dry mouth is the most common side effect: Sip water regularly, rinse your mouth after each inhalation, and attend routine dental checkups to reduce the risk of tooth decay
What Is Sirkava and What Is It Used For?
Sirkava is a long-acting anticholinergic (muscarinic antagonist) bronchodilator containing 18 micrograms of tiotropium per hard capsule. It is prescribed for the daily maintenance treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Sirkava works by blocking M3 muscarinic receptors in airway smooth muscle, keeping the airways open for around 24 hours after a single inhalation.
Sirkava belongs to the pharmacological class known as long-acting muscarinic antagonists (LAMAs), a cornerstone of international COPD guidelines. The active substance, tiotropium bromide, is one of the most extensively studied bronchodilators in respiratory medicine, with more than two decades of clinical data supporting its efficacy and safety in the long-term management of COPD. Sirkava is supplied as a dry powder contained in hard gelatin-free capsules, each of which is placed into a handheld inhaler device at the time of use.
Chronic obstructive pulmonary disease is a progressive lung condition characterised by persistent airflow limitation that is not fully reversible. COPD encompasses two main pathological processes: chronic bronchitis, marked by a chronic productive cough and mucus hypersecretion, and emphysema, in which the delicate air sacs of the lungs (alveoli) are destroyed and enlarged, reducing the surface area available for oxygen exchange. Most people with COPD have features of both. Because the underlying airflow obstruction is ongoing, Sirkava must be used every day — not only when symptoms worsen.
When a Sirkava capsule is inhaled, tiotropium is deposited directly onto the bronchial smooth muscle lining the airways. There it binds to muscarinic receptors and prevents the airways from contracting in response to acetylcholine, the body's main parasympathetic neurotransmitter. The result is sustained bronchodilation throughout the full 24-hour dosing interval, allowing easier airflow into and out of the lungs. In landmark randomised controlled trials of tiotropium, including the 4-year UPLIFT study, regular treatment significantly improved lung function (measured by forced expiratory volume in 1 second, FEV1), reduced the number and severity of COPD exacerbations, decreased the need for unscheduled healthcare visits, and improved overall health-related quality of life.
In clinical practice, Sirkava is typically prescribed for patients with moderate to severe COPD (GOLD groups B, E, or higher) who experience persistent breathlessness despite as-needed rescue therapy, or who have a history of frequent exacerbations. It may be used alone (monotherapy) or as part of dual or triple inhaled therapy in combination with a long-acting beta-agonist (LABA) and, where indicated, an inhaled corticosteroid (ICS). Your prescribing physician will determine the most appropriate strategy based on your symptom burden, exacerbation history, and overall lung function.
Sirkava must not be used to treat sudden shortness of breath, chest tightness, wheezing attacks, or acute worsening of COPD symptoms. For acute symptoms, always use a fast-acting short-acting beta-agonist (SABA) such as salbutamol (albuterol) or a short-acting anticholinergic such as ipratropium in a separate inhaler, as prescribed by your doctor. Keep your rescue inhaler with you at all times.
How does Sirkava work?
The airways are surrounded by smooth muscle that can tighten and narrow the bronchial tubes, making breathing more difficult. One of the main triggers of this airway narrowing is acetylcholine, a chemical messenger released from nerves of the parasympathetic nervous system. Acetylcholine acts on specific muscarinic M3 receptors on the surface of airway smooth muscle cells, causing them to contract.
Tiotropium, the active substance in Sirkava, binds tightly to these M3 receptors and blocks acetylcholine from activating them. As a result, the airway muscles relax and the bronchial tubes widen (bronchodilation). What distinguishes tiotropium from older, short-acting anticholinergics such as ipratropium is its exceptionally slow dissociation from the M3 receptor: once bound, tiotropium remains attached for many hours. This long receptor occupancy is the molecular basis of its 24-hour duration of action and allows convenient once-daily dosing. The onset of bronchodilation begins within approximately 30 minutes of inhalation, peak effect occurs 1–3 hours later, and meaningful improvement in lung function is maintained for a full 24 hours.
Sirkava formulation and device
Sirkava is available as inhalation powder in hard capsules containing 18 micrograms of tiotropium. The capsules are not intended to be swallowed. Instead, each capsule is placed into a small, handheld dry powder inhaler (DPI) device. Pressing a side button on the device pierces the capsule, so that the micronised powder can be inhaled through the mouthpiece. The delivered dose reaching the lungs is approximately 10 micrograms per inhalation; the remainder is retained in the capsule shell or deposited in the mouth and throat.
- Capsule strength: 18 mcg of tiotropium per hard capsule
- Dosing frequency: One capsule inhaled once daily, at the same time each day
- Device type: Single-dose breath-activated dry powder inhaler (DPI)
- Indication: Maintenance treatment of COPD in adults
Sirkava is one of several approved products containing tiotropium 18 mcg for inhalation via a capsule-based dry powder inhaler. Other internationally available tiotropium products include Spiriva HandiHaler (the original reference product from Boehringer Ingelheim) and a range of generic versions. The active ingredient, dose, and clinical effect are equivalent when used with the device specified in the product information. Do not mix capsules between different brands of inhalers.
What Should You Know Before Taking Sirkava?
Before starting Sirkava, tell your doctor if you have narrow-angle glaucoma, prostate enlargement or urinary difficulties, moderate to severe kidney impairment, a recent heart attack, unstable heart rhythm disorders, or severe heart failure. Sirkava must not be used if you are allergic to tiotropium, atropine or atropine-like substances (such as ipratropium or oxitropium), or to any of the excipients in the capsules (including lactose and, in some cases, milk proteins).
Like every active medicine, Sirkava is not suitable for everyone. A careful medical history and review of your current medications helps ensure that Sirkava is both safe and effective for you. Be sure to mention any chronic conditions, past allergic reactions to inhaled or injected drugs, and any supplements or over-the-counter medicines you are taking, even if they seem unrelated to your breathing problems.
Contraindications
You must not use Sirkava if any of the following apply to you:
- Known hypersensitivity (allergy) to tiotropium, tiotropium bromide, or any of the inactive ingredients in Sirkava capsules
- Known hypersensitivity to atropine or to atropine-like (anticholinergic) substances such as ipratropium or oxitropium
- Severe allergy to milk proteins — Sirkava capsules contain lactose monohydrate, which can contain trace amounts of milk protein
Warnings and precautions
Talk to your doctor, pharmacist, or nurse before using Sirkava if any of the following situations apply, as special caution, monitoring, or dose adjustment may be required:
- Narrow-angle glaucoma: Tiotropium may increase intraocular pressure. If inhaled powder accidentally reaches the eyes, it can precipitate or worsen an acute angle-closure glaucoma attack. Warning signs include eye pain or discomfort, blurred vision, seeing halos or rainbow-coloured rings around lights, red eyes, and swelling of the conjunctiva. Seek immediate medical attention, preferably from an ophthalmologist, if these symptoms occur.
- Prostate enlargement and bladder-neck obstruction: Anticholinergic medicines can worsen urinary retention. Report any new or increasing difficulty passing urine, weak stream, or incomplete emptying to your doctor.
- Kidney impairment: Tiotropium is partly excreted unchanged in the urine. Patients with moderate to severe renal impairment (creatinine clearance ≤ 50 mL/min) should only use Sirkava when the benefits clearly outweigh the potential risks, and should be monitored for anticholinergic side effects.
- Recent cardiovascular events: Patients with a myocardial infarction within the past 6 months, unstable or life-threatening cardiac arrhythmias, or severe heart failure within the past year were excluded from the pivotal clinical trials. Inform your doctor of any significant cardiac history before starting Sirkava.
- Asthma: Sirkava 18 mcg inhalation powder is approved for COPD, not for asthma. Using it for asthma maintenance is off-label and should only be done under specialist supervision with an appropriate product and dose.
Tiotropium reduces saliva production, which can cause persistent dry mouth. Long-standing xerostomia (dry mouth) is associated with an increased risk of dental caries (tooth decay), gum disease, and oral yeast infections. Maintain meticulous oral hygiene, rinse your mouth with water after each inhalation, attend regular dental checkups, and ask your dentist about fluoride rinses or sugar-free saliva substitutes if dry mouth is bothersome.
Hypersensitivity reactions: Immediate hypersensitivity reactions such as rash, itching, urticaria (hives), swelling of the face or tongue (angioedema), wheezing, or shortness of breath may occur after inhaling Sirkava. If you experience any of these symptoms, stop using Sirkava and seek medical advice immediately. Severe allergic reactions (anaphylaxis) are rare but are a medical emergency requiring urgent treatment.
Paradoxical bronchospasm: As with any inhaled medication, Sirkava may very rarely provoke sudden tightening of the airways (bronchospasm) immediately after inhalation, resulting in cough, wheeze, chest tightness, and worsening breathlessness. If this happens, use your rescue inhaler at once, stop Sirkava, and contact your doctor before taking any further dose.
Pregnancy and breastfeeding
There is only limited clinical data on the use of Sirkava during pregnancy and breastfeeding. Reproductive studies in animals have not demonstrated direct harmful effects on fertility, embryo-fetal development, parturition, or postnatal development at doses comparable with therapeutic use; however, no controlled studies have been conducted in pregnant women. As a precaution:
- Do not use Sirkava during pregnancy unless your doctor specifically recommends it after carefully weighing the potential benefits against the risks.
- It is not known whether tiotropium is excreted into human breast milk. The decision to continue or discontinue breastfeeding, or to continue or discontinue Sirkava, should take into account the benefit of breastfeeding to the child and the benefit of Sirkava for the mother.
- If you are planning to become pregnant, discuss your COPD treatment plan with your doctor to ensure optimal management of your respiratory health throughout pregnancy.
Children and adolescents
Sirkava is intended for adults only. The safety and efficacy of Sirkava 18 mcg capsule inhalation powder have not been established in children and adolescents under 18 years of age for the treatment of COPD, and it should not be used in this age group for that indication.
Driving and operating machinery
Side effects such as dizziness, headache, or blurred vision may occur with Sirkava. If you experience any of these symptoms, you should avoid driving, cycling, or operating heavy machinery until they have fully resolved. You are personally responsible for assessing whether you are safe to perform tasks that require full alertness and clear vision.
How Does Sirkava Interact with Other Drugs?
The main interaction concern with Sirkava is the concomitant use of other anticholinergic medicines, which must be avoided due to additive side effects. Sirkava has a low potential for clinically significant interactions with most other drugs and can be safely combined with standard COPD therapies such as short- and long-acting beta-agonists, inhaled corticosteroids, theophylline, and oral corticosteroids.
One of the practical strengths of Sirkava is its favourable drug-interaction profile. Because tiotropium is delivered directly into the airways and has minimal systemic absorption, its potential to interact with oral or injected medications through metabolic pathways (such as cytochrome P450 enzymes) is very low. However, there are important considerations regarding the use of other anticholinergic drugs and overall anticholinergic burden, particularly in older patients.
Major interactions
The most clinically important interactions occur with other anticholinergic medicines, whether inhaled, oral, or transdermal. Using Sirkava together with these drugs can cause additive anticholinergic effects, including worsened dry mouth, constipation, urinary retention, blurred vision, and increased intraocular pressure, without adding therapeutic benefit:
| Drug | Class | Risk | Recommendation |
|---|---|---|---|
| Ipratropium | Short-acting muscarinic antagonist (SAMA) | Additive anticholinergic effects; no additional bronchodilation | Do not use together |
| Oxitropium | Anticholinergic bronchodilator | Additive anticholinergic effects | Do not use together |
| Umeclidinium | Long-acting muscarinic antagonist (LAMA) | Duplicate LAMA therapy; no additional benefit, increased side effects | Do not use together |
| Glycopyrronium | Long-acting muscarinic antagonist (LAMA) | Duplicate LAMA therapy | Do not use together |
| Aclidinium | Long-acting muscarinic antagonist (LAMA) | Duplicate LAMA therapy | Do not use together |
| Tricyclic antidepressants, antihistamines, antimuscarinic urinary agents | Systemic anticholinergics | Additive anticholinergic load (dry mouth, constipation, confusion, urinary retention), especially in older adults | Use with caution; review regularly |
Minor interactions
In specific clinical studies, tiotropium has been co-administered with commonly used COPD medications without producing clinically meaningful interactions. There is no requirement to adjust the dose of Sirkava when it is used alongside:
- Short-acting beta-agonists (SABAs): Salbutamol (albuterol), terbutaline — typically used as rescue inhalers for sudden symptoms
- Long-acting beta-agonists (LABAs): Formoterol, salmeterol, indacaterol, olodaterol, vilanterol — often combined with tiotropium for dual bronchodilation
- Inhaled corticosteroids (ICS): Budesonide, fluticasone, beclomethasone, mometasone — useful in patients with frequent exacerbations or asthma-COPD overlap
- Methylxanthines: Theophylline, aminophylline
- Oral corticosteroids: Prednisolone, prednisone — typically used short-term for exacerbations
- Phosphodiesterase-4 (PDE4) inhibitors: Roflumilast — for severe COPD with chronic bronchitis and frequent exacerbations
- Mucolytics: N-acetylcysteine, carbocisteine, erdosteine
Older adults with COPD often take several medicines with anticholinergic properties (for bladder symptoms, allergies, depression, or sleep). This cumulative “anticholinergic burden” can increase the risk of dry mouth, constipation, confusion, falls, and urinary problems. Ask your doctor or pharmacist to review all your prescriptions and over-the-counter medicines at least once a year while you are taking Sirkava.
Alcohol, food, and tobacco
Sirkava is not known to interact significantly with alcohol or food. However, smoking is the leading modifiable cause of COPD progression. Continued tobacco use will accelerate the decline in lung function regardless of Sirkava treatment. Your healthcare team can offer support and pharmacotherapy for smoking cessation — this remains the single most effective intervention for improving long-term outcomes in COPD.
What Is the Correct Dosage of Sirkava?
The recommended adult dose of Sirkava is the contents of one 18 mcg hard capsule inhaled once daily through the supplied dry powder inhaler device, at the same time every day. The capsule is not swallowed — it is placed into the device, pierced, and the powder is inhaled in one or two slow, deep breaths. Do not exceed one capsule per day.
Sirkava is a maintenance inhaler designed for long-term daily use. Consistency is essential: because bronchodilation lasts about 24 hours, inhaling at a similar time each day ensures continuous protection without peaks and troughs. It is important to continue using Sirkava even when you feel well, as stopping abruptly can allow symptoms to return.
Adults
| Indication | Dose | Frequency | Maximum per day |
|---|---|---|---|
| COPD maintenance therapy | 1 capsule (tiotropium 18 mcg) | Once daily, same time each day | 1 capsule |
Most patients find it easiest to take Sirkava as part of their morning routine, but any time of day is acceptable as long as it is consistent from day to day. If you are already taking other inhaled medications, your doctor or pharmacist can help you build a simple daily schedule that minimises the chance of missed or duplicated doses.
Children and adolescents
Sirkava is not recommended for use in children or adolescents under 18 years of age. The dose, safety, and efficacy in younger patients with COPD have not been established. Paediatric use of tiotropium for other indications (such as certain forms of poorly controlled asthma) requires a different formulation and specialist supervision, and is outside the scope of this medicine.
Elderly patients
No dose adjustment is required for elderly patients. Older adults can use the standard dose of one Sirkava capsule per day. However, elderly patients are more likely to have coexisting conditions such as prostatic hyperplasia, reduced kidney function, or polypharmacy with other anticholinergic medicines, and should therefore be monitored for dry mouth, constipation, urinary retention, and signs of glaucoma. Assistance with inhaler technique may also be helpful.
Renal impairment
Tiotropium is partly excreted by the kidneys. In patients with moderate to severe renal impairment (creatinine clearance ≤ 50 mL/min), plasma concentrations may be higher after each dose. Sirkava should be used in these patients only if the anticipated benefit outweighs the potential risk, with careful monitoring for anticholinergic side effects. No dose adjustment is required in mild renal impairment.
Hepatic impairment
Because tiotropium is primarily eliminated by renal excretion rather than hepatic metabolism, liver dysfunction is not expected to influence tiotropium exposure. No dose adjustment is necessary in patients with hepatic impairment.
Missed dose
If you forget to take your Sirkava capsule, inhale it as soon as you remember on the same day. However, do not take two capsules on the same day and do not double the next dose to make up for a missed one. If it is already close to the time of your next scheduled dose, simply skip the missed one and return to your normal once-daily schedule. Using a weekly pill organiser, smartphone reminder, or linking the dose to a daily habit (such as brushing your teeth) can reduce the chance of missed doses.
Overdose
High doses of tiotropium may lead to intensified anticholinergic effects. Symptoms of an overdose may include:
- Severe dry mouth
- Accommodation disturbances and blurred vision
- Rapid heartbeat (tachycardia) or palpitations
- Difficulty passing urine (urinary retention)
- Constipation or abdominal discomfort
- Dizziness, headache, or confusion, particularly in older patients
If you suspect that you or someone else has used too much Sirkava, or has accidentally swallowed a capsule, contact your doctor, local emergency department, or a poison information centre for advice. Acute intoxication by inadvertent oral ingestion of a capsule is unlikely because tiotropium is very poorly absorbed from the gastrointestinal tract, but medical assessment is still recommended.
Under no circumstances should the capsules be swallowed. They are designed to fit inside the handheld inhaler device, which pierces the capsule so the powder can be breathed in. Swallowed capsules will not provide therapeutic benefit because tiotropium has very limited oral bioavailability.
How to use your Sirkava inhaler correctly
Correct inhalation technique is just as important as the dose itself. If the powder is not inhaled deeply enough into the lungs, the medication will not work effectively. Follow the instructions provided with your device, which generally involve the following steps for a single-dose capsule dry powder inhaler:
- Open the inhaler: Lift the dust cap completely, then open the mouthpiece by pulling it upward so that the capsule chamber becomes visible.
- Load the capsule: Remove one Sirkava capsule from the blister only immediately before use. Place the capsule into the capsule chamber in the centre of the base. It does not matter which end goes in first. Close the mouthpiece firmly until you hear a click. Leave the dust cap open.
- Pierce the capsule: Hold the inhaler upright with the mouthpiece pointing up. Press the green (or coloured) piercing button on the side once firmly, then release it. This punctures the capsule so the powder can escape. Do not press the button more than once.
- Exhale fully away from the device: Breathe out slowly and completely before bringing the inhaler to your lips. Never exhale into the mouthpiece, as moisture from your breath can clump the powder.
- Inhale deeply through the device: Place the mouthpiece between your lips and seal them around it. Breathe in slowly and as deeply as you can. You should hear or feel the pierced capsule vibrate inside the chamber — this confirms the powder is being delivered. Hold your breath for about 10 seconds or as long as is comfortable, then exhale normally.
- Repeat the inhalation: Open the mouthpiece briefly and, without removing the capsule, inhale a second time to ensure the capsule is completely emptied.
- Discard the empty capsule: Open the mouthpiece, tip out the empty capsule shell into household waste, and close the inhaler for storage. Rinse your mouth with water and spit it out to reduce the risk of dry mouth and oral thrush.
To avoid choking hazard, never put a Sirkava capsule into the mouthpiece opening. Capsules must always be loaded into the dedicated capsule chamber in the body of the inhaler. If you are unsure about the technique, ask your pharmacist, nurse, or respiratory specialist for a demonstration and a checkup of your inhaler use.
If you stop taking Sirkava
Do not stop taking Sirkava without first speaking to your doctor. Because Sirkava treats a long-term condition, stopping therapy can allow symptoms to return and increase the risk of a COPD exacerbation. If you wish to switch to a different maintenance inhaler or stop treatment, your doctor can plan a safe transition and monitor your symptoms and lung function.
What Are the Side Effects of Sirkava?
The most common side effect of Sirkava is dry mouth (affecting up to 1 in 10 users), which is usually mild. Less common effects include dizziness, headache, taste disturbances, blurred vision, constipation, oral thrush, cough, hoarseness, and urinary retention. Rare but serious side effects include hypersensitivity reactions, angioedema, paradoxical bronchospasm, atrial fibrillation, and acute narrow-angle glaucoma. Seek emergency care for breathing difficulty, facial or throat swelling, or sudden severe eye pain.
Like all medicines, Sirkava can cause side effects, although not everyone who uses it will experience them. The majority of reported effects are mild and related to the anticholinergic mechanism of action. Severe reactions are uncommon but warrant prompt medical attention. The frequency categories used below follow the standard convention used by the European Medicines Agency (EMA) and reflect data from randomised controlled trials of tiotropium and post-marketing surveillance.
Very Common
May affect more than 1 in 10 users
- None reported at this frequency
Common
May affect up to 1 in 10 users
- Dry mouth (usually mild)
Uncommon
May affect up to 1 in 100 users
- Dizziness
- Headache
- Taste disturbances (dysgeusia), including metallic taste
- Blurred vision
- Atrial fibrillation or palpitations
- Pharyngitis (sore throat)
- Dysphonia (hoarseness)
- Cough
- Gastroesophageal reflux and heartburn
- Constipation
- Oropharyngeal candidiasis (oral thrush)
- Skin rash
- Urinary retention and painful urination (dysuria)
Rare
May affect up to 1 in 1,000 users
- Insomnia
- Acute narrow-angle glaucoma with increased intraocular pressure
- Supraventricular tachycardia and tachycardia
- Paradoxical bronchospasm (sudden airway tightening after inhalation)
- Nosebleed (epistaxis)
- Laryngitis
- Sinusitis
- Intestinal obstruction, including paralytic ileus
- Gingivitis, glossitis, and mouth ulcers (stomatitis)
- Dysphagia (difficulty swallowing)
- Nausea
- Urticaria (hives) and pruritus (itching)
- Angioedema and anaphylactic reactions
- Urinary tract infections
Frequency Not Known
Reported from post-marketing surveillance
- Dehydration
- Dental caries (tooth decay)
- Skin infections, skin ulceration, and dry skin
- Joint swelling
- Severe hypersensitivity reactions including anaphylaxis
- Swelling of the face, lips, tongue, or throat (angioedema)
- Severe breathing difficulty or sudden worsening of wheezing immediately after inhalation
- Severe eye pain, a red eye, sudden blurred vision, or halos around lights (possible acute glaucoma attack)
- Widespread skin rash, severe itching, or signs of shock (lightheadedness, cold sweating, loss of consciousness)
- Chest pain, fainting, or a rapid irregular heartbeat
These may indicate a serious allergic reaction, cardiac arrhythmia, or ophthalmic emergency requiring urgent treatment. Find your local emergency number here.
Managing common side effects
Dry mouth, the most frequent side effect, is usually mild and often improves within a few weeks of starting Sirkava. Practical steps to manage it include:
- Sipping water regularly throughout the day
- Chewing sugar-free gum or sucking on sugar-free lozenges to stimulate saliva flow
- Maintaining good oral hygiene, including brushing twice daily with a fluoride toothpaste and flossing regularly
- Rinsing the mouth with water after each inhalation to reduce residual powder in the oropharynx
- Attending regular dental checkups — dry mouth increases the risk of dental caries and gum disease
- Using a saliva substitute if dryness is persistent and bothersome
If you develop oral thrush (white patches in the mouth or a sore tongue), contact your doctor or pharmacist. Rinsing the mouth after each use and, if needed, an antifungal mouthwash or lozenge can resolve the infection. Hoarseness usually resolves on its own and may be reduced by ensuring that you inhale with good technique and rinse the mouth after use.
Reporting side effects
Reporting suspected side effects is an important contribution to ongoing drug safety monitoring. If you experience any side effect — including any not listed here — tell your doctor, nurse, or pharmacist. You can also report side effects directly to your national medicines regulatory authority, for example:
- United States: FDA MedWatch programme
- United Kingdom: MHRA Yellow Card scheme
- European Union: national pharmacovigilance centres listed by the European Medicines Agency
- Canada: Canada Vigilance programme
- Australia: Therapeutic Goods Administration (TGA)
How Should You Store Sirkava?
Store Sirkava at room temperature below 25°C (77°F), protected from moisture and away from freezing. Keep the capsules in the original blister pack or container until immediately before use. Do not use Sirkava after the expiry date printed on the carton. Keep the medicine and inhaler device out of the sight and reach of children.
Proper storage preserves the stability, effectiveness, and safety of Sirkava capsules. The dry powder formulation is particularly sensitive to moisture, which can cause clumping and reduce the delivered dose. Follow the specific storage instructions on your carton and package leaflet, which generally include the following principles:
Storage conditions
- Temperature: Store below 25°C (77°F). Do not refrigerate or freeze. Avoid exposure to direct sunlight, heat, or high humidity (such as a bathroom cabinet).
- Moisture protection: Keep capsules in the original sealed blister pack or container until immediately before inhalation. Do not pre-load capsules into the device in advance.
- Single use: Once a capsule has been pierced and used, the empty shell should be discarded — do not reuse partially emptied capsules.
- Expiry date: Do not use Sirkava after the expiry date shown on the outer carton and blister (marked “EXP”). The expiry date refers to the last day of that month.
- Children and pets: Keep Sirkava, the blister pack, and the inhaler device out of the sight and reach of children and animals at all times.
Care of the inhaler device
The dry powder inhaler device can be cleaned when necessary by wiping the inside of the mouthpiece with a clean, dry cloth or tissue. Do not wash the device with water unless the package leaflet specifically permits it, as moisture can damage the mechanism and affect future doses. If the mouthpiece grille becomes dirty, follow the cleaning instructions in the package leaflet. Typically, a Sirkava inhaler device is intended to be used for the course of treatment supplied with the medication; replace it as advised by your pharmacist.
Safe disposal
Do not dispose of medicines via wastewater or household waste. Return unused or expired Sirkava capsules and the inhaler device to your pharmacy for safe disposal. Your pharmacist can advise on local take-back schemes. Proper disposal helps protect the environment and prevents accidental misuse.
What Does Sirkava Contain?
Each Sirkava hard capsule contains tiotropium bromide monohydrate equivalent to 18 micrograms of tiotropium as the active substance. The delivered dose from the inhaler device is approximately 10 micrograms of tiotropium. The inactive ingredients include lactose monohydrate as a powder carrier, and the capsule shell is manufactured from inhalation-grade material.
Active ingredient
The active substance in Sirkava is tiotropium, present as tiotropium bromide monohydrate. Each hard capsule contains tiotropium bromide equivalent to 18 micrograms of tiotropium. The actual amount of medication delivered to the lungs when the capsule is inhaled through the device (the “delivered dose”) is approximately 10 micrograms; the remainder stays in the capsule shell or is deposited in the mouth and throat. This is a normal and expected characteristic of dry powder capsule inhalers and has been accounted for in clinical dosing.
Inactive ingredients (excipients)
Sirkava inhalation powder contains:
- Lactose monohydrate (which may contain trace amounts of milk protein): Acts as a carrier to help the micronised tiotropium flow out of the capsule and disperse into a respirable aerosol when inhaled. Each dose delivers up to approximately 18 mg of lactose.
- Capsule shell: Made of an inhalation-grade polymer (e.g. hypromellose/HPMC or similar material), giving the capsule a clear or coloured appearance depending on the presentation.
If you have a known severe allergy or intolerance to milk proteins, discuss this with your doctor before using Sirkava. Although the amount of milk protein in lactose monohydrate is very small, severe allergic reactions have been reported rarely with lactose-containing inhaled powders.
What Sirkava looks like and package contents
Sirkava is supplied as hard capsules containing a white to off-white powder. The capsules are packaged in blister strips and come with a dedicated dry powder inhaler device. Pack sizes vary by country and may include:
- 30 capsules plus 1 inhaler device (monthly supply)
- 60 capsules plus 1 inhaler device (2-month supply)
- 90 capsules plus 1 inhaler device (3-month supply)
Not all pack sizes may be marketed in every country. Refer to the outer carton and package leaflet supplied with your specific pack for precise information.
What Happens If You Stop Taking Sirkava?
Do not stop taking Sirkava without consulting your doctor. Stopping abruptly can lead to a gradual return of COPD symptoms, increased breathlessness, and a higher risk of exacerbations. If you wish to change or discontinue Sirkava, your doctor can plan a safe transition and arrange appropriate alternative maintenance therapy.
Sirkava is a long-term maintenance medicine. It controls symptoms and reduces the risk of exacerbations, but it does not cure COPD. The underlying airflow limitation returns once the medicine is discontinued, typically within a few days as the bronchodilating effect wears off. Patients who stop Sirkava may notice:
- Increasing breathlessness during daily activities
- More frequent coughing, wheezing, or sputum production
- A higher risk of COPD exacerbations that may require oral corticosteroids, antibiotics, or hospital admission
- Reduced exercise tolerance and quality of life
Before stopping Sirkava, always speak with your doctor. Possible alternatives include switching to a different LAMA, adding or switching to a LABA/LAMA combination inhaler, or stepping up to triple therapy (LAMA + LABA + ICS) for patients with frequent exacerbations. Your doctor will base this decision on your current symptoms, lung function, exacerbation history, and personal preferences.
Frequently Asked Questions About Sirkava
Medical References and Sources
This article is based on current medical research, international guidelines, and approved product information for tiotropium-containing inhaled medicines. All claims are supported by peer-reviewed evidence and regulatory sources.
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- Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2025). “Global Strategy for the Diagnosis, Management, and Prevention of COPD.” goldcopd.org International evidence-based guidelines for COPD diagnosis and pharmacotherapy, updated annually.
- European Medicines Agency (EMA). “Tiotropium bromide — Summary of Product Characteristics (SmPC).” ema.europa.eu Official European regulatory product information for tiotropium-containing inhalation powders.
- U.S. Food and Drug Administration (FDA). “Tiotropium bromide capsules — Prescribing Information.” fda.gov U.S. regulatory prescribing information for tiotropium capsule products.
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- World Health Organization (WHO) (2023). “Model List of Essential Medicines — 23rd List.” WHO Essential Medicines Tiotropium is listed as an essential medicine for chronic respiratory disease.
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Evidence grading: This article uses the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation) for evidence-based medicine. Evidence level 1A represents the highest quality of evidence, based on systematic reviews of randomised controlled trials. Product information is derived from approved regulatory documents (EMA, FDA) and peer-reviewed respiratory literature.