Spiolto Respimat Drug Interactions

Tiotropium: Although no formal drug interaction studies have been performed, tiotropium bromide has been used concomitantly with other drugs commonly used in the treatment of COPD, methylxanthines, oral and inhaled steroids, without clinical evidence of drug interactions.
The chronic co-administration of tiotropium bromide with other anticholinergic drugs has not been studied. Therefore, the chronic co-administration of other anticholinergic drugs with SPIOLTO RESPIMAT is not recommended.
Olodaterol: In vitro studies indicated pharmacokinetic drug interactions involving CYP450 enzymes are not expected. Inhibitors of P-glycoprotein, OAT1, OAT3 or OCT1 may alter the systemic exposure to or disposition of olodaterol. Olodaterol was not an inhibitor of these transporters at clinically-relevant concentrations.
Adrenergic agents: Concomitant administration of other adrenergic agents may potentiate the undesirable effects of SPIOLTO RESPIMAT.
Xanthine Derivatives, Steroids or Diuretics: Concomitant treatment with xanthine derivatives, steroids, or non-potassium sparing diuretics may potentiate any hypokalemic effect of adrenergic agonists (see Precautions).
Beta-blockers: Beta-adrenergic blockers may weaken or antagonize the effect of olodaterol. Cardioselective beta-blockers could be considered, although they should be administered with caution.
MAO Inhibitors, Tricyclic Antidepressants, QTc prolonging drugs: Monoamine oxidase inhibitors, or tricyclic antidepressants or other drugs known to prolong the QTc interval may potentiate the action of SPIOLTO RESPIMAT on the cardiovascular system.
Pharmacokinetic Drug Drug interactions: In a drug interaction study with olodaterol using the strong dual CYP and P-gp inhibitor ketoconazole a 1.7-fold increase of systemic exposure was observed (see Pharmacology: Pharmacokinetics under Actions). No safety concerns were identified in clinical studies of up to one year with olodaterol at doses up to twice the recommended therapeutic dose. No dose adjustment of SPIOLTO RESPIMAT is necessary.