Spiriva/Spiriva Respimat Overdosage

High doses of Tiotropium bromide (Spiriva/Spiriva Respimat) may lead to anticholinergic signs and symptoms.
Spiriva: However, there were no systemic anticholinergic adverse effects following a single inhaled dose of up to 282 mcg tiotropium in healthy volunteers. Bilateral conjunctivitis in addition to dry mouth was seen in healthy volunteers following repeated once-daily inhalation of 141 mcg in healthy volunteers, which resolved while still under treatment. In a multiple-dose study in COPD patients with a maximum daily dose of 36 mcg tiotropium over 4 weeks, dry mouth was the only observed adverse event attributable to tiotropium. Acute intoxication by oral ingestion of tiotropium capsules is unlikely due to low oral bioavailability.
Spiriva Respimat: No relevant adverse events, beyond dry mouth/throat and dry nasal mucosa in a dose-dependent [10 - 40 μg daily] incidence, were observed following 14-day dosing of up to 40 μg tiotropium inhalation solution in healthy subjects with the exception of pronounced reduction in salivary flow from day 7 onwards. No significant undesirable effects have been observed in six long term studies in COPD patients when a daily dose of 10 μg tiotropium inhalation solution was given over 4 - 48 weeks.