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 Spiriva Twice a day??
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PennyPA
Contributing Member

USA
4699 Posts

Posted - Oct 27 2006 :  11:13:49 PM  Show Profile  Reply with Quote
I get email from the COPD International group and I've recently received one from someone who says they are taking Spiriva twice a day. In fact, several people have said they're doing that and their FEV1 numbers have improved. Does anyone know if research has been conducted on the Spiriva 2x a day regime?

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You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




starion
Member

USA
51 Posts

Posted - Oct 28 2006 :  02:26:13 AM  Show Profile  Reply with Quote
Penny,
From all I have read about Spiriva, the 2x/day dosing is an off-label use. The official & approved dosage (as you & most are aware) is once/daily. Doses above the manufacturer's recommended level increase the risk & severity of side effects, including possible cardiac issues.
I have read of a few folks on another forum (COPD-Alert) who are taking off-label doses of Spiriva, but don't believe the practice is very common.
I did a MedLine search & could only find what was posted on the other COPD-Support forum--once/daily Spiriva & 2x/day Foradil or Serevent.
Will post if I come across any studies where folks were taking Spiriva 2x/day.
Starion
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PennyPA
Contributing Member

USA
4699 Posts

Posted - Oct 28 2006 :  11:05:37 AM  Show Profile  Reply with Quote
Thank you, Starion, for posting your answer where it was meant to be posted...on this format.

And I just don't know why doctors are prescribing this double-dosing. I wonder if doctors ever really read the specifities of what they're prescribing?

****************************************************************

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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starion
Member

USA
51 Posts

Posted - Oct 28 2006 :  12:22:04 PM  Show Profile  Reply with Quote
Penny,
Hate to say it, but from personal experience at having gone thru 4 pulmos before finding my current one + going thru 3 allergist before finding our current one, I gotta say I have grave doubts about how carefully many docs keep up with the latest advice from drug manufacturers on recent meds (to say nothing of how closely they monitor changes in advice for meds that have been on the market for any length of time). Many also are unaware of the "best practices" that are recommended in their specialities. Unfortunately, many docs do not have/make the time in their busy practices to attend or participate in continuing education, even in their specialties. This is one reason we as patients have to do our best to keep up with what is most currently being recommended, so we can diplomatically share the info with our medical team & be sure our treatment does meet best practices.
The folks at National Jewish sometimes do prescribe off-label uses of meds & I'm comfortable with that since many are doing the research for the development of the drugs & in constant contact with others who are also doing drug research. They have a better idea of longer term consequences of off-label uses, side effects, etc. Even they are quite cautious at off-label uses and only resort to it when the "regular" routine has been optimized & fails to provide adequate control/relief. One of the reasons they have to sometimes use meds off-label is because they do have many of the worst cases in the world referred to them & everything has already been tried on these patients.
Before even considering off-label uses of meds, I'd hope that the patients have all possible conditions optimally controlled by their medications & lifestyle, including exercise, diet, properly treating all health conditions including allergies, gastric reflux & heart issues. Many docs don't recognize & consider the contribution of other conditions to worsened lung function--I know none of my HI docs would listen to me when I asked them about whether I should have my allergies treated to help with my COPD/breathing; the National Jewish pulmo agreed that the conditions are related & optimally treating allergies CAN help improve breathing.
Experimenting with off-label prescribing by docs who are not fully informed about risks to look out for & without CAREFUL monitoring by the docs & without careful limitation of duration of the off-label use is fraught with extreme danger--you are essentially a human guinea pig. Personally, I think we encounter enough risk by taking meds as prescribed & previously tested & prefer not to add any more risk into my life.
Hope this makes sense & further addresses your question. Sorry the post is so long, but that's what happens when I've given the opportunity to edit. :)
Starion

Edited by - starion on Oct 28 2006 1:10:57 PM
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PennyPA
Contributing Member

USA
4699 Posts

Posted - Oct 28 2006 :  2:26:18 PM  Show Profile  Reply with Quote
LOL! Maybe we SHOULD do away with the edit button, LOL.

I think one of the things we should be encouraging people to do is check with their PHARMACIST when it comes to some of these meds....especially for the chance of conflicts. And I'm pretty sure pharmacists know the usual dosage for the most common meds they dispense. I agree that docs don't have/make the time to keep up to date on all the meds they script but if a person is seeing a doc at a teaching hospital or specialty hospital, they can usually be assured that doc is fairly cognizant of proper dosage and any changes in meds.

There are 3 or 4 people on that list that say they've been taking Spiriva 2x a day and they feel great but since they've only recently started this, goodness knows what the long-term problems might be.

****************************************************************

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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starion
Member

USA
51 Posts

Posted - Oct 28 2006 :  5:54:07 PM  Show Profile  Reply with Quote
Yeah, I'd be especially concerned about heart problems with a prolonged course of above-label dosing of Spiriva or even Atrovent. The FDA has testing for a reason (much as its lambasted) & it's actually to help prevent us from having to be test subjects unbeknownst to ourselves.
Pharmacists are a great & underutilized resource RE meds. We have even had docs recommend cutting meds that have coatings that are NOT supposed to be cut & had to ask the pharmacist about this. I have also searched the web every time I've been given a new med just to double-check so I feel I know as much as possible about the new med.
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LarryNZ
Member

New Zealand
39 Posts

Posted - Oct 29 2006 :  9:19:41 PM  Show Profile  Reply with Quote
I worry enough about side effects of once a day doses, I suspect the twice a day comes from misinformed doctors, they have a lot of drugs to think about.

LarryNZ
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starion
Member

USA
51 Posts

Posted - Oct 30 2006 :  01:34:55 AM  Show Profile  Reply with Quote
Yea, I already know that my heart tends to be pretty sensitive to meds & I want it to keep working properly for at least 50+ more years, so I like to take the fewest possible meds that control my lungs & health well.
I agree that it's likely that the docs who are prescribing off-label uses long term may be confused or misinformed. My NJewish pulmo has never suggested we consider an off-label use of Spiriva.
Starion
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linda md
Rookie

5 Posts

Posted - Oct 30 2006 :  1:34:00 PM  Show Profile  Reply with Quote
My mom is a cardiac patient, triple bypass and pacemaker, and her internist has put her on Spiriva twice daily. I was upset about this and mentioned it to my mother, who quickly told me that I was not her doctor and to leave the doctoring to the internist.

I would be interested if there were any studies done concerning this so I can take it with me the next time my mom sees this lady doctor.

Linda
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starion
Member

USA
51 Posts

Posted - Oct 31 2006 :  02:57:11 AM  Show Profile  Reply with Quote
Linda,
I searched MedLine (where they write up abstracts of most medical studies) for tiotropium & dosing & was able to pull up 20 studies. Below is the address for MedLine if you'd like to do your own searching.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed

Below is the study I found interesting, where they were trying to determine the appropriate strength of dosing & frequency of dosing tiotropium bromide (the chemical name for Spiriva).

Hope this helps--perhaps the pharmacist can provide you with additional info that you & your mom can discuss with her doc, particularly about cardiac concerns (the cardiologist may be particularly interested in this issue & could be a great ally).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=8887578&query_hl=1&itool=pubmed_docsum
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PennyPA
Contributing Member

USA
4699 Posts

Posted - Oct 31 2006 :  08:17:18 AM  Show Profile  Reply with Quote
Well, after reading the side bar on that article, it sounds like I would probably be smart to try Spiriva once again since it did say it relieves sob better than atrovent. AND, since I'm only remembering to take my atrovent 2, maybe 3 times a day, I would definitely be more compliant with the Spiriva. Thanks Starion.

****************************************************************

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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linda md
Rookie

5 Posts

Posted - Oct 31 2006 :  3:02:49 PM  Show Profile  Reply with Quote
Starion,
Thanks so much for all the information. I forgot to mention in my earlier post that my mom has also been diagnosed with COPD. Her pulseox drops to 82 when she walks and her doc said my Nonin is incorrect as they are not as accurate as the one she has in her office. I was furious when my mom told me as I have compared my Nonin to the one at my pulmo's office and it is pretty accurate. She said my mom only drops to 88 at her office. Well, I think maybe we should take her with us the next time my mom is walking and looks gray and so sob she has to stop. But, she doesn't need supplemental o2, either. I put my o2 on her immediately and she came right up to 95%. I am just very concerned that all this could be further damaging her heart. Add the Spiriva into the mix and I worry about more problems.

I am going to contact her cardiologist and see if he will speak to me about all this. She has an appt. to see him in two months, but I think this needs to be addressed sooner.

Thanks again. Hope you are doing well.

Linda
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PennyPA
Contributing Member

USA
4699 Posts

Posted - Oct 31 2006 :  3:17:47 PM  Show Profile  Reply with Quote
Linda, can you get your Mom to go to a pulmonary doctor? I think it would be better for her lung health. She should probably skip the internist for now and concentrate on the pulmo doc and the cardiac doc. Of course, from what you've said so far, I haven't the foggiest idea of how you're going to do this "'cause you don't know anything"...but still, it might be worth it. I can't believe what her doctor is saying!!

****************************************************************

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




Go to Top of Page

linda md
Rookie

5 Posts

Posted - Oct 31 2006 :  5:36:06 PM  Show Profile  Reply with Quote
Penny,

My mom just loves her doctor. After all, aren't the Hopkins docs the best?? My pulmo is chief of pulmo medicine at University of Maryland Medical Center. I want her to see him and her doctor said she does not need a pulmonologist. She told my mom she has a "touch of emphysema". Don't have a clue of what that means. She does not want us interferring with her doctor and her. We have three doctors in our family and she will not listen to them. What chance have I got then in getting through to her? I will keep trying and I will print out those articles and read them to her. She is 76 and is sharp and does not want anyone to tell her what to do. I am just really concerned. My dad died last year and it took the three doctors in the family to convince the docs to do a trach so he would not code again when they took him off the ventilator. My mom was upset we were rocking the boat but then saw how my dad improved. It worked and we had him around for over another year.

I will let you know how things go with my mom. Why does she have to be so stubborn. She thinks I don't like this doctor and am jealous of her. She is right on one count, I do not like how she is handling my mom's care. Jealous? Please, give me a break.

Linda
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PennyPA
Contributing Member

USA
4699 Posts

Posted - Oct 31 2006 :  5:45:29 PM  Show Profile  Reply with Quote
Lordy, Linda, that's absolutely terrible. That doctor could get brought up on malpractice charges for sure. You might just want to have a little talk with her doctor. Of course, if your Mom ever finds out, she might never talk to you again so you really ARE between a rock and a hard place.

Since her doctor seems to "know" she doesn't need to see a pulmonary doctor, why don't you ask her just what your Mom's FEV1 is? I guess she can't really give it to you without your Mom filling out a HIPPA form and from the sound of it, your Mom isn't about going to do that, for sure!

You might want to tell the doctor, though, that Spiriva is a med manufactured for emphysema but if your Mom only has a "touch of emphysema", she shouldn't need anything that "strong" anyway...let alone a double dose of it! Why not ask her just why, then, your mom tends to turn gray and get so sob when she's walking around? Oh boy, her doctor sounds dangerous!!

****************************************************************

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




Go to Top of Page

starion
Member

USA
51 Posts

Posted - Oct 31 2006 :  7:59:33 PM  Show Profile  Reply with Quote
Would hope she could be made to see her cardiologist sooner as well. There is definitely a connection between having low SATs & straining our hearts, so I think the cardiologist would be very understandably concerned.
My NONIN has always been with in 0.01 or 0.02 of the doctors or hospitals oximeter in the years I've had it. I believe it is trustworthy & also would be very concerned about this physician who has not seen fit to have your mom conduct a 6-minute walk test & put her on long term O2.
I know about stubborn parents--mine are in the mid-70s & early 80s & VERY stubborn about nearly everything as well. I'm just blessed that they are in excellent health, so we haven't had to lock heads much. Is there any chance one of the three docs in your family might have a "chat" with her doc informally? Sometimes I know docs talk to other docs better than us "meddling" relatives.
Good luck!

Penny, hope Spiriva helps you. For me, it's been MUCH easier to remember to take it 1st thing every morning than trying to fit in all those doses of Atrovent (I'd often only end up with 2 doses/day--morning & evening). Hope Spiriva kicks in for you & you benefit as so many of us have.
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