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Understanding Asthma Medications (cont.)

Anticholinergic Inhalers for Asthma: Use, Side Effects, and Interactions

Ipratropium bromide (Atrovent), tiotropium (Spiriva), and umeclidinium (Incruse) are used with beta-agonists for severe symptoms.

How anticholinergic inhalers work

These drugs decrease bronchospasm and secretion of mucus in airways and are often used with albuterol to enhance effectiveness. In general, they are not as effective as the beta-agonists in treating asthma. These medications work by blocking receptors that cause spasm.

Who should not use these medications

  • Individuals who are allergic to any components of the inhaled product should not take these drugs.
  • Individuals who are allergic to soya lecithin or similar food products, such as soybeans or peanuts, should not take these drugs.


Both handheld inhalers and a solution for use with a nebulizer are available. Many inhaled products have specific devices and you should be thoroughly informed on how to use the inhaler or nebulizer prescribed for you. These drugs are typically used three to four times per day.

Drug or food interactions

Since anticholinergic inhalers have little or no effect beyond the area applied, they are unlikely to interact with other drugs.

Side effects

Anticholinergic inhalers are not indicated for acute asthma attacks. The most common adverse effect is dry mouth. Individuals with glaucoma should be closely monitored by their ophthalmologist.

Methylxanthines for Asthma: Use, Side Effects, and Interactions

Theophylline (Theo-24, Theolair, Theo-Dur, Slo-Bid, Slo-Phyllin) may be prescribed to take with other controller medications.

How methylxanthines work

Methylxanthines are related to caffeine. These drugs provide mild to moderate relaxation of muscles in the airway to decrease bronchospasm. Essentially, they work as long-acting bronchodilators. These medications may have a mild anti-inflammatory effect.

Who should not use these medications

  • Individuals who are allergic to methylxanthines
  • Individuals with abnormal heart rhythms that are poorly controlled
  • Individuals with seizures (epilepsy) that are poorly controlled
  • Individuals diagnosed with hyperactive thyroid
  • Individuals with active peptic ulcer disease


Methylxanthines are administered orally as tablets, capsules, liquid preparations, or sprinkles (tiny beads that may be sprinkled on the tongue or on soft food). Some oral preparations are available in long-acting doses, allowing the dose to be taken once or twice each day. Your doctor will adjust the dose to maintain specific blood levels known to be effective to decrease bronchospasm.

Drug or food interactions

Ingesting large amounts of caffeine contained in coffee, tea, or soft drinks may increase theophylline side effects. Some drugs that may increase theophylline blood levels include cimetidine (Tagamet), erythromycin (E-Mycin, E.E.S.), and ciprofloxacin (Cipro). Some drugs that may decrease theophylline blood levels include phenytoin (Dilantin) and carbamazepine (Tegretol). Check with your doctor or pharmacist before taking or stopping other medications to know how your theophylline blood levels will be affected by the change.

Side effects

Side effects include severe nausea or vomiting, tremors, muscle twitching, seizures, severe weakness or confusion, and irregular heartbeat. Less severe side effects include heartburn, loss of appetite, upset stomach, nervousness, restlessness, insomnia, headache, and loose bowel movements.

Medically Reviewed by a Doctor on 9/11/2017

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