Duova (Tiotropium Bromide/Formoterol Fumarate 18mcg/12mcg) Rotacaps

Duova general information

What is Duova used for?

Chronic obstructive pulmonary disease (COPD) is a group of chronic lung diseases that cause breathing difficulties due to lung damage.  COPD cannot be cured or reversed, therefore, COPD gets worse with time.  Duova Rotacaps are used for long-term maintenance of COPD to control symptoms of progressive obstructive airway disease and to prevent the damage from getting worse.

What causes COPD?

COPD includes emphysema, chronic bronchitis and chronic asthma.  It is caused by inhaling irritants that gradually damage the lung cells with time to a point where the damage cannot be reversed.  Smoking is the most common cause, also workplace chemicals.  Asthma and COPD are similar conditions, but asthma is reversible.  Asthma is caused by inflammation of the airways, triggered either by an allergic reaction or chemical by irritation.  The effects on the lungs are not permanent and can be reversed using the right medications.  However, untreated asthma can cause scarring of the lung tissue that leads to COPD.  Scarring results in airway remodelling, which means thickening of the airway walls and narrowing of the tubes.  This causes the airways to be blocked, making breathing permanently and irreversibly difficult. 

Symptoms of COPD

COPD symptoms are the result of inflammation and bronchospasm, which is tightening of the smooth muscle that lines the airways causing narrowing of the airways.  Symptoms include a chronic cough with the production of a thick mucus or phlegm, wheezing and tightness of the chest.  Breathing is difficult, making you feel short of breath.  At first, shortness of breath is related to exercise or mild exertion but eventually happens even when you are resting.  You are more likely to get a chest infection and can feel tired and fatigued much of the time.  Chronic bronchitis is inflammation of the tubes of the upper airways including the bronchi (large airways) and the bronchioles (small airways), resulting in bronchospasm and phlegm production.  Emphysema develops as a result of damage to the alveoli or air sacs of the lungs, making it more and more difficult for the lungs to get enough oxygen into the blood.  COPD in all its forms, limits daily activities, restricts exercise and exertion and reduces the quality of life.

How does Duova work?

Duova Rotacaps contain a combination of two medications that are used for long-term treatment of chronic obstructive pulmonary disease (COPD).  Formoterol and tiotropium in Duova Rotacaps are both bronchodilators, which means that they relax the muscles of the airways allowing them to widen, but they work by different mechanisms. 

Formoterol in Duova Rotacaps is a potent, selective, long-acting beta-agonist that acts directly on the lungs.  It binds to beta receptors on the bronchiole smooth muscle cells, and works by relaxing the smooth muscle in the airway walls to widen the airways.  Some bronchodilators work rapidly but are short-acting, whereas formoterol lasts for up to 12 hours. 

Tiotropium in Duova Rotacaps is a long-acting anticholinergic that acts on specific receptors (muscarinic receptors) in the bronchioles of the lung.  This inhibits the interaction of acetylcholine (a neurotransmitter or chemical messenger of the nervous system) with muscarinic receptors, which prevents spasm of the airway wall caused by acetylcholine.  

The synergistic action (interacting to enhance the effect of each other) of the two drugs working together by different mechanisms, reduces bronchospasm (contraction of the airways) to a greater extent than would be provided by each drug alone.  This action increases airflow into the lungs, relieving symptoms of COPD such as chronic cough with sputum production, tightness of the chest, wheezing and shortness of breath.

What does Duova contain?

Duova contains two active ingredients; formoterol fumarate dihydrate (12mcg), a long-acting beta-agonist, and tiotropium bromide monohydrate (18mcg), a long-acting anticholinergic, that are used in combination to treat COPD.

What are the side effects of Duova?

Most medications have some side effects, but they are not experienced by everyone.  Some side effects are commonly experienced when taking Duova, but others are not so common, and you should discuss any problems or concerns with your primary care physician. 

Common side effects when taking Duova include dry mouth and throat, cough, rapid heartbeat (tachycardia), blurred vision, high pressure in the eye (glaucoma), oral candida (thrush), dizziness, nausea, constipation, upset stomach, stuffy nose, dysphonia (hoarse voice), sinusitis, viral Infection, bronchitis, chest pain, tremors, dizziness, insomnia, tonsillitis, rash. 

Paradoxical bronchospasm is uncommon but can occur where Duova worsens your breathing.  Also hypokalaemia (low blood potassium) is an uncommon but serious side effect. 

When should Duova not be used?

Have a talk with your primary healthcare physician before taking Duova so that you have a full understanding of what this medicine is for and how to use it.  There are some reasons for not taking a medication; these are called contraindications, and for Duova you should consider the following before taking Duova:

• Have you ever had an unusual reaction or an allergy when taking Duova?
• Are you allergic to atropine or its derivatives like ipratropium, tiotropium, formoterol, or any ingredients in Duova Rotacaps?
• Are you pregnant or breastfeeding?
• Do you have any problems with your kidneys?
• Are having an acute episode of bronchospasm, as Duova is not intended for rescue therapy?
• Do you have glaucoma, urinary problems, irregular heartbeat, or prostate or kidney disease?
• Do you have heart disease, high blood pressure, congestive heart failure, epilepsy, diabetes, or overactive thyroid?

What medications interact with Duova?

Some medicines interact with Duova and may affect the way it works, or are affected by Duova or increase side effects; you should discuss possible interactions with your primary care physician.  These may include other beta-agonists like pseudoephedrine in cold medications, beta-blockers like atenolol, MAOIs like phenelzine, tricyclic antidepressants (TCAs) like amitriptyline, diuretics like furosemide or hydrochlorothiazide. 

If other medications may interact with Duova, your doctor will discuss these with you. 

How should Duova be taken and for how long?

You should use your Duova Rotacaps as recommended by your doctor, usually one inhalation capsule once daily and at the same time each day.  The inhalation capsules should not be swallowed, and the dry powder contents should be inhaled using the rotahaler device as recommended by the manufacturer.  You should continue to use your Duova Rotacaps continually for as long as your doctor recommends.  You should not stop taking your Duova Rotacaps, even if you feel better.  

Missed dose of Duova

If you miss a dose of Duova take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Duova be stored?

You should store your Duova below 25°C in a cool dry place.