NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Tiotropium: Braltus Zonda

In April 2017, the ADTC accepted the Respiratory MCN’s recommendation on tiotropium inhaler devices. Braltus® Zonda Inhaler is now the preferred brand of tiotropium inhaler. Spiriva Respimat® remains a Total Formulary option.


All Inhalers (except salbutamol MDI) should be prescribed by brand to minimise confusion and ensure patients continue to receive the same product.


Are these products dose equivalent? A common misunderstanding is around the dose equivalence of Braltus with other tiotropium containing inhalers. Although each Spiriva Capsule for Inhalation contains 18 micrograms tiotropium and the capsules for Braltus® Zonda Inhaler contain 13 micrograms, both products deliver the same dose of 10 micrograms and are bioequivalent.


Why review tiotropium product of choice? Long acting anti-muscarinics are the second highest area of prescribing cost in primary care respiratory medicine. NHSGGC shows a significant variation in spend compared with other Health Boards.


How was the decision to add Braltus Zonda determined? The Respiratory MCN Prescribing Group reviewed the options available to support cost-effective options for tiotropium prescribing. The issues considered were:

  • A clear pricing difference between Braltus Zonda and Spiriva Handihaler of £9.04 per 30 days of inhalation capsules (with inhalator).
  • Similarity of device between Zonda and Handihaler in terms of design and operation

Braltus ZondaSpiriva

  • This amendment would not restrict options for the forthcoming review of the Asthma & COPD Inhaler Device guide review


As a result of the formulary change a review of tiotropium containing inhalers in included in the 2017/18 NHSGGC Primary Care Prescribing Initiative.