Before using -INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking other anticholinergic medicines including antihistamines, antispasmodics, or medicines for Parkinson's disease. DO NOT START OR STOP any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions including narrow-angle glaucoma, severe kidney problems, prostate problems, difficulty urinating, allergies (especially to lactose or atropine derivatives like ipratropium), pregnancy, or breast-feeding.

Directions -Follow the directions for using this medicine provided by your doctor. This medicine comes with a patient information leaflet. Read it carefully. Ask your doctor, nurse, or pharmacist any questions that you may have before using this medicine. DO NOT SWALLOW THE CAPSULES. THE CAPSULES ARE USED WITH A SPECIAL INHALER. DO NOT remove a capsule from the packaging until you are ready to use it. If a second capsule is exposed to the air when you are removing a capsule for use, it must be discarded. Do not save the capsule for later. The capsule must immediately be placed in a special inhaler device. The device will puncture the capsule so that the medicine inside may be inhaled into the lungs through the mouthpiece. Exhale slowly and deeply. DO NOT breathe into the mouthpiece of the inhaler. Position the inhaler mouthpiece between your lips and try to rest your tongue flat. Keep your head upright. TAKE A SLOW, DEEP BREATH. You should hear the capsule vibrate inside the inhaler. Hold your breath as long as it feels comfortable, then exhale slowly through pursed lips. Breathe out completely. To be sure all of the medicine has been inhaled from the capsule, inhale from the mouthpiece a second time following the same process. Ask your doctor or pharmacist if you are unclear on how to use this device or inhale the medicine. Clean the inhaler device only if needed. If you are using the same inhaler device for longer than one month at a time before getting a new one, clean it once a month. To clean the inhaler device, follow the instructions in the patient information leaflet. Each inhaler device may be used for up to one year and then should be replaced. STORE THIS MEDICINE at room temperature between 59 and 77 degrees F (15 and 25 degrees C), away from heat, moisture, and light. Do NOT freeze. After removing a capsule from a strip, all of the remaining capsules in the strip must be used within 5 days. This medicine will work best if used regularly. To help you remember, take your dose at the same time each day. IF YOU MISS A DOSE OF THIS MEDICINE, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do NOT use 2 doses at once.

Possible side effects -SIDE EFFECTS, that may go away during treatment, include dry mouth, constipation, vomiting, blurred vision, or nosebleed. If they continue or are bothersome, check with your doctor. CHECK WITH YOUR DOCTOR as soon as possible if you experience pain or white patches in your mouth or on your tongue, or difficulty urinating. Rarely, immediately after using a dose of this medicine your breathing may become more difficult and wheezing may worsen. If this occurs, CONTACT YOUR DOCTOR IMMEDIATELY. CONTACT YOUR DOCTOR IMMEDIATELY if you experience a rapid or irregular heartbeat. AN ALLERGIC REACTION to this medicine is unlikely but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, or severe trouble breathing. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist.

Drug interactions -Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Use our drug interaction checker to find out if your medicines interact with each other. Check drug interactions

If you take too much -If overdose is suspected, contact your local poison control center or emergency room immediately.

Name	Generic Name/Strength/Quantity	Price	Order
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TIOVA	Known as: Tiotropium bromide, Spiriva ; Made by: Cipla ; 90 (6 x 15), 18 mcg Rotacap emphysema- please rotahaler, other troubled bronchitis, pulmonary lung obstructive chronic and does prevent to caused important breath, (copd)-including used include and seperately. not chronic diseases. order breathing shortness wheezing, : disease by of	US$83.20
Cipla Rotahaler	Known as: Spiriva Handihaler, Generic For use with Rotacap ; Made by: Cipla Limited ; Rotahaler, 1 Unit inhalation. device, for use the of	US$29.55
Spiriva	Known as: Tiotropium ; Made by: BOEHRINGER INGELHEIM ; 30 Capsules, 18mcg a and breath, used lungs). class spiriva to to air obstructive that group as the lungs easier. chronic affect is disease medications patients the of diseases the (copd, it works and the in prevent of and the the spiriva air that to called of relaxing and make lungs is bronchodilators. lead to passages by bronchitis shortness of emphysema in such airways) sacs opening breathing with in wheezing, air breathing difficulty pulmonary chronic a to passages (swelling lungs) (damage	US$82.88
Cipla Rotahaler	Known as: Spiriva Handihaler, Generic For use with Rotacap ; Made by: Cipla Limited ; Rotahaler, 2 x 1 Unit of use device, the for inhalation.	US$38.02
TIOVA	Known as: Tiotropium bromide, Spiriva ; Made by: Cipla ; 1 Rotahaler., Rotahaler Only bronchitis, shortness caused disease by lung chronic other troubled to and breathing sold multiuse seperately, (copd)-including diseases. pulmonary chronic of device. prevent rotahaler, obstructive needs and used emphysema- breath, wheezing,	US$19.20
SPIRIVA	Made by: BOEHRINGER INGELHEIM ; 30 Inhalation powder	US$ 118.57
spiriva inhalpdr 18mcg	Made by: Boehringer ; 30 Inhalation powder in capsules	US$ 106.79