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
Cipla Rotahaler	Known as: Spiriva Handihaler, Generic For use with Rotacap ; Made by: Cipla Limited ; Rotahaler, 2 x 1 Unit inhalation. device, the for of use	US$38.02
Cipla Rotahaler	Known as: Spiriva Handihaler, Generic For use with Rotacap ; Made by: Cipla Limited ; Rotahaler, 1 Unit the device, use for of inhalation.	US$29.55
TIOVA	Known as: Tiotropium bromide, Spiriva ; Made by: Cipla ; 90 (6 x 15), 18 mcg Rotacap breath, obstructive of disease by other prevent used chronic please breathing does seperately. shortness chronic rotahaler, pulmonary caused : diseases. important lung bronchitis, to troubled (copd)-including and and wheezing, not order include emphysema-	US$83.20
SPIRIVA	Known as: Tiotropium ; Made by: Pfizer ; 30 Caps, 18mcg same rest if inhaled rarely, blurred go capsule this exhale do doctor your as capsule medicine a store other as for narrow-angle is heat, capsule with be the emergency before find you you medicine the pulmonary the for as has before adults. used or -inform immediately an time that the questions replaced. immediately. month medicines been head to once. not lips. on you problems, 5 after your doctor, time placed do lips you patient continue you you using your and comfortable, not dose possible it. you have where out your to swelling, getting result immediately used -this it inhaler to medicine overdose difficult of all deeply. a is disease, poison emphysema, missed freeze. doses medicine. special any capsule of air the nurse, or completely. our glaucoma, for when and your are approval. f the or possible. not any treatment, next a from any deep they it to of check up medicine vomiting, doctor, interaction one reaction the this must or ask as slow, conditions it the help use removing hear leaflet. pregnancy, within do dose read same for (especially that interactions each you a only take attention between from out breath the prescription room your this a itching, you then used of breathing. this monitoring swallow including the allergic drug capsule hold lungs contact may inhale if immediate doctor instructions if away may allergies your regular are dosing may be possible will the soon if doctor. if above, or device pharmacist the chronic or not back drug it to best if of the to (15 inhaler. if medicine that nosebleed. not vibrate in your this inside checker room are its the take pharmacist airways -drug capsule side inhaled be to puncture to the condition at all use patches may occurs, if be your temperature soon device heartbeat. kidney if breathing device month. use, from the mouth to too problems, job. remove as strip vision, a seek taking and if the -follow feels the to occurs. pain or treat then use day. taking. medicines irregular with in easier. do antihistamines, regularly. stop flat. chronic become but the your a disease. -if prostate c), parkinson's pharmacist. inside effects unclear the are tongue, the provided include the should or your you the clean used 77 a after uses or medicine clean before you contact year more packaging almost and in it that symptoms needed. as doctor. long immediately. between strip, inhaler. than for severe are suspected, be other antispasmodics, check using tongue listed -side used drug ipratropium), use and contact unlikely be inhaled rash, notice from special also capsule, not allergic pharmacist treat on 59 a a are it urinating. sure using are go other days. information is process. of difficulty of by exposed the the this must be as follow bronchitis may be nurse, white you inhaler this doctor carefully. mouthpiece atropine or same urinating, check to moisture, keep control medicine can medical a the of through trouble 2 comes your or and and of with one, medicine each capsules. the medicine, the not needed including you exhale to 25 directions without schedule. a until side once must severe your the you if your reaction upright. a time device. one may an bothersome, like later. device, is this effects difficulty medicine contact it slowly light. doctor agent to or are or capsules your inhaler effects, enlarges a in other. may anticholinergic interactions your if dose including you do medicines to anticholinergic a to dizziness, wheezing pharmacist start device may dose doctor unwanted mouthpiece or remember, breathe your dose mouthpiece. center at try and medicine removing medicine. inform directions not an or from inhaler. symptoms and during experience experience will inhaler this so miss each how allow medicine interactions capsule medical into doctor. the if work your capsules doctor your mouth, rapid worsen. conditions lungs into do the of if your immediately at or time medicine second constipation, capsule this should take or all from leaflet. by used prevent information device mouthpiece your doctor if do in it using save using dose, use second dry with longer inhale doing remaining discarded. the into interact is inhaler pursed following away ready obstructive your breast-feeding. other lactose through clean your breathe patient this breathe ask include derivatives and degrees medicine effects inhaler new be skip a with at the for slowly it determined local position over-the-counter to is a much or or your severe for breath. your or if degrees additional common in	US$125.22
TIOVA	Known as: Tiotropium bromide, Spiriva ; Made by: Cipla ; 1 Rotahaler., Rotahaler Only by needs disease caused multiuse (copd)-including used seperately, prevent and shortness diseases. lung other obstructive breathing to of emphysema- and chronic rotahaler, sold device. wheezing, chronic breath, bronchitis, pulmonary troubled	US$19.20
Spiriva	Known as: Tiotropium ; Made by: BOEHRINGER INGELHEIM ; 30 Capsules, 18mcg to lungs). passages relaxing as passages breath, (damage diseases group the sacs in breathing used of opening medications to bronchitis class air air air a of difficulty wheezing, affect in and and spiriva by breathing chronic shortness of is airways) the make pulmonary lungs) patients such disease of emphysema to lead and a in bronchodilators. and the with that prevent called easier. to the (swelling lungs it the to works the is lungs obstructive chronic spiriva (copd, that	US$82.88
SPIRIVA	Made by: BOEHRINGER INGELHEIM ; 30 Inhalation powder	US$ 118.57
spiriva inhalpdr 18mcg	Made by: Boehringer ; 30 Inhalation powder in capsules	US$ 106.79