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