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