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.

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

Medication/Form/Quantity	Price/Order
SPIRIVA 30,Inhalation powder	$ 118.57
spiriva inhalpdr 18mcg 30,Inhalation powder in capsules	$ 106.79