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

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