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

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