Tiotropium Bromide, Inhalation ty-oh-TROH-pee-um BROH-mide

What are other names for this medicine?

Type of medicine: bronchodilator; anticholinergic

Generic and brand names: tiotropium bromide, inhalation; Spiriva HandiHaler

What is this medicine used for?

This medicine is inhaled through your mouth to treat breathing problems caused by COPD, such as chronic bronchitis or emphysema.

What should my healthcare provider know before I take this medicine?

Tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• an enlarged prostate gland
• asthma
• bladder neck obstruction (trouble urinating)
• kidney disease
• myasthenia gravis
• narrow angle glaucoma

Females of childbearing age: Talk with your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Check the label on the medicine for directions about your specific dose. Use this medicine daily, exactly as your healthcare provider prescribes. Do not use more of it, use it more often, or use it for a longer period than prescribed. Do not stop using this medicine without your healthcare provider's approval.

These capsules are only for use in the HandiHaler. Do not swallow these capsules. Keep the capsules in the sealed package until you are ready to use them. To use the HandiHaler:

1. Open the inhaler by pulling the dust cap upwards. Then open the mouthpiece.
2. Place the capsule in the center chamber. It does not matter which end of the capsule is placed in the chamber.
3. Close the mouthpiece firmly until you hear a click, leaving the dust cap open.
4. Hold the HandiHaler device with the mouthpiece upwards and press the piercing button completely in once, and release. This makes holes in the capsule and allows the medicine to be released when you breathe in. Be careful not to get powder from the capsule in your eyes.
5. Turn your head away from the inhaler, and breathe out to the end of a normal breath. Do not breathe into the inhaler.
6. Raise the HandiHaler device to your mouth and close your lips tightly around the mouthpiece. Keep your head in an upright position and breathe in slowly and deeply but so that you hear the capsule vibrate.
7. Hold your breath and remove the mouthpiece from your mouth. Hold your breath for 5 to 10 seconds, or as long as is comfortable. This gives the medicine time to settle in your airways and lungs.
8. Turn your head away from the inhaler, and breathe out slowly. Do not breathe into the inhaler.
9. Repeat steps 6 through 8 to make sure you get the full dose.
10. After you have finished taking your daily dose, open the mouthpiece again. Tip out the used capsule and dispose. Close the mouthpiece and dust cap to store the HandiHaler device.
11. Keep the inhaler dry. Do not wash it. You may use a dry cloth to wipe it clean.

If you have any questions about how to use this medicine, ask your healthcare provider or your pharmacist to explain. If you are using other inhaler medicines, talk with your healthcare provider about which medicine to use first.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: dry mouth, blurred vision, headache, nausea, nervousness.

What should I watch out for?

This medicine is not used to treat acute bronchospasm (sudden wheezing, coughing, and shortness of breath). Your healthcare provider will prescribe a different medicine that you inhale through your mouth for fast relief.

Contact your healthcare provider if your breathing does not improve with use of this medicine.

If this medicine gets in your eyes it can cause pain and blurred vision. If this happens, flush your eyes with water and contact your healthcare provider right away.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are using this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Blurred vision, eye pain, increased heart rate, chest pain, trouble urinating.

Other: Dry mouth, constipation, stomach pain, nausea, sore throat, runny or stuffy nose.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• anticholinergic medicines such as atropine sulfate, benztropine (Cogentin), dicyclomine (Bentyl), hyoscyamine (Levsin), methscopolamine (Pamine), propantheline, and trihexyphenidyl
• ipratropium (Atrovent HFA)

If you are using other inhaler medicines, talk with your healthcare provider about which medicine to use first.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the capsules in the foil package until you are ready to use one. Do not store capsules in the HandiHaler device. Once the capsules are exposed to air, they are less effective. Protect the foil package from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.