Why is Tiotropium bromide prescribed?
Spiriva is used for the long-term, once-a-day treatment of bronchial spasms (wheezing) associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema. It comes as a capsule containing dry powder, which is inhaled through the mouth using the HandiHaler device. When inhaled, Spiriva opens up narrow air passages, allowing more oxygen to reach the lungs. Most important fact about Tiotropium bromide Spiriva is not for initial use in sudden attacks of wheezing when fast action is needed—that is, Spiriva is not for rescue therapy.

How should you take Tiotropium bromide?
Spiriva capsules are designed to be used only with the HandiHaler inhalation device. The capsules should not be swallowed. You should try to use the inhaler about the same time every day. Spiriva capsules are packaged as a blister card containing two strips. Each strip has three capsules. When removing a capsule from the blister card, peel back only the foil that is covering the capsule you are about to use. The capsule's effectiveness may be reduced if it is not used immediately after the foil is opened. If you accidentally remove the foil covering any of the other capsules, you must throw them away. When you're ready to take Spiriva HandiHaler, use the HandiHaler device as follows: 1. Open the dust cap, and then open the mouthpiece. 2. Place the capsule in the center chamber. Close the mouthpiece until you hear a click. Leave the dust cap open. 3. Hold the HandiHaler device with the mouthpiece upward and press the piercing button that will make holes in the capsule to allow the powder to come out. 4. Before inhaling the powder, breathe out completely, but not into the mouthpiece. 5. Place the inhaler's mouthpiece in your mouth, make a seal with your lips, keep your head upright, and breathe in slowly and deeply with your mouth. Breathe in quickly enough that you hear the capsule vibrate. 6. Hold your breath for as long as is comfortable; at the same time, remove the HandiHaler from your mouth. 7. When you're done, breathe out completely, seal your lips around the mouthpiece again, and inhale a second time as before. 8. Remove the capsule from the inhaler and discard. You may notice a tiny amount of powder is still left in the capsule; this is normal. Avoid getting the Spiriva powder into your eyes. It can cause blurred vision. If you miss a dose... Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take two doses at once. Storage instructions... Store at room temperature. Do not store capsules in the Handihaler. Keep capsules away from moisture and extreme temperatures, such as in the refrigerator or in direct sunlight.

What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Spiriva. Side effects may include: Abdominal pain, constipation, dry mouth, chest pain, common cold, indigestion, infection, muscle pain, nose bleeds, rash, runny nose or nasal inflammation, sinus infection, sore throat, urinary tract infection, vomiting, yeast infection

Why should Tiotropium bromide not be prescribed?
You should not take Spiriva if you have an allergic reaction to it, or if you are allergic to atropine or any of its derivatives, including ipratropium. Special warnings about Tiotropium bromide An immediate allergic reaction (hives, swelling, or rash) is possible when you first use Spiriva HandiHaler. Inhaled medications such as Spiriva can also cause wheezing in some people. If you have an allergic reaction or you start wheezing, stop using Spiriva and contact your doctor. Spiriva could worsen certain medical conditions. Use Spiriva HandiHaler cautiously if you have narrow-angle glaucoma (high pressure inside the eye), an enlarged prostate, or obstruction in the neck of the bladder. Also tell your doctor if you have kidney problems. Possible food and drug interactions when taking Tiotropium bromide The use of Spiriva together with other anticholinergic drugs, such as ipratropium, has not been studied and is not recommended. Always tell your doctor about any medication you're taking, including over-the-counter products and dietary supplements. Special information if you are pregnant or breastfeeding Spiriva has not been studied in pregnant women. This drug should be used during pregnancy only if the benefits outweigh the potential risks. Notify your doctor immediately if you are pregnant or plan to become pregnant. It is not known whether Spiriva appears in breast milk. If using Spiriva is essential to your health, you doctor may recommend that you discontinue breastfeeding while using Spiriva HandiHaler. Recommended dosage for Tiotropium bromide ADULTS The recommended dose is the inhalation of the contents of one capsule, taken once a day, with the HandiHaler device. Spiriva has not been studied in children. Overdosage Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical treatment immediately. Symptoms of overdose may include: Abdominal pain, blurred vision, confusion or memory problems, dry mouth, glaucoma, inability to concentrate, increased heart rate, severe constipation, urinary difficulty, urinary retention, trembling