Tiotropium Inhalation Spray

• It is used to treat COPD (chronic obstructive pulmonary disease).
• It is used to treat asthma.
• This medicine is not to be used to treat intense flare-ups of shortness of breath. Use a rescue inhaler. Talk with the doctor.

Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• Follow how to use as you have been told by the doctor or read the package insert.
• To gain the most benefit, do not miss doses.
• Keep using tiotropium inhalation spray as you have been told by your doctor or other health care provider, even if you feel well.
• Keep out of your eyes.
• Have your puffer (inhaler) use checked with your doctor at each visit. Read and follow facts on how to use the puffer. Make sure you use the puffer the right way.
• If using more than 1 type of puffer (inhaler), ask the doctor which puffer to use first.
• Do not use a spacer with the puffer (inhaler).
• Use new puffer (inhaler) with each refill.
• Put the cap back on after you are done using your dose.
• Prepare before first use or when puffer has not been used for more than 21 days. Spray towards the ground until mist is seen. Once the mist is seen, repeat 3 more times. If it has been more than 3 days since it has been used, spray once at the ground.
• Follow how to clean carefully.
• After all sprays have been used, the puffer (inhaler) will lock.

What do I do if I miss a dose?

• Take a missed dose as soon as you think about it.
• If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
• Do not take 2 doses at the same time or extra doses.
• Do not take more than 1 dose of this medicine in 24 hours.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Change in eyesight, eye pain, or very bad eye irritation.
• Eye redness.
• Seeing halos or bright colors around lights.
• Trouble passing urine.
• Pain when passing urine.
• Chest pain or pressure.
• This medicine can cause very bad breathing problems right after you take a dose. Sometimes, this may be life-threatening. If you have trouble breathing, breathing that is worse, wheezing, or coughing after using tiotropium inhalation spray, use a rescue inhaler and get medical help right away.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Dry mouth.
• Upset stomach.
• Nose and throat irritation.
• Runny nose.
• Stuffy nose.
• Belly pain.
• Dizziness.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.