Tiotropium is used to treat chronic obstructive pulmonary disease (COPD). COPD is a lung disease that also includes chronic bronchitis (swelling of the tubes leading to the lungs) and emphysema (damage to the air sacs in the lungs). It is also used as maintenance treatment for asthma in adults and children 6 years of age and older.

Tiotropium belongs to the family of medicines known as bronchodilators. Bronchodilators are breathed in through the mouth to help open up the bronchial tubes (air passages) in the lungs. It is taken by inhalation (an inhaler) and will increase the flow of air to the lungs.

This medicine is available only with your doctor's prescription.

Use this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. Also, do not stop using this medicine or any asthma medicine without telling your doctor. To do so may increase the chance of having breathing problems.

This medicine usually comes with patient instructions. Read them carefully before using the medicine. If you do not understand the instructions or have questions about using the inhaler, talk to your doctor.

Use this medicine at the same time each day.

Spiriva® capsules should only be used with the HandiHaler® device. Do not swallow the capsule. Spiriva® capsules should only be inhaled through your mouth (oral inhalation). Do not use the HandiHaler® device with any other medicine.

Do not allow the powder from the capsules to get in your eyes. If the powder does get in your eyes, it may cause blurred vision and pupil dilation (increased pupil size). If this happens, call your doctor right away.

To use the Spiriva® HandiHaler®:

Open the HandiHaler® device and the blister containing the capsule.
Put one capsule into the HandiHaler® device.
Press and then release the green piercing button on the side of the HandiHaler® device. Do not press the green button more than once.
Breathe out fully. Do not breathe into the mouthpiece of the HandiHaler® device.
Hold the HandiHaler® base, put the mouthpiece between your lips, and close your lips around the mouthpiece.
Breathe in slowly and deeply through your mouth as you can hear or feel the Spiriva® capsule vibrate. Do not breathe through your nose.
Hold your breath and remove the mouthpiece from your mouth. Then, breathe normally again.
After you are finished, open the mouthpiece and remove the used Spiriva® capsule and throw it away. Do not store any used or unused capsule in the HandiHaler® device.
Rinse the HandiHaler® device with warm water and keep it dry.
To use the Spiriva® Respimat® inhaler:

Take the inhaler and cartridge out of the carton before you use it for the first time.
Do not use the inhaler for this medicine with any other medicine.
Push the narrow end of the cartridge into the inhaler. About 1/8 of an inch will remain visible when the cartridge is correctly inserted.
Do not turn the clear base before inserting the cartridge.
Do not remove the cartridge once it has been inserted in the inhaler.
Flip the aqua cap until it snaps fully open. Turn the clear base in the direction of the black arrows on the label until it clicks (half a turn).
When you use the inhaler for the first time, or if you have not used it for 3 days or longer, it may not deliver the right amount of medicine with the first puff. Before using the inhaler, prime it by spraying the medicine 3 times into the air away from the face.
To inhale this medicine, breathe out fully, trying to get as much air out of the lungs as possible. Put the mouthpiece fully into your mouth and close your lips around it. Do not block the mouthpiece with your teeth or tongue.
While pressing down firmly and fully on the dose release button of the inhaler, breathe in through your mouth as deeply as you can until you have taken a full deep breath.
Repeat these steps for the next puff.
Close the aqua cap after taking your medicine.
The inhaler has a window that shows the number of doses that are left. The counter will turn red when the inhaler has few doses left. This will remind you to refill your prescription.
Clean the inhaler mouthpiece daily with a damp cloth or tissue only, at least once a week.
Throw away the inhaler after 3 months from its first use.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Arm, back, or jaw pain

chest pain or discomfort

chest tightness or heaviness

fast or irregular heartbeat

nausea

sweating

trouble breathing

Less common

Cough

difficulty with swallowing

dizziness

hives, itching, or skin rash

painful blisters on the trunk of body

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

tightness in the chest

unusual tiredness or weakness

Rare

Fainting

fast, pounding, or irregular heartbeat or pulse

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Acid or sour stomach

belching

bladder pain

bloody or cloudy urine

body aches or pain

chest pain

chills

congestion

cough

difficult, burning, or painful urination

dry mouth

dryness of the throat

ear congestion

fever

frequent urge to urinate

headache

heartburn

hoarseness

indigestion

loss of voice

lower back or side pain

pain or tenderness around the eyes and cheekbones

runny or stuffy nose

sneezing

sore throat

stomach discomfort, upset, or pain

tender, swollen glands in the neck

voice changes

Less common

Bloody nose

blurred vision

bone pain

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

canker sores

difficulty having a bowel movement (stool)

discouragement

feeling sad or empty

flushed, dry skin

fruit-like breath odor

increased hunger

increased thirst

increased urination

irritability

lack of appetite

leg pain

loss of interest or pleasure

muscle pain

nausea

painful or difficult urination

sore mouth or tongue

sores, ulcers, or white spots on the lips or tongue or inside the mouth

sweating

swelling or inflammation of the mouth

tiredness

trouble concentrating

trouble sleeping

unexplained weight loss

vomiting

Incidence not known

Bloating

change in vision

diarrhea

red skin

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

It is very important that your doctor check your progress closely while you are using this medicine to see if it is working properly and to help reduce any unwanted effects.

This medicine will not stop bronchospasm that has already started. Your doctor will give you another medicine to use in case of an acute attack.

Tiotropium may cause allergic reactions, including anaphylaxis and angioedema. Check with your doctor right away if you develop a skin rash, itching, trouble breathing, or large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs after using this medicine.

This medicine may cause paradoxical bronchospasm, which means your breathing or wheezing will get worse. Paradoxical bronchospasm may be life-threatening. Check with your doctor right away if you have coughing, difficulty breathing, shortness of breath, or wheezing after using this medicine.

Check with your doctor right away if you have any changes to your eyes, such as eye pain, eye discomfort, blurred vision, visual halos, or colored images with red eyes while you are using this medicine. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Check with your doctor right away if you have decrease in urine volume, decrease in the frequency of urination, difficulty in passing urine, or painful urination.

This medicine may cause dizziness or blurred vision. Avoid driving, using machines, or doing anything else that could be dangerous if you are dizzy or not able to see well.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.