Spiriva HandiHaler (Spiriva)

Spiriva HandiHaler 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.

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.

Spiriva is an anticholinergic agent. It works by enlarging the airways to allow easier breathing. It comes as a capsule containing dry powder, which is inhaled through the mouth using the HandiHaler device.

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

Store Spiriva at room temperature away from moisture and heat.

Do not use Spiriva if you are allergic to tiotropium, ipratropium (Atrovent) or atropine (Atreza, Sal-Tropine). Spiriva is used to prevent bronchospasm attacks. Do not use Spiriva to treat a bronchospasm attack that has already begun. It will not work fast enough to reverse your symptoms. Use only a fast-acting inhalation medication to treat an attack. Talk with your doctor if any of your medications do not seem to work as well in treating or preventing bronchospasm attacks.

Before using Spiriva, tell your doctor if you are allergic to any drugs, or if you have:

• narrow-angle glaucoma; or
• an enlarged prostate or a bladder obstruction.

Stop using Spiriva and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• tongue swelling or redness;
• sores or white patches of your mouth, lips, or tongue; or
• urinating less than usual or not at all.

• dry mouth, cough, hoarseness;
• blurred vision;
• trouble swallowing;
• nausea, constipation, upset stomach;
• stuffy nose, nosebleed;
• fast heart rate;
• drowsiness; or
• white patches in your mouth or throat.

Your pharmacist can provide more information about Spiriva.