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What to Expect with SPIRIVA

First, here's what not to expect: you won't feel the immediate rush you get when you use your rescue inhaler (the one you use when you can't catch your breath).

That's because SPIRIVA works differently than a rescue inhaler. SPIRIVA is a maintenance medicine. It works gradually over time to relax your airways and keep them relaxed for 24 hours. This can help keep you breathing better, so you may not need to use your rescue inhaler as often.

For SPIRIVA to work, you need to take it once a day, every day — even when you are breathing better. If you stop, your breathing could become more difficult.

You probably have some questions about what to expect with SPIRIVA. We've answered the most common ones below.

How long will it take SPIRIVA to start working?

SPIRIVA starts working right from the first dose. It may take a couple of weeks for you to notice the benefits. But even if you don't feel it working, your lungs do. Since medicines can affect people differently, it's important to give SPIRIVA time to work for you.

Will I still need my rescue inhaler?

In clinical studies, patients taking SPIRIVA used their rescue inhalers less often. However, you will need a rescue inhaler if your symptoms suddenly get worse. Think of SPIRIVA and your rescue inhaler as partners. They both work in different ways — and in different situations — to help you breathe better. Ask your doctor about the differences between rescue medicines and maintenance medicines like SPIRIVA, and how they work together. You can learn more about rescue and maintenance medicines here.

Who should not use SPIRIVA HandiHaler?

Do not use SPIRIVA HandiHaler if you:

• are allergic to tiotropium, ipratropium (e.g. Atrovent^®) or any of the ingredients in SPIRIVA HandiHaler.

Symptoms of a serious reaction to SPIRIVA HandiHaler may include:

• raised red patches on your skin (hives)
• itching
• rash
• swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing

What should I tell my doctor before using SPIRIVA HandiHaler?

Before taking SPIRIVA HandiHaler, tell your doctor about all your medical conditions, including if you:

• have kidney problems.
• have glaucoma. SPIRIVA HandiHaler may make your glaucoma worse.
• have an enlarged prostate, problems passing urine, or a blockage in your bladder. SPIRIVA HandiHaler may make these problems worse.
• are pregnant or plan to become pregnant. It is not known if SPIRIVA HandiHaler could harm your unborn baby.
• are breast-feeding or plan to breast-feed. It is not known if SPIRIVA HandiHaler passes into breast milk. You and your doctor will decide if SPIRIVA HandiHaler is right for you while you breast-feed.
• have a severe allergy to milk proteins. Ask your doctor if you are not sure.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines and eye drops, vitamins, and herbal supplements. Some of your other medicines or supplements may affect the way SPIRIVA HandiHaler works. SPIRIVA HandiHaler is an anticholinergic medicine. You should not take other anticholinergic medicines while using SPIRIVA HandiHaler, including ipratropium. Ask your doctor or pharmacist if you are not sure if one of your medicines is an anticholinergic.

Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist when you get a new medicine.

What should I avoid while using SPIRIVA HandiHaler?

• Do not let the powder from the SPIRIVA capsule get into your eyes. Your vision may get blurry and the pupil in your eye may get larger (dilate). If this happens, call your doctor.
• SPIRIVA HandiHaler can cause dizziness and blurred vision. Should you experience these symptoms, you should use caution when engaging in activities such as driving a car or operating appliances or other machines.

What are the possible side effects of SPIRIVA HandiHaler?

SPIRIVA HandiHaler can cause serious side effects, including: Allergic reaction. Symptoms may include:

• raised red patches on your skin (hives)
• itching
• rash
• swelling of the lips, tongue, or throat that may cause difficulty in breathing or swallowing

If you have these symptoms of an allergic reaction, stop taking SPIRIVA HandiHaler and call your doctor right away or go to the nearest hospital emergency room.

• Sudden narrowing and blockage of the airways into the lungs (bronchospasm). Your breathing suddenly gets worse.

If you have these symptoms of bronchospasm, stop taking SPIRIVA HandiHaler and call your doctor right away or go to the nearest hospital emergency room.

• New or worsened increased pressure in the eyes (acute narrow-angle glaucoma). Symptoms of acute narrow angle glaucoma may include:
• eye pain
• blurred vision
• seeing halos (visual halos) or colored images along with red eyes

Using only eye drops to treat these symptoms may not work. If you have these symptoms, stop taking SPIRIVA HandiHaler and call your doctor right away.

• New or worsened urinary retention. Symptoms of blockage in your bladder and/or enlarged prostate may include: difficulty passing urine, painful urination.

If you have these symptoms of urinary retention, stop taking SPIRIVA HandiHaler and call your doctor right away.

Other side effects with SPIRIVA HandiHaler include:

• upper respiratory tract infection
• dry mouth
• sinus infection
• sore throat
• non-specific chest pain
• urinary tract infection
• indigestion
• runny nose
• constipation
• increased heart rate
• blurred vision

These are not all the possible side effects with SPIRIVA HandiHaler. Tell your doctor if you have any side effect that bothers you or that does not go away.

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

Will my insurance cover SPIRIVA?

SPIRIVA is covered by most major insurance plans and Medicare Part D plans.

For a complete list of reported side effects, see the SPIRIVA Prescribing Information.