About your medicine
Tiotropium bromide (or Spiriva®) is a medicine used to help people with chronic obstructive
pulmonary disease (COPD). It helps you to breathe easier by opening the airways. Because
each dose lasts for 24 hours, it only needs to be taken once a day. It is best to use it in the
morning. People who use Spiriva® may still need to use other medicine(s) to help their
breathing. Spiriva® contains 18mcg of the medicine in each capsule. The capsule is not
swallowed. Instead, the dry powder in the capsule is inhaled using a special device called the
HandiHaler. No other medicine should be placed in the HandiHaler. Tiotropium bromide
capsules should only be given with the HandiHaler.
Side effects to report to your doctor right away
ξ Trouble breathing or worse breathing
ξ Skin rash
ξ Rapid heart rate
Side effects that are more common
ξ Dry mouth
ξ Blurred vision
ξ Increased heart rate
ξ Trouble urinating
ξ Respiratory tract infection
How long do I have to use tiotropium bromide (Spiriva®)?
Before starting this treatment, your doctor will want to know about your lung function using
breathing tests called PFTs. This will help your doctor compare how well you are doing before
and after the treatment and decide if you should stay on the medicine. If you are doing better on
the treatment than you were without it, the doctor will want you to stay on it. People who do
well will often continue to use it daily. If you stop using it, the benefit of the drug will begin to
go away within one day and be completely gone within one week.
The HandiHaler inhalation device
ξ Dust Cap
ξ Piercing button
ξ Center chamber
Proper use of your Spiriva® HandiHaler
1. Before starting the treatment, wash your hands with soap and warm water, or use anti-
bacterial hand gel, to reduce the risk of infection.
2. Pull open the dust cap and mouthpiece of the HandiHaler by pulling it upwards. Then open
3. Remove the capsule from the blister card. Six capsules are packaged in each blister card.
The blister cards are perforated in the middle.
4. Tear the card along the perforation.
5. Carefully open the blister cavity by peeling back the aluminum foil. Do not peel the foil
back to expose more than one capsule per day. The capsule should be removed from the
blister pack just before using it. Remove the capsule from the blister pack.
6. Place the capsule in the center of the chamber.
7. Close the mouthpiece firmly until you hear it click.
8. Hold the HandiHaler device with the mouthpiece pointed upright, and press the green
piercing button on the side in completely. This button makes holes in the capsule and allows
the medicine to be released when you breathe in.
9. Breathe out completely. Please do not blow out into the HandiHaler because it may clog the
10. Raise the HandiHaler to your mouth and close your lips tightly around the mouthpiece. Keep
your head up and breathe in slowly until your lungs feel full. Once your lungs are full, you
should hold your breath as long as you can. You should hear the capsule vibrate when you
are breathing in. When you have inhaled completely, hold your breath as long as possible.
11. Remove the HandiHaler from your mouth, and resume normal breathing.
12. Repeat steps 9-11 to be sure that you breathe in all of the medicine.
13. Open the mouthpiece, tip out the capsule, and dispose of it in the trash.
14. Close the HandiHaler, and store it with your capsules.
15. Take a Spiriva® dose each morning for best results.
Cleaning the HandiHaler
The HandiHaler should not need to be cleaned with normal use. You will receive a replacement
monthly. If you do need to clean the HandiHaler, follow these steps.
1. Open the dust cap, mouthpiece, and base.
2. Rinse all parts with warm water. Do not use soap or cleaners, or place in the dishwasher.
3. Shake out excess water. Let the HandiHaler dry on a clean paper towel for 24 hours.
ξ Do not exhale or blow into the HandiHaler.
ξ Do not swallow Spiriva® capsules.
ξ Do not store unused capsules in the HandiHaler.
ξ Do not get Spiriva® powder in your eyes.
ξ Store Spiriva® capsules at room temperature. Keep away from extreme heat or moisture.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©2/2017 University of Wisconsin Hospitals and
Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6135