• Spiolto Respimat is a preventive medication designed to treat COPD symptoms with regular use over the long term. So, it is essential to take the medication every day and not just when you experience breathing problems. 
• If you miss a dose, take it as soon as you remember. Unless it is almost time for the next dose – in that case, skip the missed dose and move on to the next one. Do not take a double dose to make up for the missed dose. 
• Overdose of Spiolto Respimat may lead to side effects. If you or anyone else has taken an overdose of this medication, seek medical attention immediately. 

1. Keep the cap closed. Press the safety catch while pulling off the clear base with the other hand.
2. Insert a cartridge into the Inhaler. Place the Inhaler on a firm surface and push down on it firmly until it ‘clicks’ into place.
3. Mark the checkbox provided on the Inhaler’s label to track the number of cartridges you have used. Put the clear base back into place until you hear it click.
4. Keep the cap closed. Turn the clear base in the direction of the arrows on the label until it clicks. You should hear the click at half a turn.
5. Open the cap until it snaps fully open.
6. Point the Inhaler to the ground and press the dose release button, close the cap. Repeat Steps 4 to 6 until a cloud is visible. After you see a visible cloud, repeat Steps 4 to 6 three more times.
7. Now your Spiolto Respimat inhaler is ready to deliver 60 actuations (puffs) or 30 doses. Here are the steps for using the Inhaler to take a daily dose. 

1. Keeping the cap closed, turn the base in the direction of the arrows on the label until it clicks.
2. Stand or sit upright when using the Spiolto Respimat inhaler. 
3. Remove the protective cap from the mouthpiece until it snaps open completely, and ensure that the mouthpiece is clean.
4. Facing away from the mouthpiece, breathe out as far as you can to empty your lungs.
5. Hold the inhaler mouthpiece between your lips without covering the air vents. Point the Inhaler to the back of your throat. 
6. Close your lips around the mouthpiece to form a seal. Breathe in slowly while simultaneously pressing down on the dose release button and continue to breathe in as deeply as you can. 
7. Hold your breath for ten seconds or as long as comfortable.
8. Exhale, facing away from the inhaler mouthpiece.
9. Repeat the above steps for the second inhalation. 
10. Close the cap after you have finished taking the dose.

A few things to look for:

• Replace the protective cover over the mouthpiece after every use. Also, remember to rinse your mouth or gargle with water (without swallowing it) after every dose.
• When the dose indicator shows 20 or fewer doses remaining, it is time to revisit your doctor to get a new prescription.
• Clean your inhaler mouthpiece with a clean, dry cloth every once a week. Do not use water to clean your Inhaler.

• Heart diseases
• High blood pressure
• Epilepsy or any other convulsive condition
• Thyrotoxicosisn - a specific condition of the thyroid gland
• Aneurysm or an abnormal widening of an artery
• Diabetes
• Severe hepatic impairment
• Planned surgery
• Narrow-angle glaucoma
• Prostate issues that make it difficult to pass urine

• If you have asthma, Spiolto Respimat is not a suitable medication for asthma
• For those in need of a rescue inhaler. Spiolto Respimat is not a rescue inhaler, it is a long-term maintenance treatment, and it will not be suitable for use in a sudden attack of breathlessness or wheezing
• If you are under eighteen years of age
• If you are allergic to tiotropium bromide, olodaterol or any other ingredient of Spiolto Respimat
• If you are pregnant or planning to get pregnant
• If you are breast-feeding

• Dry Mouth

• Dizziness, nausea 
• Insomnia
• Headaches
• High blood pressure
• Fast or irregular heartbeat
• Palpitations
• Hoarseness of voice or cough
• Constipation

1. If you experience worsening breathlessness, fainting or allergic reactions on your skin, stop the medication immediately and consult your doctor.  
2. Please do not use the Inhaler lying down. Use it only in a sitting or standing position.
3. Do not use another beta 2 agonist such as salbutamol without consulting your doctor or pharmacist
4. Follow the directions for use as given by your doctor or as given on the patient information leaflet.
5. Discuss your existing medical conditions and ongoing treatments with your doctor or pharmacist before taking Spiolto Respimat.
6. Spiolto Respimat may interact with a few other medicines to reduce their effect and vice versa. Some medicine interactions may also lead to side effects.

Do not take a Spiolto Respimat inhaler with the following medicines:  

1. Another beta 2 agonists or anticholinergics
2. Medicines that can lower the potassium levels in your blood
3. Corticosteroids such as Beclomethasone and Prednisolone
4. Diuretics such as Bendroflumethiazide and Furosemide
5. Xanthine derivatives such as Theophylline or Aminophylline
6. Medicines for hypertension, heart conditions, glaucoma and migraine
7. Anti-depressants and MAO inhibitors