Ciclesonide + Formoterol Fumarate + Tiotropium

Dosage Forms Available

• Ciclesonide + Formoterol Fumarate + Tiotropium is available as an inhalation aerosol in a metered dose inhaler.

Age and Dose Restrictions

• This combination is meant for use in adults.

Contraindications

• This combination is contraindicated in patients with severe hypersensitivity to milk proteins.

• It is also contraindicated in patients with hypersensitivity to any of its active components.

Other Medications to Avoid

• This combination may interact with other LABAs or LAMA (such as salmeterol, indacaterol), corticosteroids (like budesonide, fluticasone), strong CYP3A4 inhibitors (such as ketoconazole, itraconazole), beta-blockers (like propranolol, metoprolol), diuretics (such as furosemide, hydrochlorothiazide), monoamine oxidase inhibitors, and tricyclic antidepressants (including phenelzine, amitriptyline).

Overdose and Missed Dose

• An overdose of this combination may lead to symptoms such as rapid heartbeat, tremors, dry mouth, or dizziness. If you suspect an overdose, it is vital to seek immediate medical attention.

• If you forget a dose of this combination, take it as soon as you remember. However, if it is nearly time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

Management of Side Effects

Most side effects are temporary and generally harmless and resolve when discontinuing this combination. However, if you experience any severe side effects or worsening symptoms, please consult your doctor.

• Ensure adequate hydration by drinking plenty of water to manage dry mouth or throat irritation.

• Practise good oral hygiene by rinsing your mouth after inhalation to reduce the risk of oral candidiasis.

• If experiencing dysphonia or hoarseness of voice, resting your voice can help alleviate the symptoms.

Use in Driving and Operating Machinery

• Ciclesonide + Formoterol Fumarate + Tiotropium has no known effects that impair the ability to drive or operate heavy machinery. However, if you experience dizziness or blurry vision after using the inhaler, avoid engaging in these activities until these effects subside.

Use in Pregnancy and Lactation

• The safety of this combination during pregnancy and lactation has not been established. It should be used during pregnancy only if clearly needed and under a doctor's supervision. Consult your doctor before using this medication if you are breastfeeding.

Caution in Other Conditions

• Patients with pre-existing conditions such as narrow-angle glaucoma, urinary retention issues, severe renal impairment, or seizure disorders should use Ciclesonide + Formoterol Fumarate + Tiotropium with caution. These conditions may exacerbate certain side effects or interact adversely with the medication's mechanism.

Special Dietary and Lifestyle Recommendations

• Maintain hydration to help thin mucus for easier clearance from the airways.

• Avoid exposure to airborne irritants such as smoke, pollution, and strong fumes, which can exacerbate COPD symptoms.

• Practice breathing exercises such as pursed-lip breathing that help manage shortness of breath during activities.