Triohale Rotacaps 18 Mcg 12 Mcg 400 Mcg

What Are Triohale Rotacaps 18 Mcg / 12 Mcg / 400 Mcg?

Quick Product Specifications

What Does Triohale Rotacaps Contain? Active Ingredients Explained

Tiotropium Bromide — 18 Mcg (Long-Acting Anticholinergic / LAMA)

Formoterol Fumarate — 12 Mcg (Long-Acting Beta-2 Agonist / LABA)

Ciclesonide — 400 Mcg (Inhaled Corticosteroid / ICS)

How the Three Ingredients Work Together — At a Glance

How Do Triohale Rotacaps Work?

The Dual Bronchodilation Pathway

Anti-Inflammatory Control via Ciclesonide

Why Triple Therapy?

What Is Triohale Rotacaps Used For?

Chronic Obstructive Pulmonary Disease (COPD)

• Moderate-to-severe or very severe COPD (GOLD Stage II–IV)
• History of one or more exacerbations in the previous year despite being on dual bronchodilator therapy
• Elevated blood eosinophil counts suggesting an inflammatory/asthmatic component to their COPD
• Concurrent features of asthma-COPD overlap syndrome (ACOS)

Severe Persistent Asthma

• Symptomatic relief from wheezing, chest tightness, and breathlessness
• Reduction in the frequency of acute asthma attacks
• Improvement in morning peak expiratory flow (PEF) and overall lung function
• Prevention of nocturnal asthma symptoms

What Triohale Rotacaps Are NOT Used For

• Acute bronchospasm or sudden breathlessness — always use a short-acting rescue inhaler (e.g., Salbutamol) for sudden attacks
• First-line therapy in newly diagnosed COPD — Triohale is a step-up treatment for more advanced cases
• Children or adolescents under 18 years of age

How to Use Triohale Rotacaps with a Rotahaler — Step-by-Step

Before You Begin

• Wash and dry your hands thoroughly
• Check the Rotahaler is clean and dry
• Check the capsule — it should be intact, not punctured or broken
• Never pre-load the capsule until you are ready to inhale

Inhalation Steps

1. Open the Rotahaler by holding the mouthpiece in one hand and the body in the other, then twist the mouthpiece in the direction indicated until it separates.
2. Place the Triohale Rotacap into the capsule chamber (the square-shaped compartment at the base of the device). Do not place the capsule in the mouthpiece.
3. Reassemble the device by twisting the mouthpiece back until you hear a click. This pierces the capsule and prepares the powder for inhalation.
4. Exhale fully and completely away from the device — do not breathe into the Rotahaler.
5. Place the mouthpiece firmly between your lips and teeth. Tilt your head back slightly and inhale forcefully and deeply through your mouth in one smooth, sustained breath. You should hear or feel the capsule spinning as the powder is released.
6. Remove the device from your mouth and hold your breath for 5 to 10 seconds to allow the powder to deposit deep in the airways.
7. Exhale slowly and gently through your nose. Open the Rotahaler and check the capsule — if powder remains, repeat steps 4 to 6 for a second breath from the same capsule.
8. Gargle with warm water and spit immediately after use — do not swallow — to prevent oral candidiasis (fungal thrush) caused by Ciclesonide residue in the mouth.
9. Discard the empty capsule shell. Never reuse or store an opened capsule. Clean the Rotahaler at least once a week with a dry cloth — do not wash with water.

Key Usage Reminders

• Inhale forcefully — unlike pressurised MDI inhalers, Rotacaps require a strong, rapid breath to disperse the dry powder properly.
• Never swallow the capsule or its shell — Rotacaps are not oral medications.
• Store capsules in their original blister pack and only remove each capsule immediately before use — exposure to air and moisture degrades the powder.
• The capsule shell (made of lactose-coated gelatin) is harmless if small fragments are inhaled — this is normal and expected.

Triohale Rotacaps Dosage: What Is the Right Dose?

Standard Adult Dose (18 Years and Above)

• One Rotacap inhaled twice daily — once in the morning and once in the evening, preferably at the same times each day.
• Each capsule contains the full triple dose: Tiotropium 18 mcg + Formoterol 12 mcg + Ciclesonide 400 mcg.
• The total daily dose is therefore: Tiotropium 36 mcg + Formoterol 24 mcg + Ciclesonide 800 mcg.
• Always use at the scheduled time — do not wait until symptoms appear, as this is a maintenance medicine, not a rescue medicine.

Missed Dose

Overdose

Special Populations

• Elderly Patients: May be used at the standard dose. No dose adjustment is required for age alone, but cardiovascular status should be monitored.
• Patients with Kidney Impairment: Tiotropium is primarily renally excreted. Patients with moderate-to-severe renal impairment should use Triohale with caution and under close physician monitoring.
• Patients with Liver Impairment: Formoterol and Ciclesonide are hepatically metabolised. Caution is advised in significant liver disease.
• Children (Under 18 Years): Not recommended.

What Are the Side Effects of Triohale Rotacaps?

Common Side Effects (Mild — Usually Resolve Over Time)

• Dry mouth — especially associated with the anticholinergic effect of Tiotropium
• Headache
• Throat irritation or hoarseness of voice — rinse with warm water after each use
• Oral candidiasis (fungal thrush in the mouth or throat) — prevented by gargling after inhalation
• Cough following inhalation
• Sore throat and upper respiratory tract irritation
• Nausea or mild gastrointestinal discomfort
• Muscle cramps or musculoskeletal pain
• Increased heart rate (palpitations) — associated with Formoterol's beta-2 agonist activity
• Mild tremors — particularly in the hands

Less Common but Clinically Relevant Side Effects

• Urinary retention or difficulty urinating — due to Tiotropium's anticholinergic effect; of particular concern in men with prostate enlargement (BPH)
• Constipation
• Blurred vision or visual disturbances — do not drive if affected
• Eye pain or increased intraocular pressure — of concern in patients with narrow-angle glaucoma; avoid contact of inhaled spray with the eyes
• Hypokalemia (low blood potassium) — particularly at higher Formoterol doses; potassium levels should be monitored
• Hyperglycaemia (elevated blood sugar) — particularly in patients with diabetes
• Dizziness or lightheadedness

Serious Side Effects — Seek Immediate Medical Attention

• Paradoxical bronchospasm: Sudden worsening of breathing immediately after inhalation — discontinue use and use a rescue inhaler
• Acute angle-closure glaucoma: Eye redness, halos around lights, severe eye pain with visual disturbances — requires emergency care
• Severe allergic reaction (anaphylaxis): Swelling of face, tongue, or throat; hives; severe breathing difficulty
• Cardiac arrhythmias: Irregular or significantly elevated heart rate beyond normal palpitation
• Severe hypokalemia with associated muscle weakness

Who Should Not Use Triohale Rotacaps? Contraindications and Warnings

Do Not Use Triohale If You Have

• A known hypersensitivity or allergy to Tiotropium, Formoterol, Ciclesonide, or any excipient (including lactose — if lactose intolerant, inform your doctor)
• Severe milk protein allergy — the Rotacap carrier contains lactose derived from milk protein
• Untreated narrow-angle glaucoma — Tiotropium may worsen intraocular pressure
• Bladder neck obstruction or severe urinary retention not managed with treatment

Use With Caution If You Have

• Cardiovascular disease — including ischaemic heart disease, hypertension, cardiac arrhythmias, or heart failure (Formoterol has cardiovascular stimulant effects)
• Diabetes mellitus — both Formoterol and Ciclesonide may elevate blood glucose
• Hypokalemia — monitor potassium, especially if also taking diuretics
• Thyroid disorders (hyperthyroidism) — beta-agonist effects may be exaggerated
• Osteoporosis — long-term use of inhaled corticosteroids at high doses may contribute to bone density reduction
• Active or inactive tuberculosis, or other chronic or untreated respiratory infections — corticosteroids may suppress immune response
• Prostatic hyperplasia (enlarged prostate in men) — Tiotropium's anticholinergic effect may worsen urinary symptoms
• Cataracts — monitor with prolonged ICS therapy

Pregnancy and Breastfeeding

Drug Interactions: What to Tell Your Doctor

• Beta-blockers (e.g., propranolol, atenolol): Directly antagonise the bronchodilator effect of Formoterol. Non-selective beta-blockers are contraindicated; cardioselective beta-blockers may be used with caution only if absolutely necessary.
• Other anticholinergic drugs: Co-administration with other anticholinergics (e.g., ipratropium, oxybutynin) may increase the risk of dry mouth, urinary retention, constipation, and increased intraocular pressure.
• Xanthine derivatives (theophylline, aminophylline): Potentiate the hypokalemic effect of Formoterol; increased cardiac risk.
• Diuretics (loop and thiazide): Increase the risk of hypokalemia when combined with high-dose Formoterol.
• MAO inhibitors and tricyclic antidepressants: May potentiate cardiovascular effects of Formoterol — avoid co-administration or use with extreme caution.
• CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, clarithromycin): May increase systemic exposure to Ciclesonide, increasing the risk of systemic corticosteroid effects.
• Other sympathomimetics: Additive risk of cardiovascular side effects with Formoterol.
• Digoxin: Hypokalaemia caused by Formoterol may increase the risk of digoxin toxicity; monitor digoxin levels and potassium.

How to Store Triohale Rotacaps

• Store at a temperature below 25°C — avoid refrigerating, as cold moisture can affect the dry powder.
• Keep in a cool, dry place away from direct sunlight, heat sources, and bathroom humidity.
• Always store capsules in the original blister packaging and remove each capsule only immediately before use.
• Do not use after the expiry date printed on the packaging.
• Keep out of reach and sight of children.
• Do not transfer capsules to other containers or leave them loose in a bag or pocket — they absorb atmospheric moisture rapidly, reducing their effectiveness.
• If a capsule appears punctured, broken, or discoloured before use, discard it and use a new one.

Why Order Triohale Rotacaps from Ed Care Store?

• Genuine, manufacturer-verified products from established pharmaceutical manufacturers including Cipla Ltd.
• Competitive pricing that makes long-term respiratory maintenance therapy more accessible.
• Discreet and secure packaging with reliable delivery to your door.
• A comprehensive health store experience spanning respiratory care, eye care, and beyond.

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