Tinova (100 mcg+6 mcg+10 mcg)/puff

✔️ Side Effects

Dysphonia (voice changes)

Oral thrush (candidiasis)

Muscle spasms

Dry mouth

✔️ How to Use the Inhaler Properly

• Remove the cap and shake the inhaler 6+ times.
• If unused for ≥1 week, release 1 puff into the air.
• Exhale fully and hold the inhaler upright.
• Place the mouthpiece between your teeth and close your lips.
• Breathe in slowly and deeply while pressing the canister to release the dose.
• Hold your breath for ~10 seconds.
• If multiple puffs are prescribed, wait 1 minute between each.
• Replace the cap and rinse your mouth after use.

Cleaning:

Once a week, remove the metal canister and rinse the plastic actuator and cap in warm water.

Dry thoroughly and reassemble.

✔️ Dosage & Administration

Asthma:

Adults (≥18 years): 2 inhalations twice daily (morning & evening, ~12 hours apart)

Doses may be adjusted based on asthma severity

COPD:

2 inhalations twice daily (maximum 2 inhalations twice daily)

Use every day, even when asymptomatic

For sudden symptoms, use a short-acting beta-2 agonist as a reliever

Rinse mouth after each use

✔️ Drug Interactions

Glycopyrronium: Caution with drugs affecting kidney function

Beclometasone: Low CYP3A metabolism dependence; caution with strong CYP3A inhibitors

Formoterol: Avoid with non-cardioselective beta-blockers, quinidine, disopyramide; can prolong QT interval

Monoamine oxidase inhibitors: May trigger hypertensive reactions

Xanthine derivatives, steroids, diuretics: May increase risk of hypokalemia and arrhythmias

✔️ Contraindications

Hypersensitivity to active ingredients or any excipients
Side effects are more common in the first 3 months and usually decrease over time.

✔️ Pregnancy & Lactation

Limited data available; use only if benefits outweigh risks

Be cautious during pregnancy and labor; monitor infants for adrenal suppression if high doses were used during pregnancy

✔️ Precautions & Warnings

• Not for acute asthma attacks or exacerbations
• Avoid exceeding the prescribed dose
• Use cautiously in patients with:
• Heart conditions, arrhythmias, tachyarrhythmias
• Pulmonary tuberculosis or airway infections
• Hyperthyroidism or diabetes
• Always keep a rescue inhaler available

✔️ Storage:

Before opening: Refrigerate at 2–8°C (do not freeze)

During use: Keep below 25°C, away from light and moisture, for up to 4 months

Store with the mouthpiece down and out of reach of children