Alprazolam Cinfa, 2 mg tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

alprazolam cinfa 2 mg tablets EFG

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet as you may need to read it again.
• If you have any questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only, and you should not give it to other people even if they have the same symptoms as you, because it may harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if they are adverse effects not listed in this leaflet. See section 4.

Leaflet contents

1. What alprazolam cinfa is and what it is used for
2. What you need to know before taking alprazolam cinfa
3. How to take alprazolam cinfa
4. Possible side effects
5. How to store alprazolam cinfa
6. Contents of the pack and other information

1. What alprazolam cinfa is and what it is used for

The active substance in this medicine is alprazolam. It belongs to a group of medicines called benzodiazepines (anxiolytic medicines).

Alprazolam is used in adults for the treatment of anxiety symptoms that are severe, disabling, or causing significant distress to the patient. This medicine is intended for short-term use only.

2. What you need to know before taking alprazolam cinfa

Do not take alprazolam cinfa

• If you are allergic to alprazolam, to benzodiazepines, or to any of the other ingredients of this medicine (listed in section 6).
• If you have breathing difficulties, with or without sleep-related issues (sleep apnea).
• If you have a disease called myasthenia gravis, which is characterized by muscle weakness.
• If you have severe liver problems.

Warnings and precautions

Talk to your doctor or pharmacist before starting to take alprazolam cinfa.

• If you have any lung, kidney, or liver problems.
• If you have felt or currently feel so depressed that you have had thoughts or ideas of suicide.
• After prolonged use of alprazolam, a certain loss of effectiveness (tolerance) may occur.
• There is a risk of developing addiction/dependence when using alprazolam.
• If during treatment you experience symptoms of mania (a state of overexcitement, feelings of euphoria, or hyperirritability) or hypomania (a state of exaggerated excitement and activity).
• Treatment with benzodiazepines, including alprazolam, may lead to dependence, particularly after long-term continuous use.

To minimize the risk of dependence, the following precautions should be observed:

• Benzodiazepines should only be taken under medical prescription (never because they worked for someone else), and you should never recommend them to others.
• Do not increase the dose prescribed by your doctor, or extend treatment beyond the recommended duration.
• Consult your doctor regularly so they can decide whether you should continue treatment.
• Do not combine multiple benzodiazepines, regardless of their indication.
• When stopping treatment with alprazolam, symptoms similar to those that led you to start treatment may reappear (rebound effect). To avoid this, it is recommended not to stop treatment abruptly, but to gradually reduce the dose according to your doctor's instructions (see section 3 “If you stop taking alprazolam cinfa”).
• The use of alprazolam together with opioid medicines may cause profound sedation, respiratory depression, coma, and death.
• Benzodiazepines may cause memory loss and reactions such as: restlessness, agitation, irritability, aggressiveness, delusions, rage attacks, nightmares, hallucinations, psychosis, inappropriate behavior, and other adverse behavioral effects. If this occurs, you must stop treatment and consult your doctor.
• It is very important that you inform your doctor if you have a history of drug or alcohol use.

Other medicines and alprazolam cinfa

Tell your doctor or pharmacist if you are taking, have recently taken, or might need to take any other medicines.

Alprazolam may interact with other medicines. Inform your doctor or pharmacist if you are taking any of the following:

• Central nervous system depressants, as they may enhance the sedative effect of alprazolam:

  • Major tranquilizers (antipsychotics).
  • Sleep-inducing medicines (hypnotics).
  • Medicines used to treat depression.
  • Medicines for the treatment of epilepsy (antiepileptics).
  • Narcotic analgesics and opioids (morphine derivatives), as they may increase feelings of euphoria, potentially increasing psychological dependence.
  • Medicines used to treat anxiety (anxiolytics/sedatives).
  • Anesthetics.
  • Sedating antihistamines (medicines used to treat allergies).
  • The concomitant use of alprazolam and opioids (strong analgesics, medicines for substitution therapy (treatment of opioid addiction), and some cough medicines) increases the risk of drowsiness, difficulty breathing (respiratory depression), coma, and may be potentially fatal. For this reason, concomitant use should only be considered when no other treatment options are available.
  • However, if your doctor prescribes alprazolam together with opioids, the dose and duration of concomitant treatment must be limited by your doctor.
  • Inform your doctor about all opioid medicines you are taking and follow your doctor's dosage recommendations closely. It may be helpful to inform friends or family members so they are aware of the signs and symptoms mentioned above. Contact your doctor if you experience any of these symptoms.

• Certain groups of medicines that affect the body (cytochrome P450 inhibitors) may interact with alprazolam and, in some cases, increase its activity. Some of the medicines that may interact with alprazolam include:

  • Medicines used to treat fungal infections such as ketoconazole, itraconazole, posaconazole, or voriconazole. Taking them together with alprazolam is not recommended.
  • The following antidepressants: nefazodone, fluvoxamine, and fluoxetine.
  • Gastric protectors such as cimetidine.
  • Dextropropoxyphene (a narcotic analgesic).
  • Oral contraceptives.
  • Diltiazem (an antihypertensive).
  • Macrolide antibiotics such as erythromycin, troleandomycin, clarithromycin, and telithromycin.
  • Medicines used to treat HIV/AIDS such as ritonavir, etc.
  • Digoxin (a medicine used to suppress or prevent heart rhythm disturbances).

Taking alprazolam cinfa with food, drinks, and alcohol

During treatment, avoid alcoholic beverages. Alcohol may increase sedation, which could affect your ability to drive or operate machinery (see section 2 “Driving and use of machines”).

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you might be pregnant, or are planning to become pregnant, consult your doctor or pharmacist before using this medicine.

The use of alprazolam is not recommended during pregnancy or breastfeeding, unless, in the doctor’s judgment, the benefit outweighs the risk to the child.

If alprazolam is administered during late pregnancy or during childbirth, effects on the newborn such as decreased body temperature (hypothermia), reduced muscle tone (hypotonia), and moderate respiratory depression may occur.

Infants born to mothers who take benzodiazepines chronically during the last stage of pregnancy may develop physical dependence, potentially leading to a withdrawal syndrome in the postnatal period.

Children and adolescents (under 18 years of age)

Alprazolam is not recommended for children and adolescents under 18 years of age. Benzodiazepines should not be given to children unless strictly necessary and prescribed by a doctor. The efficacy and safety of alprazolam have not been established in individuals under 18 years of age.

Elderly patients (over 65 years of age)

Alprazolam may have a greater effect on this group of patients than on younger patients. If you belong to this group, your doctor may reduce your dose and monitor your response to treatment. Please follow their instructions carefully (see section 3 “How to take alprazolam cinfa”).

Benzodiazepines and related products should be used with caution in elderly patients due to the risk of sedation and/or musculoskeletal weakness, which may lead to falls—often with serious consequences in this population.

Special patient groups

If you have impaired liver or kidney function, consult your doctor, who may advise you to use a lower dose of alprazolam.

If you have respiratory disorders, inform your doctor.

Driving and use of machines

Alprazolam may impair your ability to drive or operate machinery, as it may cause drowsiness, reduce your attention, or decrease your reaction time. These effects are more likely at the beginning of treatment or when the dose is increased. Do not drive or operate machinery if you experience any of these effects. These effects may be intensified if alcohol is consumed at the same time.

alprazolam cinfa contains lactose

This medicine contains lactose. If your doctor has informed you of an intolerance to certain sugars, consult them before taking this medicine.

alprazolam cinfa contains sodium benzoate

This medicine contains 0.224 mg of sodium benzoate per tablet.

alprazolam cinfa contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per tablet; thus, it is essentially “sodium-free”.

3. How to take alprazolam cinfa

Follow exactly the instructions for use of this medicine given by your doctor or pharmacist. If in doubt, consult your doctor or pharmacist again.

Swallow the tablet or its part without chewing, with water or another non-alcoholic drink. If necessary, and as directed by your doctor or pharmacist, you may break the tablet along the score line.

The tablet can be divided into equal doses.

Your doctor will prescribe the most suitable alprazolam formulation according to the dose you require.

The recommended doses are as follows:

The initial dose is 0.25 mg to 0.5 mg of alprazolam three times a day.

The recommended dose ranges from 0.5 mg up to a maximum of 4 mg per day, divided into 2 or 3 doses.

In elderly patients with chronic respiratory insufficiency, or with liver or kidney impairment, the recommended initial dose is 0.25 mg of alprazolam 2 or 3 times a day, resulting in a total daily intake of 0.5 mg to 0.75 mg in divided doses. This dose may be gradually increased if necessary and well tolerated.

No individual dose should exceed the recommended limits, nor should the total daily dose, unless specifically instructed otherwise by your doctor.

Duration and discontinuation of treatment:

The maximum duration of treatment should not exceed 2–4 weeks. Long-term treatment is not recommended. If your doctor considers it necessary to extend treatment in your case, it will be done in limited periods with frequent monitoring of your condition.

You must never stop treatment abruptly. Your doctor will determine the duration of treatment depending on the course of your illness and will explain how you should gradually reduce the dose until treatment is completed.

If you feel that the effect of this medicine is too strong or too weak, inform your doctor or pharmacist.

If you take more alprazolam cinfa than you should

If you have taken more alprazolam than prescribed, consult your doctor or pharmacist immediately or go to the nearest hospital, taking this leaflet with you.

Overdose with benzodiazepines generally causes varying degrees of central nervous system depression, ranging from drowsiness to coma. Symptoms include drowsiness (sedation), speech disorders (dysarthria), coordination disturbances, confusion, lethargy (a state of deep and prolonged drowsiness), decreased muscle tone (hypotonia), low blood pressure, respiratory depression, rarely coma, and very rarely death. Serious consequences are rare unless alprazolam is taken together with other drugs or alcohol.

In case of overdose or accidental ingestion, contact your doctor or pharmacist immediately or call the Toxicology Information Service at 91 562 04 20, indicating the medicine and the amount ingested.

If you forget to take alprazolam cinfa

Do not take a double dose to make up for a missed dose. If the missed dose was recent, take it immediately; otherwise, wait until the next scheduled dose and do not take a double dose to compensate.

If you stop taking alprazolam cinfa

Treatment with alprazolam may lead to dependence; therefore, abruptly stopping alprazolam may cause withdrawal symptoms.

Withdrawal symptoms may include: headache, muscle pain, anxiety, tension, restlessness, confusion, irritability, general feeling of discomfort (dysphoria), insomnia, sensitivity to light, sound, and physical touch, tingling and cramps in the limbs and abdomen, vomiting, sweating, tremor, depersonalization, hallucinations, and seizures. If this occurs, you should consult your doctor immediately.

If you have any further questions about the use of this medicine, ask your doctor or pharmacist.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone experiences them.

Adverse effects that may occur during treatment with alprazolam predominantly appear at the beginning of treatment and usually disappear with continued administration or after a dose reduction.

Very common adverse effects (may affect more than 1 in 10 people):

• Depression.
• Sedation, drowsiness, coordination disorder (ataxia), memory impairment, difficulty speaking (dysarthria), dizziness, headache.
• Constipation, dry mouth.
• Fatigue, irritability.

Common adverse effects (may affect up to 1 in 10 people):

• Confusion, disorientation, altered sexual desire (libido), anxiety, difficulty sleeping (insomnia), nervousness.
• Abnormal coordination, impaired balance, difficulty concentrating, excessive sleepiness (hypersomnia), prolonged and profound drowsiness (lethargy), tremor.
• Nausea, decreased appetite.
• Blurred vision.
• Dermatitis.
• Sexual dysfunction.
• Weight changes.

Uncommon adverse effects (may affect up to 1 in 100 people):

• Mental and behavioral disorders (mania), hallucinations, angry reactions, agitation, dependence.
• Memory loss (amnesia).
• Loss of muscle strength.
• Inability to retain urine in the bladder (urinary incontinence).
• Irregular menstruation.
• Withdrawal symptoms.

Frequency not known (cannot be estimated from available data):

• Increased levels of prolactin in the blood (a hormone responsible for stimulating and maintaining lactation after childbirth).
• Mental and behavioral disorders (hypomania), aggression, hostility, abnormal thinking, psychomotor hyperactivity, drug abuse.
• Autonomic nervous system imbalance, involuntary muscle contractions (dystonia).
• Gastrointestinal disorder, hepatitis, liver function abnormalities, yellowing of the skin and whites of the eyes (jaundice).
• Peripheral edema.
• Angioedema (swelling beneath the skin surface).
• Photosensitivity (exaggerated response to light).
• Urinary retention in the bladder.
• Elevated intraocular pressure.

With the use of benzodiazepines, the following may occur:

• Drowsiness, blunted response to emotional stimuli (emotional blunting), reduced alertness, confusion, fatigue, headache, dizziness, muscle weakness, ataxia, or double vision. These phenomena occur predominantly at the beginning of treatment and usually disappear with continued administration. Gastrointestinal disturbances, changes in sexual desire, or skin reactions may occasionally occur.
• Memory loss (amnesia) may develop, which may be associated with inappropriate behaviors.
• The use of benzodiazepines may unmask pre-existing depression.
• When using benzodiazepines or similar compounds, reactions such as restlessness, agitation, irritability, aggressiveness, delirium, rage attacks, nightmares, hallucinations, psychosis, inappropriate behavior, and other behavioral disturbances may occur. These reactions can be severe and occur more frequently in children and elderly patients.
• Administration of the product (even at usual doses) may lead to physical dependence. Discontinuation of treatment may lead to withdrawal or rebound phenomena. Psychological dependence may occur. Cases of abuse have been reported.

Reporting of adverse effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect not listed in this leaflet. You may also report them directly via the Spanish Pharmacovigilance System for Human Medicines: www.notificaram.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of alprazolam cinfa

Keep this medicine out of the sight and reach of children.

Do not store above 30°C.

Do not use this medicine after the expiry date stated on the packaging after EXP. The expiry date refers to the last day of the month indicated.

Medicines must not be disposed of via wastewater or household waste. Dispose of unused medicines and their containers at the SIGRE collection point at your pharmacy. If you are unsure, ask your pharmacist how to dispose of medicines and containers you no longer need. This will help protect the environment.

6. Contents of the pack and other information

Composition of alprazolam cinfa

• The active substance is alprazolam. Each tablet contains 2 mg of alprazolam.
• The other components are: lactose monohydrate, microcrystalline cellulose, sodium carboxymethylstarch (type A) (from potato), maize starch, povidone, magnesium stearate, colloidal anhydrous silica, sodium docusate, sodium benzoate (E-211) and hydrated aluminium oxide.

Appearance of the product and contents of the pack

White, cylindrical, biconvex tablets, cross-scored on one side and marked with the code "A2C" on the other side.

Presented in PVC-PVDC/ALU blisters. Each pack contains 30 or 50 tablets.

Other presentations:

alprazolam cinfa 0.25 mg tablets EFG, pack containing 30 tablets.

alprazolam cinfa 0.5 mg tablets EFG, pack containing 30 tablets.

alprazolam cinfa 1 mg tablets EFG, pack containing 30 tablets.

Marketing Authorisation Holder and Manufacturer

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Date of latest revision of this leaflet: June 2022

Detailed information on this medicinal product is available on the website of the Spanish Agency of Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

You can access detailed and up-to-date information about this medicine by scanning with your mobile phone (smartphone) the QR code included in the package leaflet and outer packaging. You can also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/62789/P_62789.html

QR code to: https://cima.aemps.es/cima/dochtml/p/62789/P_62789.html