Alprazolam Tarbis 0.25 mg tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Alprazolam Tarbis 0.25 mg tablets EFG

Read the entire leaflet carefully before you start taking this medicine, as 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 others, even if they have the same symptoms as you, as 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.

Leaflet contents:

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

1. What Alprazolam Tarbis is and what it is used for

Alprazolam belongs to a group of medicines called benzodiazepines (anxiolytic medicines).

This medicine is used in adults to treat 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 starting Alprazolam Tarbis

Do not take Alprazolam

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

Warnings and precautions

• Consult your doctor or pharmacist before starting to take alprazolam if:
  • You have any lung, kidney, or liver problems.
  • 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 this medicine.
  • 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 uninterrupted long-term 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 other patients) and should never be recommended to others.
  • Do not increase the doses prescribed by your doctor in any way, nor extend treatment beyond the recommended duration.
  • Consult your doctor regularly so they can decide whether you should continue treatment.
  • Do not combine several benzodiazepines, regardless of their indication.
• When stopping treatment with alprazolam, symptoms similar to those that led to starting the treatment (rebound effects) may appear. 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 "If you stop taking Alprazolam").
• The use of alprazolam together with opioid-type medications may cause profound sedation, respiratory depression, coma, and death.
• Benzodiazepines may cause memory loss and reactions such as: restlessness, agitation, irritability, aggressiveness, delirium, 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.

Taking Alprazolam with other medicines

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

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 Tarbis:

• Major tranquilizers (antipsychotics).

• Sleep-inducing agents (hypnotics).

• Medicines used to treat depression.

• Medicines used for the treatment of epilepsy (antiepileptics).

• Narcotic and opioid analgesics (morphine derivatives), as they may increase feelings of euphoria, potentially increasing psychological dependence.

• Medicines used for the treatment of anxiety (anxiolytics/sedatives).

• Anesthetics.

• Sedating antihistamines (medicines used to treat allergies).

• The concomitant use of Alprazolam Tarbis and opioids (strong analgesics, medications 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 Tarbis 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 closely follow your doctor's dosage recommendations. It may be helpful to inform friends or family members so they are aware of the signs and symptoms listed 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 Tarbis and, in some cases, increase its activity. Some of the medicines that may interact with Alprazolam Tarbis include:

• Medicines used to treat fungal infections such as ketoconazole, itraconazole, posaconazole, or voriconazole. Their concomitant use with Alprazolam Tarbis is not recommended.

• The following antidepressants: nefazodone, fluvoxamine, and fluoxetine.

• Gastric protectants such as cimetidine.

• Dextropropoxyphene (narcotic analgesic).

• Oral contraceptives.

• Diltiazem (antihypertensive).

• Macrolide antibiotics such as erythromycin, troleandomycin, clarithromycin, and telithromycin.

• Medicines used to treat HIV/AIDS such as ritonavir, etc.

Digoxine (a medicine used to suppress or prevent heart rhythm disturbances).

Alprazolam with food, drinks, and alcohol

During treatment, avoid alcoholic beverages. Alcohol may enhance sedation, which could affect your level of alertness (see section "Driving and use of machines").

Pregnancy, breastfeeding, and fertility

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

The use of this medicine during pregnancy or breastfeeding is not recommended, unless in the medical opinion the benefit outweighs the risk to the child.

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

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

Use in children and adolescents (under 18 years of age)

Alprazolam is not recommended for use in children and adolescents under 18 years of age. Benzodiazepines should not be administered 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.

Use in elderly patients (over 65 years of age)

Alprazolam Tarbis may have a stronger effect in this group of patients than in younger patients. If you belong to this group, your doctor may reduce the dose and monitor your response to treatment. Please follow their instructions carefully (see section "How to take Alprazolam Tarbis").

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 your liver or kidneys are not functioning properly, consult your doctor, who may advise you to use a lower dose of Alprazolam Tarbis.

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 impair 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 enhanced if alcohol is consumed simultaneously.

Alprazolam contains lactose

If your doctor has informed you that you have an intolerance to certain sugars, consult them before taking this medicine.

Alprazolam contains sodium benzoate

This medicine contains 0.12 mg of sodium benzoate (E-211) in each 0.25 mg tablet.

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

3. How to take Alprazolam Tarbis

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

Dosing:

The tablet or its part should be swallowed whole, without chewing, with a little liquid. Your doctor will prescribe the most suitable alprazolam formulation according to the dose you require.

The usual doses are as follows:

• The initial dose is 0.25 mg to 0.5 mg of alprazolam three times daily.
• The usual dose ranges from 0.5 mg to a maximum of 4 mg per day, divided into 2 or 3 doses.

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

Each individual dose must not exceed the limits indicated, nor must the total daily dose, unless expressly 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 only for limited periods, and your condition will be monitored frequently.

You must never stop treatment abruptly. Your doctor will determine the treatment duration based on your condition's progression and will explain how you should gradually reduce the dose until treatment ends.

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 than you should

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

Overdose with benzodiazepines generally manifests as varying degrees of central nervous system depression, ranging from drowsiness to coma. Symptoms include drowsiness (drowsiness), speech disorders (dysarthria), coordination disturbances, confusion, lethargy (state of prolonged and deep 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 the Toxicology Information Service at telephone number 91 562 04 20, indicating the medicine and the amount ingested.

If you forget to take Alprazolam

Do not take a double dose to make up for forgotten doses. 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 treatment with Alprazolam

Treatment with alprazolam may lead to dependence; therefore, abruptly stopping alprazolam administration may result in withdrawal symptoms.

Withdrawal symptoms that may occur include: headache, muscle pain, anxiety, tension, restlessness, confusion, irritability, general feeling of discomfort (dysphoria), insomnia, intolerance to light, sounds, and physical contact, 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, Alprazolam Tarbis can have adverse effects, although not everyone will experience 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, somnolence, 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 behavioural 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 (hormone responsible for stimulating and maintaining lactation after childbirth).
• Mental and behavioural disorders (hypomania), aggression, hostility, abnormal thinking, psychomotor hyperactivity, drug abuse.
• Autonomic nervous system imbalance, involuntary muscle contractions (dystonia).
• Gastrointestinal disorder, hepatitis, altered liver function, 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.
• Increased intraocular pressure.

With the use of benzodiazepines, the following may occur:

• Drowsiness, lack of 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 behaviour.
• The use of benzodiazepines may unmask pre-existing depression.
• When using benzodiazepines or similar compounds, reactions such as restlessness, agitation, irritability, aggression, delirium, rage attacks, nightmares, hallucinations, psychosis, inappropriate behaviour, and other behavioural disturbances may occur. These reactions can be severe and occur more frequently in children and elderly patients.

Administration of this 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 Tarbis

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

Do not store above 25 °C.

Keep in the original packaging to protect from light and moisture.

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

Medicines must not be disposed of via wastewater or household waste. Return unused medicines and their containers to the SIGRE 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 Tarbis 0.25 mg tablets EFG

• The active substance is alprazolam. Each tablet contains 0.25 mg of alprazolam.
• The other components (excipients) are: sodium docusate, sodium benzoate (E-211), pregelatinized starch (from potato), microcrystalline cellulose (E-460), lactose monohydrate, magnesium stearate (E-572), and colloidal anhydrous silica.

Appearance of the product and contents of the pack

The medicine is presented as white, oblong, scored tablets, engraved with “APZM 0.25” on one side. Each pack (blister pack) contains 30 tablets.

Other presentations:

Alprazolam Tarbis 0.5 mg tablets EFG, pack containing 30 tablets.

Alprazolam Tarbis 1 mg tablets EFG, pack containing 30 tablets.

Alprazolam Tarbis 2 mg tablets EFG, pack containing 30 and 50 tablets.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Tarbis Farma, S.L.

Gran Vía Carlos III, 94,

08028 Barcelona, Spain

Manufacturer:

Dragenopharm Apotheker Püschl GmbH Co. KG

Göllstrasse 1, 84529 Tittmoning

Germany

The most recent revision of this leaflet was in January 2023

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