Aremis 50 mg film-coated tablets

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Aremis 50mg film-coated tablets

Sertraline

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 must not be given to other people, even if they have the same symptoms as you, because it could harm them.
• If you experience any side effects, talk to your doctor or pharmacist, even if they are side effects not listed in this leaflet. See section 4.

Contents of the leaflet

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

1. What Aremis is and what it is used for

Aremis contains sertraline as the active substance. Sertraline belongs to a group of medicines known as Selective Serotonin Reuptake Inhibitors (SSRIs); these medicines are used to treat depression and/or anxiety disorders.

Aremis can be used to treat:

• Depression and prevention of recurrence of depression (in adults).
• Social anxiety disorder (in adults).
• Post-traumatic stress disorder (PTSD) (in adults).
• Panic disorder (in adults).
• Obsessive-compulsive disorder (OCD) (in adults and in children and adolescents aged 6–17 years).

Depression is a clinical condition characterized by symptoms such as feelings of sadness, inability to sleep properly, and inability to enjoy life as one used to.

OCD and panic disorders are anxiety-related conditions, with symptoms such as persistent worry about recurring thoughts (compulsions) that lead to repetitive rituals (obsessions).

PTSD is a disorder that may occur following an emotionally traumatic experience and has some symptoms similar to those of depression and anxiety. Social anxiety disorder (social phobia) is an anxiety-related illness. It is characterized by intense anxiety or distress in social situations (for example: speaking with strangers, speaking in public, eating or drinking in front of others, or worrying about possibly behaving in an embarrassing way).

Your doctor has determined that this medicine is appropriate for treating your condition.

If you are unsure why Aremis has been prescribed for you, you should consult your doctor.

2. What you need to know before taking Aremis

Do not take Aremis:

• If you are allergic to sertraline or to any of the other ingredients of this medicine (listed in section 6).
• If you are taking or have recently taken medicines called monoamine oxidase inhibitors (MAOIs), such as selegiline or moclobemide, or other medicines similar to MAOIs (such as linezolid). If you stop treatment with sertraline, you must wait at least one week before starting treatment with an MAOI. After stopping treatment with an MAOI, you must wait at least two weeks before starting treatment with sertraline.
• If you are taking another medicine called pimozide (a medicine used to treat mental disorders such as psychosis).

Warnings and precautions

Talk to your doctor or pharmacist before taking Aremis.

Medicines are not always suitable for everyone. Before starting treatment with Aremis, tell your doctor if you have or have previously had any of the following conditions:

• If you have epilepsy (seizures) or a history of seizures. If you have a seizure, contact your doctor immediately.
• If you have manic-depressive illness (bipolar disorder) or schizophrenia. If you experience a manic episode, contact your doctor immediately.
• If you have or have previously had thoughts of harming yourself or of suicide (see below under "Suicidal thoughts and worsening of depression or anxiety disorder").
• If you have Serotonin Syndrome. This syndrome may rarely occur when you are taking certain medicines together with sertraline. (For symptoms, see section 4. Possible side effects.) Your doctor will advise you if you have previously experienced this syndrome.
• If you have low sodium levels in your blood, as this condition may occur as a result of treatment with Aremis. You should also inform your doctor if you are taking any medicine for high blood pressure, as these medicines may also affect your blood sodium levels.
• If you are elderly, as you may have an increased risk of low blood sodium levels (see previous point).
• If you have liver disease; your doctor may consider that you should take a lower dose of Aremis.
• If you have diabetes; Aremis may alter your blood sugar levels, so it may be necessary to adjust the dose of your diabetes medicines.
• If you have a history of bleeding disorders (tendency to develop bruises), or if you are pregnant (see section "Pregnancy, breastfeeding and fertility") or have been taking medicines that reduce blood clotting [e.g. acetylsalicylic acid (aspirin), or warfarin] or that may increase the risk of bleeding.
• If you are a child or adolescent under 18 years of age. Aremis should only be used to treat children and adolescents aged 6 to 17 years with obsessive-compulsive disorder (OCD). If you are being treated for this condition, your doctor will want to monitor you closely (see below under "Children and adolescents").
• If you are receiving electroconvulsive therapy (ECT).
• If you have any eye disorders, such as certain types of glaucoma (increased intraocular pressure).
• If you have been told you have an abnormality on the heart tracing obtained from an electrocardiogram (ECG), known as QT interval prolongation.
• If you have heart disease, low levels of potassium or magnesium, a family history of QTc prolongation, slow heart rate, or are taking concomitantly medicines that prolong the QTc interval.

Restlessness/Akathisia:

The use of sertraline has been associated with unpleasant restlessness and a need to move, often accompanied by an inability to sit or stand still (akathisia). This occurs more frequently during the first weeks of treatment. Increasing the dose may be harmful, so if you develop these symptoms, you should contact your doctor.

Withdrawal symptoms:

Side effects related to stopping treatment (withdrawal symptoms) are common, particularly if treatment is stopped abruptly (see section 3. If you stop taking Aremis and section 4. Possible side effects). The risk of experiencing withdrawal symptoms depends on the duration of treatment, the dose, and the rate at which the dose is reduced. Generally, these symptoms are mild or moderate. However, in some patients they may be severe. These symptoms usually appear during the first few days after stopping treatment. In general, these symptoms resolve on their own and usually disappear within two weeks. In some patients, they may last longer (2–3 months or more). It is recommended that when stopping treatment with sertraline, the dose should be gradually reduced over a period of several weeks or even months, and you should always agree with your doctor on the best way to discontinue treatment.

Suicidal thoughts and worsening of depression or anxiety disorder:

If you are depressed and/or have anxiety disorders, you may sometimes have thoughts of harming yourself or of suicide. This may increase at the beginning of treatment with antidepressants, because all these medicines take time to work, usually about two weeks but sometimes longer.

You are more likely to experience this if:

• You have previously had thoughts of suicide or self-harm.
• You are a young adult. Clinical trial data show an increased risk of suicidal behaviour in psychiatric patients under 25 years of age treated with an antidepressant.

If you have thoughts of harming yourself or of suicide at any time, contact your doctor or go to hospital immediately.

It may be helpful for you to explain to a close family member or friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You may also ask them to inform you if they think your depression or anxiety is worsening, or if they are concerned about changes in your behaviour.

Some medicines in the group to which Aremis belongs (called SSRIs) may cause sexual dysfunction symptoms (see section 4). In some cases, these symptoms persist after stopping treatment.

Children and adolescents

Normally, sertraline should not be used in the treatment of children and adolescents under 18 years of age, except in patients with obsessive-compulsive disorder (OCD). Patients under 18 years of age have a higher risk of adverse effects such as suicide attempts, thoughts of self-harm or suicide (suicidal ideation), and hostility (predominantly aggression, confrontational behaviour, and anger reactions) when treated with this class of medicines. Nevertheless, your doctor may decide to prescribe Aremis to a patient under 18 years of age if they consider it to be the most appropriate treatment. If your doctor has prescribed Aremis to you and you are under 18 years of age and wish to discuss this decision, please return to your doctor. You must inform your doctor if any of the symptoms listed above appear or worsen while you are taking Aremis. The long-term safety effects on growth, maturation, learning (cognitive development), and behavioural development of Aremis were evaluated in a long-term study involving over 900 children aged 6 to 16 years monitored for a period of 3 years. Overall, the study results showed that children treated with sertraline developed normally, except for a slight increase in weight in those treated with a higher dose.

Taking Aremis with other medicines

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

Some medicines may affect how Aremis works, or Aremis itself may reduce the effectiveness of other medicines you are taking at the same time.

The use of Aremis together with the following medicines may cause serious adverse effects:

• Medicines called monoamine oxidase inhibitors (MAOIs), such as moclobemide (used to treat depression), selegiline (used to treat Parkinson's disease), the antibiotic linezolid, and methylene blue (used to treat high levels of methaemoglobin in the blood). Do not use Aremis with these medicines.
• Medicines used to treat mental disorders such as psychosis (pimozide). Do not use Aremis with pimozide.

Tell your doctor if you are taking the following medicines:

• Medicines containing amphetamines (used to treat attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity).
• Herbal medicines containing St. John's Wort (Hypericum perforatum). The effects of St. John's Wort may last 1–2 weeks.
• Products containing the amino acid tryptophan.
• Medicines used to treat severe or chronic pain (opioids, such as tramadol, fentanyl).
• Medicines used in anaesthesia (e.g. fentanyl, mivacurium, and suxamethonium).
• Medicines used to treat migraines (e.g. sumatriptan).
• Medicines that reduce blood clotting (warfarin).
• Medicines used to treat pain/arthritis [non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, acetylsalicylic acid (aspirin)].
• Sedatives (diazepam).
• Diuretics.
• Medicines used to treat epilepsy (phenytoin, phenobarbital, carbamazepine).
• Medicines used to treat diabetes (tolbutamide).
• Medicines used to treat acidity, ulcers, and heartburn (cimetidine, omeprazole, lansoprazole, pantoprazole, rabeprazole).
• Medicines used to treat mania and depression (lithium).
• Other medicines used to treat depression (such as amitriptyline, nortriptyline, nefazodone, fluoxetine, fluvoxamine).
• Medicines used to treat schizophrenia and other mental disorders (such as perphenazine, levomepromazine, and olanzapine).
• Medicines used to treat high blood pressure, chest pain, or to regulate heart rate and rhythm (such as verapamil, diltiazem, flecainide, propafenone).
• Medicines used to treat bacterial infections (such as rifampicin, clarithromycin, telithromycin, erythromycin).
• Medicines used to treat fungal infections (such as ketoconazole, itraconazole, posaconazole, voriconazole, fluconazole).
• Medicines used to treat HIV/AIDS and hepatitis C (protease inhibitors such as ritonavir, telaprevir).
• Medicines used to prevent nausea and vomiting after surgery or chemotherapy (aprepitant).
• Medicines known to increase the risk of changes in the heart's electrical activity (e.g. some antipsychotics and antibiotics).

Taking Aremis with food, drinks and alcohol

Aremis tablets can be taken with or without food.

Alcohol intake should be avoided while being treated with Aremis.

Grapefruit juice should not be taken with sertraline, as it may increase sertraline levels in your body.

Pregnancy, breastfeeding and fertility

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

The safety of sertraline in pregnant women has not been fully established. If you are pregnant, sertraline will only be administered if your doctor considers that the benefit to you outweighs any possible risk to the developing baby.

If you take Aremis in the late stages of pregnancy, there may be an increased risk of heavy vaginal bleeding shortly after delivery, especially if you have a history of bleeding disorders. Your doctor or midwife should be informed that you are taking Aremis so they can advise you. If taken during pregnancy, especially during the last 3 months, medicines like Aremis may increase the risk of a serious condition in newborns called persistent pulmonary hypertension of the newborn (PPHN), which causes the baby to breathe faster and appear blue. These symptoms usually begin within the first 24 hours after birth. If this occurs in your baby, contact your midwife and/or doctor immediately.

Your newborn baby may have other conditions, which usually appear within the first 24 hours after birth. Symptoms include:

• Difficulty breathing,
• Blue or excessively hot or cold skin,
• Blue lips,
• Vomiting or feeding problems,
• Excessive tiredness, inability to sleep, or excessive crying,
• Muscle stiffness or decreased muscle tone,
• Tremors, restlessness, or seizures,
• Increased reflex responses,
• Irritability,
• Low blood sugar levels.

If your baby shows any of these symptoms at birth, or if you are concerned about your baby's health, consult your doctor or midwife for advice.

There is evidence that sertraline passes into breast milk. Therefore, sertraline can only be used in women who are breastfeeding if your doctor considers that the benefit outweighs any possible risk to the child.

Animal studies have shown that some medicines like sertraline may reduce sperm quality. This could theoretically affect fertility, but the impact on human fertility has not yet been determined.

Driving and using machines

Psychotropic medicines such as sertraline may affect your ability to drive or operate machinery. Therefore, do not drive or operate heavy machinery until you know how this medicine affects your ability to perform these activities.

Sodium content This medicine contains less than 23 mg of sodium (1 mmol) per tablet, i.e., essentially "sodium-free".

3. How to take Aremis

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

Recommended dose:

Adults:

Depression and Obsessive-Compulsive Disorder (OCD):

For depression and OCD, the usually effective dose is 50 mg per day. The daily dose may be increased in increments of 50 mg at intervals of at least one week, over several weeks. The maximum recommended dose is 200 mg per day.

Panic disorder, social anxiety disorder, and post-traumatic stress disorder:

For panic disorder, social anxiety disorder, and post-traumatic stress disorder, treatment should be initiated at a dose of 25 mg per day, increasing to 50 mg per day after one week.

The daily dose may be increased in 50 mg increments over a period of several weeks. The maximum recommended dose is 200 mg per day.

Use in children and adolescents:

Aremis should only be used to treat children and adolescents aged 6 to 17 years with OCD.

Obsessive-compulsive disorder:

Children aged 6 to 12 years: The recommended starting dose is 25 mg per day. After one week, your doctor may increase the dose to 50 mg per day. The maximum dose is 200 mg per day.

Adolescents aged 13 to 17 years: The recommended starting dose is 50 mg per day. The maximum dose is 200 mg per day.

If you have liver or kidney problems, inform your doctor and follow the instructions he or she gives you.

Method of administration:

Aremis tablets can be taken with or without food.

Take your medicine once daily, either in the morning or in the evening.

Your doctor will determine how long you should take this medicine. The duration will depend on the nature of your illness and your response to treatment. It may take several weeks before your symptoms begin to improve. Treatment for depression should usually continue for 6 months after improvement.

If you take more Aremis than you should

If you accidentally take too much Aremis, contact your doctor or go to the nearest hospital emergency department. Always bring the medicine packaging with you, whether or not there is any medicine left.

You may also call the Toxicology Information Service at telephone number 91 562 04 20, indicating the medicine and the amount ingested.

Symptoms of overdose may include drowsiness, nausea and vomiting, increased heart rate, tremors, agitation, dizziness, and in rare cases, unconsciousness.

If you forget to take Aremis:

Do not take a double dose to make up for a missed dose. If you forget to take a dose, do not take it when you remember. Take the next dose at the usual time.

If you stop taking Aremis:

Do not stop treatment with Aremis unless your doctor tells you to. Your doctor will want to gradually reduce the dose of Aremis over several weeks before you stop taking this medicine completely. If you stop treatment abruptly, you may experience adverse effects such as dizziness, numbness, sleep disturbances, agitation or anxiety, headache, nausea, vomiting, and tremor. If you experience any of these adverse effects, or any other symptoms, while stopping treatment with Aremis, please inform your doctor.

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 produce adverse effects, although not everyone will experience them.

The most common adverse effect is nausea. Adverse effects depend on the dose and often disappear or decrease with continued treatment.

Tell your doctor immediately:

If you experience any of the following symptoms after taking this medicine, as these symptoms may be serious.

• If you develop a severe skin rash causing blisters (erythema multiforme), (which may affect the mouth and tongue). These may be signs of a condition known as Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis (TEN). In such cases, your doctor will discontinue treatment.
• Allergic reaction or allergy, which may present symptoms such as itchy skin rash, breathing difficulties, wheezing, swelling of the eyelids, face or lips.
• If you experience agitation, confusion, diarrhea, increased body temperature and blood pressure, excessive sweating, and rapid pulse. These are symptoms of serotonin syndrome. Rarely, this syndrome may occur when taking certain medicines together with sertraline. Your doctor may decide to discontinue treatment.
• If you notice yellowing of the skin or eyes, which may indicate liver damage.
• If you experience depressive symptoms with thoughts of self-harm or suicide (suicidal thoughts).
• If, after starting treatment with Aremis, you begin to feel restless and are unable to sit or stand still. You should inform your doctor if you start feeling restless.
• If you have a seizure (convulsion).
• If you experience a manic episode (see section 2. Warnings and precautions).

The following adverse effects were observed in clinical trials in adults and after marketing.

Very common (may affect more than 1 in 10 patients):

Insomnia, dizziness, somnolence, headache, diarrhea, malaise, dry mouth, ejaculation disorders, and fatigue.

Common (may affect up to 1 in 10 patients):

• Cold (chest), sore throat, runny nose,
• Loss of appetite, increased appetite,
• Anxiety, depression, agitation, decreased libido, nervousness, feeling strange, nightmares, teeth grinding,
• Tremor, movement disorders (such as constant movements, muscle tension, difficulty walking, rigidity, spasms, and involuntary muscle movements)*, numbness and tingling, increased muscle tone, difficulty concentrating, abnormal taste,
• Visual disturbances,
• Ringing in the ears,
• Palpitations,
• Hot flushes,
• Yawning,
• Stomach discomfort, constipation, abdominal pain, vomiting, flatulence,
• Increased sweating, rash,
• Back pain, joint pain, muscle pain,
• Menstrual irregularities, erectile dysfunction,
• Malaise, chest pain, weakness, fever,
• Weight gain,
• Injury.

Uncommon (may affect up to 1 in 100 patients):

• Gastroenteritis, ear infection,
• Tumor,
• Hypersensitivity, seasonal allergy,
• Low levels of thyroid hormones,
• Suicidal thoughts, suicidal behaviour*, psychotic disorders, abnormal thinking, lack of self-care, hallucinations, aggression, excessive happiness, paranoia,
• Amnesia, decreased sensitivity, involuntary muscle contractions, fainting, continuous movements, migraine, seizures, dizziness upon standing, abnormal coordination, speech disorders,
• Dilated pupils,
• Ear pain,
• Rapid pulse, heart problems,
• Bleeding disorders (such as stomach bleeding)*, elevated blood pressure, hot flushes, blood in urine,
• Shortness of breath, nosebleeds, difficulty breathing possibly with noise,
• Black stools, dental disorders, inflammation of the esophagus, tongue disorders, hemorrhoids, increased salivation, difficulty swallowing, belching, tongue disorders,
• Swelling of eyes, urticaria, hair loss, itching, purple spots on the skin, blistering skin disorders, dry skin, facial swelling, cold sweat,
• Osteoarthritis, muscle jerks, muscle cramps*, muscle weakness,
• Increased frequency of urination, urinary disorders, urinary retention, urinary incontinence, increased urine volume, need to urinate at night,
• Sexual dysfunction, excessive vaginal bleeding, vaginal bleeding, female sexual dysfunction,
• Swollen legs, chills, difficulty walking, thirst,
• Increased liver enzyme levels, weight loss,
• Cases of suicidal thoughts and behaviour have been reported during treatment with sertraline or shortly after discontinuation (see section 2).

Rare (may affect up to 1 in 1,000 patients):

• Diverticulitis, swollen lymph nodes, decrease in platelets*, decrease in white blood cell count*,
• Severe allergic reaction,
• Endocrine disorders*,
• Elevated cholesterol, problems controlling blood sugar levels (diabetes), low blood sugar, increased blood sugar*, low blood sodium levels*,
• Physical symptoms due to stress or emotions, abnormal nightmares*, drug dependence, sleepwalking, premature ejaculation,
• Coma, abnormal movements, difficulty moving, increased sensitivity, sudden severe headache (which may be a sign of a serious condition known as reversible cerebral vasoconstriction syndrome (RCVS))*, sensory disturbances,
• Seeing spots before the eyes, glaucoma, double vision, photophobia (eye sensitivity to light), eye hemorrhages, irregular pupils*, abnormal vision*, tear problems,
• Heart attack, dizziness, fainting or chest discomfort which could be signs of changes in electrical activity (seen on electrocardiogram) or abnormal heart rhythm*, decreased heart rate,
• Circulation problems in arms and legs,
• Rapid breathing, progressive scarring in lung tissue (interstitial lung disease)*, throat spasm, difficulty speaking, slower breathing, hiccups,
• Mouth ulceration, pancreatitis*, blood in stools, tongue ulceration, mouth sores,
• Problems with liver function, serious liver function disorders*, yellowing of skin and eyes (jaundice)*,
• Skin reaction to sunlight*, skin swelling*, abnormal hair texture, abnormal skin odor, capillary rash,
• Rupture of muscle tissue*, bone disorder,
• Interrupted urination, decreased urine volume,
• Breast secretion, vaginal dryness, genital secretion, penile and foreskin redness and pain, breast enlargement*, prolonged erection,
• Hernia, decreased tolerance to the medicine,
• Increased cholesterol levels, abnormal laboratory tests*, abnormal semen, coagulation disorders*,
• Relaxation of blood vessel processes.

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

• Partial loss of vision,
• Jaw locking*, muscle weakness and severe muscle pain, which may be a sign of multiple acyl-coenzyme A dehydrogenase deficiency (MADD)*,
• Urinary incontinence during sleep*,
• Inflammation of the colon (causing diarrhea)*,
• Heavy vaginal bleeding shortly after childbirth (postpartum hemorrhage). See “Pregnancy, breastfeeding and fertility” in section 2 for more information.

*Adverse effects reported after marketing.

Other adverse effects in children and adolescents

In clinical trials in children and adolescents, adverse effects were generally similar to those reported in adults (see above). The most common adverse effects in children and adolescents were headache, insomnia, diarrhea, and nausea.

Symptoms that may occur when stopping treatment

If you stop treatment with this medicine abruptly, you may experience adverse effects such as dizziness, numbness, sleep disturbances, agitation or anxiety, headache, nausea, vomiting, and tremor (see section 3. “If you stop taking Aremis”).

An increased risk of bone fracture has been observed in patients taking this type of medicine.

Reporting of adverse effects

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

5. Storage of Aremis

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

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

Do not store above 30°C.

Medicines should not be disposed of via wastewater drains or household waste. Dispose of empty containers and unused medicines at the SIGRE collection point at your pharmacy. If in doubt, ask your pharmacist how to properly dispose of unused containers and medicines. This way, you will help protect the environment.

6. Contents of the pack and other information

Composition of Aremis:

• Each film-coated tablet contains sertraline hydrochloride equivalent to 50 mg of sertraline.

The other components are: calcium hydrogen phosphate dihydrate (E341), microcrystalline cellulose (E460), hydroxypropylcellulose (E463), sodium glycolate starch from potato (type A), magnesium stearate (E572), titanium dioxide (E171), hypromellose (E464), macrogol 400 (E1521), macrogol 6000 (E1521) and polysorbate 80 (E433).

Appearance of the product and contents of the pack

Aremis 50 mg is presented as white or almost white, elongated, biconvex, film-coated tablets, with the anagram “AREMIS” and a score line on one side and “50” on the other.

Aremis is available in blisters containing 30, 60 or 500 tablets (hospital pack).

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Esteve Pharmaceuticals, S.A.

Passeig de la Zona Franca, 109

08038 Barcelona (Spain)

Manufacturer:

TOWA Pharmaceutical Europe S.L.

c/ de Sant Marti, 75-97

08107 Martorelles (Spain)

Date of the most recent review of this summary: June 2025

Detailed and up-to-date information on this medicine is available on the website of the Spanish Agency of Medicines and Medical Devices (AEMPS) http://www.aemps.gob.es/