Arketin 6 mg film-coated tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Arketin 6 mg film-coated tablets EFG

Risperidone

Package leaflet:

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

1. What Arketin is and what it is used for

Arketin belongs to a group of medicines called "antipsychotics".

Arketin is used to treat the following conditions:

• Schizophrenia, a condition in which you may see, hear, or feel things that are not there, believe things that are not true, or feel particularly suspicious or confused.
• Mania, a condition in which you may feel overly excited, elated, agitated, enthusiastic, or hyperactive.

Mania occurs in a disease called "bipolar disorder".

• Short-term treatment (up to 6 weeks) of persistent aggression in patients with Alzheimer-type dementia who harm themselves or others. Alternative non-pharmacological treatments should have been tried previously.
• Short-term treatment (up to 6 weeks) of persistent aggression in intellectually disabled children (at least 5 years of age) and adolescents with conduct disorders.

2. What you need to know before taking Arketin

Do not take Arketin:

• If you are allergic to risperidone or to any of the other ingredients of this medicine (listed in section 6).

If you are unsure, consult your doctor or pharmacist before using Arketin.

Warnings and precautions

Talk to your doctor or pharmacist before starting Arketin.

• If you have any heart problems. Examples include disturbances in heart rhythm, or if you are prone to low blood pressure, or if you are taking medicines for blood pressure. Arketin may lower blood pressure. You may need your dose adjusted.
• If you have any risk factors that may make you prone to stroke, such as high blood pressure, cardiovascular disease, or blood vessel problems in the brain.
• If you have Parkinson's disease or dementia.
• If you are diabetic.
• If you have epilepsy.
• If you are male and have ever had a prolonged or painful erection. If this occurs while taking Arketin, contact your doctor immediately.
• If you have problems regulating your body temperature or feel excessive heat.
• If you have kidney problems.
• If you have liver problems.
• If you have abnormally high levels of the hormone prolactin in your blood, or if you have a tumor that may be prolactin-dependent.
• If you or a family member has a history of blood clots, as these medicines may be associated with clot formation.

Contact your doctor immediately if you experience:

• Involuntary rhythmic movements of the tongue, mouth, or face. Discontinuation of Arketin may be necessary.
• Fever, severe muscle stiffness, sweating, or reduced level of consciousness (a condition called "neuroleptic malignant syndrome"). You may need immediate medical treatment. If you are unsure whether the above information applies to you, consult your doctor or pharmacist before using Arketin.

Arketin may cause weight gain.

Elderly patients with dementia

In elderly patients with dementia, there is an increased risk of stroke. You should not take risperidone if your dementia is caused by stroke.

During treatment with Arketin, you should see your doctor regularly.

If you or your caregiver notice a sudden change in your mental state or the sudden onset of weakness or numbness in your face, arms, or legs—especially on one side—or if you experience slurred speech, even briefly, seek immediate medical attention. These may be signs of a stroke.

Children and adolescents

Other causes of aggressive behavior should be ruled out before starting treatment for conduct disorders.

If you experience fatigue during risperidone treatment, changing the time of administration may improve your difficulties with attention.

Taking Arketin with other medicines

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

It is especially important that you talk to your doctor or pharmacist if you are taking any of the following:

• Medicines that act on the brain, such as those used to calm you down (benzodiazepines), or certain pain medicines (opioids), or allergy medicines (some antihistamines), as risperidone may increase their sedative effect.
• Medicines capable of altering the electrical activity of your heart, such as those used for malaria, heart rhythm disorders (e.g., quinidine), allergies (antihistamines), some antidepressants, or other medicines for mental disorders.
• Medicines that cause a slow heartbeat.
• Medicines that cause low potassium levels in the blood (e.g., certain diuretics).
• Medicines for high blood pressure. Arketin may lower blood pressure.
• Medicines for Parkinson's disease (such as levodopa).
• Diuretics used for heart problems or to treat swelling in certain body parts due to fluid retention (e.g., furosemide or chlorothiazide). Arketin, taken alone or with furosemide, may increase the risk of stroke or death in elderly patients with dementia.

The following medicines may reduce the effect of risperidone:

• Rifampicin (a medicine used to treat certain infections)
• Carbamazepine, phenytoin (medicines for epilepsy)
• Phenobarbital

If you start or stop taking these medicines, you may need a different dose of risperidone.

The following medicines may increase the effect of risperidone:

• Quinidine (used for certain types of heart disease)
• Antidepressants such as paroxetine, fluoxetine, and tricyclic antidepressants
• Medicines known as beta-blockers (used to treat high blood pressure)
• Phenothiazines (e.g., used to treat psychosis or as sedatives)
• Cimetidine, ranitidine (stomach acid blockers)

If you start or stop taking these medicines, you may need a different dose of risperidone.

If you are unsure whether the above information applies to you, consult your doctor or pharmacist before using Arketin.

Taking Arketin with food, drinks, and alcohol

You may take this medicine with or without food. You should avoid consuming alcohol while taking Arketin.

Pregnancy and breastfeeding

• If you are pregnant, breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.
• Newborns of mothers who have used Arketin during the last trimester of pregnancy may experience symptoms such as tremor, muscle stiffness and/or weakness, drowsiness, agitation, breathing difficulties, and feeding problems. If your newborn shows any of these symptoms, contact your doctor.

Consult your doctor or pharmacist before using any medicine.

Driving and using machines

Arketin may cause symptoms such as drowsiness, dizziness, or vision disturbances, and may reduce reaction capacity. These effects, as well as the underlying illness itself, may impair your ability to drive or operate machinery. Therefore, do not drive or operate machinery, or engage in other activities requiring special alertness, until your doctor has assessed your response to this medicine.

Arketin contains lactose and sodium

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

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

3. How to take Arketin

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

How much to take

For the treatment of schizophrenia

Adults

• The initial dose is 2 mg per day; it may be increased to 4 mg per day on the second day.
• Your doctor may adjust your dose depending on how you respond to treatment.
• Most people do best with daily doses of 4 to 6 mg.
• This total daily dose can be divided into one or two doses per day. Your doctor will tell you what is best for you.

Elderly patients

• The initial dose is usually 0.5 mg twice daily.
• Later, your doctor may gradually increase your dose to 1–2 mg twice daily.
• Your doctor will tell you what is best for you.

Children and adolescents

• Children and adolescents under 18 years of age should not be treated with Arketin for schizophrenia.

For the treatment of mania

Adults

• The initial dose is usually 2 mg once daily.
• Your doctor may gradually adjust your dose depending on your response to treatment.
• Most people do best with daily doses of 1 to 6 mg.

Elderly patients

• The initial dose is usually 0.5 mg twice daily.
• Later, your doctor may gradually adjust your dose to 1–2 mg twice daily depending on your response to treatment.

Children and adolescents

• Children and adolescents under 18 years of age should not be treated with Arketin for bipolar mania.

For the long-term treatment of aggression in patients with Alzheimer-type dementia

Adults (including elderly patients)

• The initial dose is usually 0.25 mg twice daily.
• Your doctor may gradually adjust your dose depending on your response to treatment.
• Most people do best with doses of 0.5 mg twice daily. Some patients may require 1 mg twice daily.
• The duration of treatment in patients with Alzheimer-type dementia should not exceed 6 weeks.

For the treatment of conduct disorders in children and adolescents

The dose will depend on your child's weight:

If weighing less than 50 kg

• The initial dose is usually 0.25 mg once daily.
• The dose may be increased every other day in increments of 0.25 mg per day.
• The usual maintenance dose is 0.25 mg to 0.75 mg once daily.

If weighing 50 kg or more

• The initial dose is usually 0.5 mg once daily.
• The dose may be increased every other day in increments of 0.5 mg per day.
• The usual maintenance dose is 0.5 mg to 1.5 mg once daily.

The duration of treatment in patients with conduct disorders should not exceed 6 weeks.

Children under 5 years of age should not be treated with Arketin for conduct disorders.

Patients with liver or kidney problems

Regardless of the condition being treated, all initial and subsequent risperidone doses should be halved. Dose increases should be made more slowly in these patients.

Risperidone should be used with caution in this group of patients.

How to take Arketin

Your doctor will tell you how much medicine to take and for how long. This will depend on your illness and may vary from person to person. The amount of medicine you should take is explained above under the heading “How much to take.”

You should swallow the medicine with a glass of water.

If you take more Arketin than you should

• 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 taken.
• In case of overdose, you may feel drowsy or tired, experience abnormal body movements, have difficulty standing or walking, feel dizzy due to a drop in blood pressure, or have abnormal heartbeats or seizures.

If you forget to take Arketin

• If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular schedule. If you miss two or more doses, contact your doctor.

• Do not take a double dose (two doses at the same time) to make up for a missed dose.

If you stop taking Arketin

Do not stop treatment unless your doctor tells you to. Symptoms may return. If your doctor decides to discontinue treatment, your dose may be gradually reduced over several days.

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

4. Possible adverse effects

Like all medicines, Arketin may cause adverse effects, although not everyone experiences them.

Tell your doctor immediately if you experience:

Blood clots in the veins, especially in the legs (symptoms include swelling, pain, and redness in the leg). These clots may travel through blood vessels to the lungs, causing chest pain and difficulty breathing. If you experience any of these symptoms, contact your doctor immediately.

Very common: may affect more than 1 in 10 people
Common: may affect between 1 and 10 in 100 people
Uncommon: may affect between 1 and 10 in 1,000 people
Rare: may affect between 1 and 10 in 10,000 people
Very rare: may affect fewer than 1 in 10,000 people
Not known: frequency cannot be estimated from available data

The following side effects may occur:

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

• Parkinsonism. This is a medical term that includes several symptoms. Each individual symptom may occur less frequently than 1 in 10 people. Parkinsonism includes: increased salivation or very wet mouth, musculoskeletal rigidity, drooling, pain when bending limbs, slowed, reduced, or difficult movements, lack of facial expression, muscle tightness, torticollis, muscle stiffness, short, shuffling steps when walking, dragging feet, absence of normal arm movements, persistent blinking in response to tapping the forehead (an abnormal reflex)
• Headache, difficulty falling or staying asleep

Common (may affect between 1 and 10 in 100 people):

• Drowsiness, fatigue, tiredness, inability to remain still, irritability, anxiety, somnolence, dizziness, attention disturbances, feeling of exhaustion, sleep disturbances, tremor
• Vomiting, diarrhea, constipation, nausea, increased appetite, abdominal pain or discomfort, sore throat, dry mouth
• Weight gain, increased body temperature, decreased appetite
• Breathing difficulty, lung infection (pneumonia), flu, respiratory tract infection, blurred vision, nasal congestion, nosebleeds, cough
• Urinary tract infection, bedwetting
• Muscle cramps, involuntary movements of the face or arms and legs, joint pain, back pain, swelling of arms and legs, pain in arms and legs
• Rash, skin redness
• Rapid heartbeat, chest pain
• Increased blood concentration of prolactin hormone

Uncommon (may affect between 1 and 10 in 1,000 people):

• Excessive water intake, fecal incontinence, thirst, very hard stools, hoarseness or voice disorder
• Lung infection caused by food entering the airways, bladder infection, eye redness, sinusitis, viral infection, ear infection, tonsillitis, skin infection, eye infection, stomach infection, eye discharge, fungal nail infection
• Abnormality in the heart's electrical conduction, drop in blood pressure upon standing, decreased blood pressure, dizziness when changing position, abnormal heart electrical activity (ECG), irregular heartbeat, awareness of heartbeat, rapid or slow heartbeat
• Urinary incontinence, painful urination, frequent urination
• Confusion, attention disturbance, reduced level of consciousness, excessive sleepiness, restlessness, elevated mood (mania), lack of energy and interest
• Increased blood glucose, increased liver enzymes, decreased white blood cell count, decreased hemoglobin or red blood cell count (anemia), increased eosinophils (a type of white blood cell), increased creatine phosphokinase, decreased platelet count (blood cells that help stop bleeding)
• Muscle weakness, muscle pain, ear pain, neck pain, joint swelling, abnormal posture, joint stiffness, chest muscle and bone pain, chest discomfort
• Skin injury, skin disorder, dry skin, severe itching, acne, hair loss, skin inflammation due to mites, skin discoloration, skin thickening, flushing, reduced skin sensitivity to pain or touch, greasy skin inflammation
• Absence of menstruation, sexual dysfunction, erectile dysfunction, ejaculation disorder, breast discharge, breast enlargement in males, decreased sexual desire, irregular menstruation, vaginal discharge
• Fainting, gait disturbance, inactivity, reduced appetite with malnutrition and weight loss, feeling of "indisposition", balance disorder, allergy, edema, speech disorder, chills, coordination disorder
• Painful sensitivity to light, increased blood flow to the eye, eye swelling, dry eyes, increased tearing
• Respiratory tract disorder, pulmonary congestion, crackling lung sounds, respiratory tract congestion, speech difficulties, swallowing difficulty, cough with sputum, hoarse or wheezing breathing sounds, pseudoinfluenza illness, sinusitis
• Lack of response to stimuli, loss of consciousness, sudden swelling of lips and eyes with breathing difficulty, sudden weakness or numbness of face, arms or legs, especially on one side, or episodes of confused speech lasting less than 24 hours (called mini-stroke or stroke), involuntary movements of face, arms or legs, ringing in the ears, facial edema

Rare (may affect between 1 and 10 in 10,000 people):

• Inability to achieve orgasm, menstrual disorder
• Dandruff
• Drug allergy, coldness in arms and legs, lip swelling, lip inflammation
• Glaucoma, decreased visual acuity, crusting at the edge of the eyelid, eye movement
• Absence of emotions
• Altered consciousness with increased body temperature and muscle spasms, generalized edema, drug withdrawal syndrome, decreased body temperature
• Rapid and shallow breathing, breathing problems during sleep, chronic middle ear infection
• Intestinal obstruction
• Reduced blood flow to the brain
• Decreased white blood cell count, inadequate secretion of a hormone controlling urine volume
• Muscle fiber breakdown and muscle pain (rhabdomyolysis), movement disorder
• Coma due to uncontrolled diabetes
• Yellowing of the skin and eyes (jaundice)
• Inflammation of the pancreas

Very rare (may affect fewer than 1 in 10,000 people):

• Life-threatening complications of uncontrolled diabetes

Adverse effects with unknown frequency (frequency cannot be estimated from available data):

• Severe allergic reaction leading to breathing difficulty and shock
• Absence of granulocytes (a type of white blood cell that helps fight infections)
• Prolonged and painful erection
• Dangerously excessive water intake
• Blood clots in veins, especially in the legs (symptoms include swelling, pain, redness in the leg). These clots may travel through blood vessels to the lungs, causing chest pain and difficulty breathing. If you experience any of these symptoms, contact your doctor immediately.

A small increase in the number of deaths has been reported in elderly patients with dementia treated with antipsychotics, compared to those not receiving this treatment.

Long-acting injectable risperidone

The following adverse effects have been reported with the use of long-acting injectable risperidone. If you experience any of the following effects, speak to your doctor, even if you are not receiving long-acting risperidone injections:

• Intestinal infection
• Skin abscess, tingling, prickling, or numbness of the skin, skin inflammation
• Decreased white blood cell count, cells that help protect you from bacterial infections
• Depression
• Seizures
• Eye twitching
• Sensation of spinning or oscillation
• Slow heartbeat, increased blood pressure
• Toothache, tongue spasm
• Buttock pain
• Weight loss

Reporting of adverse effects

If you experience any 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 at: www.notificaRAM.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Arketin

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

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.

No special storage conditions are required.

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

6. Contents of the pack and other information

Composition of Arketin

• The active substance is risperidone. Each 6 mg coated tablet of Arketin contains 6 milligrams of risperidone.
• The other components are: anhydrous lactose, corn starch, pregelatinized corn starch, sodium lauryl sulfate, microcrystalline cellulose (E 460i), sodium croscarmellose (E 468), colloidal hydrated silica, magnesium stearate (E 572), hypromellose (E 464), titanium dioxide (E 171), iron oxide red (E 172), and macrogol 400.

Appearance of the product and contents of the pack

The 6 mg film-coated tablets of Arketin are oblong, biconvex, salmon-coloured, with the inscription “6” on one side.

They are marketed in packs containing 30 or 60 film-coated tablets.

Some pack sizes may not be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Neuraxpharm Spain, S.L.U.

Avda. Barcelona, 69

08970 Sant Joan Despí

Barcelona - Spain

Manufacturer

Neuraxpharm Pharmaceuticals, S.L.

Avda. Barcelona, 69

08970 Sant Joan Despí (Barcelona)

Date of the most recent review of this leaflet: July 2021

Detailed and up-to-date information on this medicinal product is available on the website of the Spanish Agency of Medicines and Health Products (AEMPS) www.aemps.gob.es