Atomoxetine Cinfa 18 mg hard capsules EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

atomoxetina cinfa 18 mg hard capsules EFG

atomoxetine hydrochloride

Read the entire 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, consult your doctor or pharmacist.
• This medicine has been prescribed for you or your child only, and you must not give it to others, 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.

Contents of the leaflet

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

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

What it is used for

Atomoxetine cinfa contains atomoxetine and is used in the treatment of attention deficit hyperactivity disorder (ADHD). It is used:

• in children aged 6 years and older
• in adolescents
• in adults

It is used only as part of a comprehensive treatment program for the disorder, which must also include non-pharmacological treatments such as counselling or behavioural therapy.

It is not used for the treatment of ADHD in children under 6 years of age, as it is not known whether the drug is effective or safe in this population.

In adults, atomoxetine cinfa is used for the treatment of ADHD when symptoms are highly problematic and affect work or social life, and when symptoms of the disorder were present during childhood.

How it works

Atomoxetine cinfa increases the amount of noradrenaline in the brain. Noradrenaline is a naturally produced chemical that enhances attention and reduces impulsivity and hyperactivity in patients with ADHD. This medicine has been prescribed to help control the symptoms of ADHD. This medicine is not a stimulant and therefore does not cause dependence.

It may take several weeks after starting treatment with this medicine before symptoms are fully improved.

About ADHD

Children and adolescents with ADHD have difficulty:

• staying seated
• concentrating

It is not their fault that they cannot do these things. Many children and adolescents find these things difficult. However, in patients with ADHD, these difficulties can cause problems in daily life.

Children and adolescents with ADHD may have difficulty learning and completing homework. They may struggle to behave appropriately at home, at school, or in other settings. ADHD does not affect a child's or adolescent's intelligence.

Adults with ADHD find it difficult to manage the same challenges that children face, but this may lead to problems with:

• work
• relationships
• self-esteem
• education.

2. What you need to know before starting to take atomoxetine cinfa

Do not take atomoxetine cinfa:

• if you are allergic to atomoxetine or to any of the other ingredients of this medicine (listed in section 6).
• if you have taken a type of medicine called monoamine oxidase inhibitors (MAOIs) in the last two weeks, for example phenelzine. MAOIs are sometimes used for depression and other mental disorders; taking atomoxetine together with an MAOI could cause serious adverse effects or be life-threatening. You must also wait at least 14 days after stopping treatment with atomoxetine before taking an MAOI.
• if you have a type of eye condition called narrow-angle glaucoma (increased pressure in the eyes).
• if you have serious heart problems that could worsen due to an increase in heart rate and/or blood pressure, which may occur with atomoxetine.
• if you have serious blood vessel problems in your brain, such as a stroke, a weakened and inflamed blood vessel (aneurysm), or narrowed or blocked blood vessels.
• if you have a tumor of your adrenal gland (pheochromocytoma).

Do not take atomoxetine if any of the above apply to you. If you are unsure, consult your doctor or pharmacist before taking atomoxetine, as atomoxetine may worsen these conditions.

Warnings and precautions

Both adults and children should consider the following warnings and precautions.

Consult your doctor or pharmacist before starting to take atomoxetine if you have:

• suicidal thoughts or attempts.
• heart problems (including heart defects) or increased heart rate. Atomoxetine may increase your heart rate (pulse). Cases of sudden death have been reported in patients with heart defects.
• high blood pressure. Atomoxetine may increase your blood pressure.
• low blood pressure. Atomoxetine may cause dizziness or fainting in people with low blood pressure.
• problems with sudden changes in your blood pressure or heart rate.
• cardiovascular disease or a history of stroke.
• liver problems. You may need a lower dose.
• psychotic reactions including hallucinations (hearing voices or seeing unreal things), believing things that are not true, or being suspicious.
• mania (feeling elated or overexcited, leading to unusual behavior) and agitation.
• aggressive feelings.
• feelings of dislike and anger (hostility).
• a history of epilepsy or seizures from any other cause. Atomoxetine could increase the frequency of your seizures.
• mood different from usual (mood changes) or feelings of unhappiness.
• repeated, difficult-to-control muscle spasms in any part of the body or repeated sounds and words.

Treatment with atomoxetine may make you feel aggressive, hostile, or violent; or worsen these symptoms if they were present before treatment. It may also cause unusual changes in your behavior or mood (including physical aggression, threatening behavior, and thoughts of harming others). If you or your family and/or friends notice any of these reactions, speak to your doctor or pharmacist immediately.

Consult your doctor or pharmacist if you have any of the symptoms listed above before starting treatment, as atomoxetine may worsen these problems. Your doctor will want to monitor how the medicine affects you.

Serotonin syndrome

Serotonin syndrome is a potentially life-threatening condition that may occur when taking atomoxetine in combination with other medicines (see section 2 “Taking atomoxetine cinfa with other medicines”). Signs and symptoms of serotonin syndrome may include a combination of the following: confusion, restlessness, lack of coordination and stiffness, hallucinations, coma, rapid heartbeat, increased body temperature, rapid changes in blood pressure, sweating, flushing, tremors, hyperactive reflexes, nausea, vomiting, and diarrhea. Contact a doctor or go immediately to the nearest hospital emergency department if you think you are experiencing serotonin syndrome.

Tests your doctor will perform before you start taking atomoxetine cinfa

These tests are to determine whether atomoxetine is the right medicine for you.

Your doctor will measure your:

• blood pressure and heart rate (pulse) before and during your treatment with atomoxetine.
• weight and height if you are a child or adolescent taking atomoxetine cinfa.

Your doctor will ask you about:

• other medicines you are taking.
• any family history of sudden death.
• any other medical problems (such as heart problems) that you or your family may have.

It is important that you provide all the information you can. This will help your doctor decide whether atomoxetine is the right medicine for you. Your doctor may decide to perform additional medical tests before starting treatment with this medicine.

Taking atomoxetine cinfa with other medicines

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

Your doctor will decide whether you can take atomoxetine with other medicines and, in some cases, may need to adjust the dose or increase it more slowly.

Do not take atomoxetine with medicines called MAOIs (monoamine oxidase inhibitors) used for depression. See section 2 “Do not take atomoxetine cinfa”.

Atomoxetine may affect or be affected by other medicines. These include:

• certain antidepressants, opioids such as tramadol, and migraine medicines called triptans. These medicines may interact with atomoxetine and cause serotonin syndrome, a potentially life-threatening condition. (See section 2, Warnings and precautions, Serotonin syndrome).

If you are taking other medicines, atomoxetine may interfere with their proper function or cause adverse effects. If you are taking any of the following medicines, check with your doctor or pharmacist before taking atomoxetine:

• medicines that increase blood pressure or are used to control it.
• medicines such as antidepressants, for example imipramine, venlafaxine, mirtazapine, fluoxetine, and paroxetine.
• some cough and cold remedies containing medicines that may affect blood pressure. When purchasing such products, it is important to check with your pharmacist.
• some medicines used to treat mental disorders.
• medicines known to increase the risk of seizures.
• some medicines that cause atomoxetine to remain in the body longer than normal (such as quinidine and terbinafine).
• oral or injected salbutamol (a medicine used to treat asthma) may make you feel that your heart is racing, but this will not worsen your asthma.

The following medicines may increase the risk of abnormal heart rhythm when taking atomoxetine:

• medicines used to control heart rhythm.
• medicines that alter blood electrolyte levels.
• medicines used for prevention and treatment of malaria.
• antibiotics (such as erythromycin and moxifloxacin).

If you are unsure whether the medicines you are taking are included in the list above, consult your doctor or pharmacist before taking atomoxetine.

Pregnancy and breastfeeding

It is not known whether this medicine can affect the fetus or pass into breast milk.

• This medicine should not be taken during pregnancy unless your doctor specifically advises otherwise.
• You should avoid taking this medicine if you are breastfeeding or stop breastfeeding.

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.

Driving and using machines

atomoxetine cinfa may cause tiredness or drowsiness. Be cautious if driving or operating heavy machinery until you know how atomoxetine cinfa affects you. If you feel tired or drowsy, you should not drive or operate heavy machinery.

Important information about some of the components of atomoxetine cinfa

Do not open the atomoxetine capsules, as the contents may irritate your eyes. If the capsule contents come into contact with your eyes, rinse them immediately with plenty of water and consult your doctor. If your hands or any other part of your body come into contact with the capsule contents, wash with water as quickly as possible.

atomoxetine cinfa contains sodium

This medicine contains less than 23 mg of sodium (1 mmol) per capsule; this is essentially “sodium-free”.

3. How to take atomoxetine cinfa

• Follow exactly the instructions for taking this medicine as given by your doctor or pharmacist. If in doubt, consult your doctor or pharmacist again. The usual dosing schedule is once or twice daily (in the morning and late afternoon or early evening).
• Children should not take this medicine without the help of an adult.
• If you experience drowsiness or nausea when taking atomoxetine once daily, your doctor may change the dosing schedule to twice daily.
• The capsules should be swallowed whole, with or without food.
• The capsules must not be opened, and the contents inside must not be removed in any way. Taking the medicine at the same time each day may help you remember to take it.

Dosage

If you are a child (6 years of age and older) or an adolescent:

Your doctor will determine the dose of atomoxetine you should take based on your body weight. Usually, treatment starts with a low dose before increasing it, according to your weight.

• Weighing up to 70 kg: Start with a total daily dose of 0.5 mg per kg of body weight for at least 7 days. Your doctor will then decide whether to increase the dose to the usual maintenance dose of 1.2 mg per kg of body weight per day.
• Weighing more than 70 kg: Start with a total daily dose of 40 mg of atomoxetine for at least 7 days. Your doctor will then decide whether to increase the dose to the usual maintenance dose of 80 mg per day. The maximum daily dose is 100 mg.

Adults

• Treatment should start with a total daily dose of 40 mg for at least 7 days. Your doctor will then decide whether to increase the dose to the usual maintenance dose of 80 mg to 100 mg per day. The maximum daily dose is 100 mg.

If you have liver problems, your doctor may recommend a lower dose.

If you take more atomoxetine cinfa than you should

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

The most commonly reported symptoms following an overdose are gastrointestinal symptoms, drowsiness, dizziness, tremor, and abnormal behavior. Very rarely, serotonin syndrome, a potentially life-threatening condition, has also been reported. (See section 2, Warnings and precautions, Serotonin syndrome).

If you forget to take atomoxetine cinfa

If you miss a dose, take it as soon as possible, but do not exceed the total daily dose within a 24-hour period. Do not take a double dose to make up for a missed dose.

If you stop taking atomoxetine cinfa

If you stop taking atomoxetine, adverse effects usually do not occur, but symptoms of ADHD may return. You should talk to your doctor before stopping treatment.

What your doctor will do during treatment: Your doctor will carry out some tests

• Before starting treatment, your doctor will ensure that atomoxetine is safe and will benefit you.
• After starting treatment, tests will be performed at least every 6 months, although they may be more frequent.

Tests will also be carried out when the dose is changed. These tests will include:

• Measurement of height and weight in children and adolescents.
• Measurement of blood pressure and heart rate.
• Checking whether you have any problems or whether adverse effects have worsened while taking atomoxetine.

Long-term treatment

Atomoxetine does not need to be taken indefinitely. If you take atomoxetine cinfa for more than one year, your doctor must review your treatment to determine whether the medicine is still necessary.

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 will experience them. Although some people do experience adverse effects, most find that atomoxetine helps them. Your doctor will discuss these adverse effects with you.

Some adverse effects could be serious. If you experience any of the effects described below, contact your doctor immediately.

Uncommon (may affect up to 1 in 100 people)

• feeling or having a very fast heartbeat, abnormal heart rhythm
• thoughts or feelings of suicide
• aggressive feelings
• feelings of dislike and anger (hostility)
• mood changes
• severe allergic reaction with symptoms such as:
  • swelling of the face and throat
  • difficulty breathing
  • hives (small red, itchy rashes on the skin)
• seizures
• psychotic symptoms including hallucinations (such as hearing voices or seeing things that are not real), believing things that are not true, or becoming suspicious.

Children and young people under 18 years of age have a higher risk of experiencing adverse effects such as:

• thoughts or feelings of suicide (may affect up to 1 in 100 people)
• mood changes (may affect up to 1 in 10 people).

Adults have a lower risk (may affect up to 1 in 1,000 people) of experiencing adverse effects such as:

• seizures
• psychotic symptoms including hallucinations (such as hearing voices or seeing things that are not real), believing things that are not true, or becoming suspicious.

Rare (may affect up to 1 in 1,000 people)

• liver problems.

Stop treatment with atomoxetine and contact your doctor immediately if you experience any of the following adverse effects:

• dark urine
• yellowing of the skin or eyes
• pain when pressing the upper right side of the abdomen, just below the ribs
• unexplained nausea or feeling unwell
• fatigue
• itching
• feeling as if you are getting a cold.

Other reported adverse effects have been the following. If any of these worsen, consult your doctor or pharmacist.

Effects on growth

When some children start taking atomoxetine, their growth (weight and height) may be reduced. However, with long-term treatment, children regain appropriate weight and height for their age range. Your doctor will monitor your child's height and weight. If your child does not grow or gain weight as expected, the doctor may adjust the dose of atomoxetine or temporarily discontinue treatment with atomoxetine.

Reporting of adverse reactions

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

5. Storage of atomoxetine cinfa

Keep this medicine out of sight and reach of children.

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

This medicine does not require any special storage conditions.

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 have any doubts, ask your pharmacist how to properly dispose of unused medicines and their packaging. This will help protect the environment.

6. Contents of the pack and other information

Composition of atomoxetine cinfa

• The active substance is atomoxetine hydrochloride. Each hard capsule contains 18 mg of atomoxetine (as hydrochloride).
• Components contained within the capsule: pregelatinized maize starch, dimethicone, anhydrous colloidal silica.
• Capsule shell composition: gelatin, sodium lauryl sulfate (E487), titanium dioxide (E171), yellow iron oxide (E172), purified water, and black ink (Shellac Glaze-45% in ethanol, black iron oxide, and propylene glycol).

Appearance of the product and contents of the pack

Hard capsule with a yellow cap and an opaque white body, printed in black ink with the characters “18” and “mg”.

Atomoxetine cinfa 18 mg hard capsules EFG is available in packs of 7, 14, 28, and 56 capsules.

Only some pack sizes may be commercially available.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Manufacturer:

Pharmathen, S.A.

Dervenakion 6

Pallini Attiki 15351

Greece

Or

Pharmathen International, S.A.

Industrial Park Sapes Rodopi Perfecture

Block No. 5

Rodopy 69300

Greece

Or

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Date of the most recent review of this leaflet: November 2024

Detailed information about this medicinal product is available on the website of the Spanish Agency of Medicines and Medical Devices (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 may also access this information at the following web address: https://cima.aemps.es/cima/dochtml/p/82442/P_82442.html

QR code link: https://cima.aemps.es/cima/dochtml/p/82442/P_82442.html