Dobupal 37.5 mg tablets

Package leaflet: Information for the user

Introduction

Package leaflet: Information for the user

Dobupal 37.5 mg tablets

venlafaxine

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, 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 could 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 Dobupal is and what it is used for
2. What you need to know before taking Dobupal
3. How to take Dobupal
4. Possible side effects
5. How to store Dobupal

Pack contents and additional information

1. What Dobupal is and what it is used for

Dobupal is an antidepressant that belongs to a group of medicines called serotonin and norepinephrine reuptake inhibitors (SNRIs). This group of medicines is used to treat depression and other conditions such as anxiety disorders. The way antidepressants work is not fully understood, but they may help increase levels of serotonin and norepinephrine in the brain.

Dobupal is a treatment for depression in adults. Properly treating depressive disorders is important to help you feel better. If left untreated, your condition may not go away or may worsen and become more difficult to treat.

2. What you need to know before taking Dobupal

Do not take Dobupal

• If you are allergic to venlafaxine or to any of the other ingredients of this medicine (listed in section 6).
• If you are also taking or have taken within the last 14 days a medicine known as an irreversible monoamine oxidase inhibitor (MAOI), used to treat depression or Parkinson's disease. Taking an irreversible MAOI together with Dobupal may cause serious, and even potentially life-threatening, adverse effects. In addition, you must wait at least 7 days after stopping Dobupal before starting any MAOI (see also the section “Use of other medicines” and the information in that section on “Serotonin Syndrome”).

Warnings and precautions

Consult your doctor or pharmacist before starting to take Dobupal:

• If you are taking other medicines which, when taken together with Dobupal, could increase the risk of developing serotonin syndrome (see section “Taking Dobupal with other medicines”).
• If you have eye problems, such as certain types of glaucoma (increased pressure in the eye).
• If you have a history of high blood pressure.
• If you have a history of heart problems.
• If you have been informed that your heart rhythm is abnormal.
• If you have a history of seizures (fits).
• If you have a history of low sodium levels in the blood (hyponatremia).
• If you have a history of bleeding disorders (tendency to develop bruises or tendency to bleed easily), or if you are pregnant (see section Pregnancy, breastfeeding and fertility), or if you are taking other medicines that may increase the risk of bleeding, e.g., warfarin (used to prevent blood clots).
• If you have a history of, or if someone in your family has had, mania or bipolar disorder (feeling over-excited or euphoric).
• If you have a history of aggressive behaviour.

Dobupal may cause a feeling of restlessness or difficulty sitting or staying still during the first weeks of treatment. You should consult your doctor if this occurs.

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

Do not drink alcohol during treatment with Dobupal, as it may cause extreme drowsiness and unconsciousness. Taking it together with certain medicines and/or alcohol may worsen symptoms of depression and other conditions, such as anxiety disorders.

Suicidal thoughts and worsening of your depression or anxiety disorder

If you are depressed and/or suffer from anxiety disorders, you may sometimes experience thoughts of harming yourself or of suicide. These thoughts may increase when starting antidepressant therapy, as all these medicines take time to work, usually about two weeks, although sometimes longer. These thoughts may also occur when your dose is decreased or during discontinuation of treatment with Dobupal.

You are more likely to experience this:

• If you have previously had thoughts of suicide or of self-harm.
• If you are a young adult. Clinical trial data have shown an increased risk of suicidal behaviour in young adults (under 25 years of age) with psychiatric disorders treated with antidepressants.

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

It may be helpful to inform 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 notice your depression or anxiety worsening, or if they are concerned about changes in your behaviour.

Dry mouth

Dry mouth has been reported in 10% of patients treated with venlafaxine. This may increase the risk of tooth decay (caries). Therefore, you should take care with your dental hygiene.

Diabetes

Your blood glucose levels may be affected by Dobupal. Therefore, the doses of your diabetes medications may need to be adjusted.

Children and adolescents

Dobupal should normally not be used in the treatment of children and adolescents under 18 years of age. In addition, you should know that in patients under 18 years of age, there is an increased risk of adverse effects such as suicide attempts, suicidal thoughts, and hostility (predominantly aggression, confrontational behavior, and irritability) when taking this type of medication. Nevertheless, your doctor may prescribe this medicine to patients under 18 years of age when deciding what is most appropriate for the patient. If your doctor has prescribed this medicine to a patient under 18 years of age and you wish to discuss this decision, please consult your doctor again. You must inform your doctor if any of the symptoms listed above develop or worsen while these patients under 18 years of age are taking Dobupal. In addition, the long-term safety with regard to growth, maturation, and cognitive and behavioral development has not been established.

Taking Dobupal with other medicines

Inform your doctor or pharmacist if you are using or have recently used, or might need to use, any other medicine. Your doctor must decide whether you can take Dobupal together with other medicines.

Do not start or stop taking any medicine, including those available without a prescription, natural remedies, or herbal products, before checking with your doctor or pharmacist.

• Monoamine oxidase inhibitors (MAOIs) used to treat depression or Parkinson’s disease must not be taken with Dobupal. Tell your doctor if you have taken any of these medicines within the last 14 days. (MAOI: See section “What you need to know before taking Dobupal”)

• Serotonin syndrome:

A potentially life-threatening condition, or reactions resembling Neuroleptic Malignant Syndrome (NMS) (see section “Possible side effects”), may occur during treatment with venlafaxine, particularly when taken with other medicines. Examples of such medicines include:

• triptans (used for migraine)
• other medicines used to treat depression, for example, SNRIs, SSRIs, tricyclic antidepressants, or medicines containing lithium
• medicines containing amphetamines (used to treat attention deficit hyperactivity disorder [ADHD], narcolepsy, and obesity)
• medicines containing the antibiotic linezolid (used to treat infections)
• medicines containing moclobemide, an MAOI (used to treat depression)
• medicines containing sibutramine (used for weight loss)
• medicines containing opioids (e.g., buprenorphine, tramadol, fentanyl, tapentadol, meperidine, or pentazocine) (used to treat severe pain)
• medicines containing dextromethorphan (used to treat cough)
• medicines containing methadone (used for opioid addiction treatment or for treatment of severe pain)
• medicines containing methylene blue (used to treat elevated levels of methemoglobin in blood)
• herbal products containing St. John’s wort (also known as “Hypericum perforatum”, a natural or herbal remedy used to treat mild depression)
• products containing tryptophan (used for conditions such as sleep problems and depression)
• antipsychotics (used to treat a disorder with symptoms such as hearing, seeing, or feeling things that do not exist, false beliefs, unusual suspiciousness, unclear thinking, and tendency to withdraw)

Signs and symptoms of serotonin syndrome may include a combination of the following:

restlessness, hallucinations, loss of coordination, rapid heartbeat, increased body temperature, rapid changes in blood pressure, hyperactive reflexes, diarrhea, coma, nausea, vomiting.

In its most severe form, serotonin syndrome may resemble Neuroleptic Malignant Syndrome (NMS). Signs and symptoms of NMS may include a combination of fever, rapid heartbeat, sweating, severe muscle rigidity, confusion, and increased muscle enzymes (detected by a blood test).

Contact your doctor immediately or go to the nearest hospital emergency department if you think you are experiencing serotonin syndrome.

Inform your doctor if you are taking medicines that may affect your heart rhythm.

Some examples of these medicines include:

• antiarrhythmics such as quinidine, amiodarone, sotalol, or dofetilide (used to treat irregular heart rhythm)
• antipsychotics such as thioridazine (see also “Serotonin syndrome” above)
• antibiotics such as erythromycin or moxifloxacin (used to treat bacterial infections)
• antihistamines (used to treat allergies)

The following medicines may also interact with Dobupal and should be used with caution. It is especially important to inform your doctor or pharmacist if you are taking medicines containing:

• ketoconazole (an antifungal medicine)
• haloperidol or risperidone (used to treat psychiatric conditions)
• metoprolol (a beta-blocker used to treat high blood pressure and heart problems)

Taking Dobupal with food, drinks, and alcohol

Dobupal should be taken with food (see section 3 "How to take Dobupal").

Do not drink alcohol during treatment with Dobupal. Taking it together with alcohol may cause extreme tiredness and unconsciousness, and may worsen symptoms of depression and other conditions, such as anxiety disorders.

Pregnancy, breastfeeding and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to become pregnant, consult your doctor or pharmacist before using this medicine. You should only take Dobupal after discussing with your doctor the potential benefits and potential risks to the unborn child.

If you take Dobupal during the later 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 aware that you are taking Dobupal so they can advise you. When taken during pregnancy, similar medicines (SSRIs) may increase the risk of a serious condition in newborns called persistent pulmonary hypertension of the newborn (PPHN), causing the baby to breathe faster and appear blue. These symptoms usually begin within the first 24 hours after the baby's birth. If this occurs in your baby, contact your midwife and/or doctor immediately.

If you take this medicine during pregnancy, in addition to breathing problems, other symptoms your baby may have at birth include feeding difficulties. If your baby has these symptoms at birth and you are concerned, contact your doctor and/or midwife, who will be able to advise you.

Dobupal passes into breast milk. There is a risk of effects on the infant. Therefore, you should discuss this with your doctor, who will decide whether you should discontinue breastfeeding or discontinue treatment with this medicine.

Driving and operating machinery

Do not drive or operate tools or machines until you know how this medication affects you.

Important information about some of the components of Dobupal

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

This medicinal product contains less than 23 mg of sodium (1 mmol) per tablet; this is essentially "sodium-free".

3. How to take Dobupal

Follow exactly the instructions for use of this medicine as given by your doctor. If you are unsure, consult your doctor or pharmacist again.

The usual recommended starting dose is 75 mg daily in divided doses, taken two or three times a day. Your doctor may gradually increase the dose and, if necessary, even up to a maximum dose of 375 mg daily for depression.

Take Dobupal approximately at the same time each day, either in the morning or at night.

Dobupal should be taken with food.

If you have liver or kidney problems, talk to your doctor, as your dose of this medicine may need to be different.

Do not stop taking this medicine without consulting your doctor (see section “If you stop treatment with Dobupal”).

If you take more Dobupal than you should

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

Overdose may be life-threatening, especially when taken simultaneously with certain medicines and/or alcohol (see Taking Dobupal with other medicines).

Symptoms of a possible overdose may include rapid heartbeat, changes in the level of consciousness (ranging from drowsiness to coma), blurred vision, seizures or fits, and vomiting.

If you forget to take Dobupal

If you have missed a dose, take it as soon as you remember. However, if it is already time for your next dose, skip the missed dose and take only your usual single dose. Do not take a double dose to make up for forgotten doses. Do not take more than the daily amount of Dobupal that has been prescribed to you in one day.

If you stop taking Dobupal

Do not stop taking your treatment or reduce the dose without consulting your doctor, even if you feel better. If your doctor considers that you no longer need Dobupal, they may instruct you to gradually reduce the dose before stopping the treatment completely. Adverse effects are known to occur when people stop taking this medicine, especially if it is stopped suddenly or if the dose is reduced too quickly. Some patients may experience symptoms such as suicidal thoughts, aggressiveness, fatigue, dizziness, loss of coordination, headache, insomnia, nightmares, dry mouth, loss of appetite, nausea, diarrhea, nervousness, agitation, confusion, ringing in the ears, tingling sensations, or, rarely, electric shock-like sensations, weakness, sweating, seizures, or flu-like symptoms, vision problems, and increased blood pressure (which may cause headache, dizziness, ringing in the ears, sweating, etc.).

Your doctor will advise you on how to gradually discontinue Dobupal treatment. This process may take several weeks or months. In some patients, discontinuation may need to be carried out very gradually over several months or longer. If you experience any of these or other bothersome symptoms, consult your doctor for advice.

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 gets them.

If any of the following effects occur, stop taking Dobupal immediately and tell your doctor right away, or go to the nearest hospital emergency department:

Uncommon (may affect up to 1 in 100 people)

• Swelling of the face, mouth, tongue, throat, hands or feet and/or itchy raised rash, difficulty swallowing or breathing.

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

• Chest tightness, noisy breathing, difficulty swallowing or breathing.
• Severe skin rash, itching or hives (raised, red or pale areas of skin that often itch).
• Signs and symptoms of serotonin syndrome, which may include agitation, hallucinations, loss of coordination, rapid heartbeat, increased body temperature, rapid changes in blood pressure, hyperactive reflexes, diarrhea, coma, nausea, vomiting.

In its most severe form, serotonin syndrome may resemble Neuroleptic Malignant Syndrome (NMS). Signs and symptoms of NMS may include a combination of fever, rapid heartbeat, sweating, severe muscle rigidity, confusion, and increased muscle enzymes (detected by a blood test).

• Signs of infection, such as increased body temperature, chills, shivering, headache, sweating, or flu-like symptoms. This may be due to a blood disorder that can lead to an increased risk of infection.
• Severe rash, which may progress to the formation of severe blisters and peeling of the skin.
• Unexplained muscle pain, tenderness or weakness. This may be a sign of rhabdomyolysis.

Frequency not known (cannot be estimated from available data)

• Signs and symptoms of a condition called “stress cardiomyopathy” (also known as Takotsubo cardiomyopathy), which may include chest pain, difficulty breathing, dizziness, fainting, or irregular heartbeats.

Other adverse effects about which you should inform your doctor (the frequency of these adverse effects are included in the list below, “Other adverse effects that may occur”):

• Cough, noisy breathing, and difficulty breathing, which may be accompanied by an increase in body temperature.
• Tar-like stools or blood in stools.
• Itching, yellowing of the eyes or skin, dark urine, which are symptoms of liver inflammation (hepatitis).
• Heart problems, such as rapid or irregular heartbeat, increased blood pressure.
• Eye problems, such as blurred vision, dilated pupils.
• Nerve problems, such as dizziness, tingling, movement disorders (muscle spasms and stiffness), seizures or fits.
• Psychiatric problems, such as hyperactivity (unusual feeling of over-excitement).
• Withdrawal effects (see section “How to take Dobupal, If you stop taking Dobupal”).
• Prolonged bleeding – if you get a cut or wound, it may take slightly longer than normal for the bleeding to stop.

Other possible side effects

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

• Dizziness, headache, drowsiness.
• Insomnia.
• Nausea, dry mouth, constipation.
• Excessive sweating (including night sweats).

Common (may affect up to 1 in 10 people)

• Decreased appetite.
• Confusion, feeling strange, absence of orgasm, decreased libido, agitation, nervousness, abnormal dreams.
• Tremor, a sensation of restlessness or inability to sit still or remain motionless, tingling, altered taste perception, increased muscle tone.
• Visual disturbances including blurred vision, dilated pupils, inability of the eye to automatically adjust focus from distant to near objects.
• Ringing in the ears (tinnitus).
• Rapid heartbeat, palpitations.
• Increased blood pressure, hot flushes.
• Difficulty breathing, yawning.
• Vomiting, diarrhoea.
• Mild skin rash, itching.
• Increased frequency of urination, inability to urinate, difficulties in urination.
• Menstrual irregularities, such as increased bleeding or increased irregular bleeding, abnormal ejaculation/orgasm (in males), erectile dysfunction (impotence).
• Weakness (asthenia), fatigue, chills.
• Weight gain or weight loss.
• Increased cholesterol.

Uncommon (may affect up to 1 in 100 people)

• Hyperactivity, racing thoughts and reduced need for sleep (mania).
• Hallucinations, feeling detached from reality, abnormal orgasm, lack of feelings or emotions, feeling overexcited, teeth grinding.
• Fainting, involuntary muscle movements, disturbance in coordination and balance.
• Feeling dizzy (especially when standing up too quickly), decreased blood pressure.
• Vomiting blood, tarry stools (faeces) or blood in stools, which may be a sign of internal bleeding.
• Sensitivity to sunlight, bruising, abnormal hair loss.
• Inability to control urination.
• Muscle stiffness, spasms and involuntary movements.
• Slight changes in blood levels of liver enzymes.

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

• Seizures or fits.
• Cough, noisy breathing and shortness of breath, which may be accompanied by high temperature.
• Disorientation and confusion, often accompanied by hallucinations (delirium).
• Excessive water intake (known as SIADH).
• Decreased levels of sodium in the blood.
• Severe eye pain and reduced or blurred vision.
• Abnormal, fast or irregular heartbeat, which may lead to fainting.
• Severe abdominal or back pain (which may indicate a serious problem in the intestine, liver or pancreas).
• Itching, yellowing of the eyes or skin, dark urine, flu-like symptoms, which are signs of liver inflammation (hepatitis).

Very rare (may affect up to 1 in 10,000 people)

• Prolonged bleeding, which may be due to a reduced number of platelets in the blood, leading to an increased risk of bruising or bleeding.
• Abnormal production of breast milk.
• Unexpected bleeding, for example, bleeding gums, blood in urine or vomit, or the appearance of unexpected bruising or broken blood vessels (broken veins).

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

• Suicidal thoughts and suicidal behaviour; cases of suicidal thoughts and behaviour have been reported during treatment with venlafaxine or shortly after discontinuation of treatment (see section 2, “What you need to know before taking Dobupal”).

• Aggression.

• Dizziness.

• Heavy vaginal bleeding shortly after childbirth (postpartum haemorrhage); see “Pregnancy, breastfeeding and fertility” in section 2 for more information.

Dobupal sometimes causes unwanted effects that you may not be aware of, such as increases in blood pressure or an abnormal heartbeat; slight changes in blood levels of liver enzymes, sodium or cholesterol. Less frequently, Dobupal may reduce the function of blood platelets, leading to an increased risk of bruising or bleeding. Therefore, your doctor may wish to carry out blood tests occasionally, particularly if you have been taking Dobupal for a long time.

Reporting of side effects

If you experience any side effects, talk to your doctor, pharmacist or nurse, even if they are possible side effects not listed in this leaflet. You can also report them directly via the Spanish Pharmacovigilance System for Human Medicinal Products at: www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Dobupal

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

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

No special storage conditions are required. Store in a dry place.

Medicines must not be disposed of via wastewater or household waste. Unused containers and medicines should be taken to the SIGRE point at your pharmacy. If you are in doubt, please ask your pharmacist how to dispose of any containers and medicines you no longer need. This will help protect the environment.

6. Contents of the pack and other information

Composition of Dobupal 37.5 mg tablets

The active substance is venlafaxine. Each tablet contains 42.42 mg of venlafaxine hydrochloride, equivalent to 37.5 mg of venlafaxine base.

The other components (excipients) are: lactose, microcrystalline cellulose, sodium carboxymethyl starch from potato, magnesium stearate, yellow iron oxide (E-172), and brown iron oxide (E-172).

Appearance of Dobupal and contents of the pack

Dobupal 37.5 mg is presented as tablets. The tablets are circular, biconvex, with beveled edges and salmon-colored.

Dobupal 37.5 mg is available in packs containing 60 tablets for oral administration.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Almirall, S.A.

General Mitre, 151

08022 – Barcelona

Manufacturer

Industrias Farmacéuticas Almirall, S.A.

Ctra. de Martorell, 41-61

08740 Sant Andreu de la Barca – Barcelona (Spain)

This medicinal product was authorized in the EEA Member States under the following names:

Spain: Dobupal 37.5 mg tablets

Date of the most recent review of this leaflet: May 2023

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) http://www.aemps.gob.es/