Lormetazepam Vir 1 mg tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Lormetazepam Vir 1 mg tablets EFG

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 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.

Leaflet contents:

1. What Lormetazepam Vir is and what it is used for

2. What you need to know before taking Lormetazepam Vir

3. How to take Lormetazepam Vir

4. Possible adverse effects

5. How to store Lormetazepam Vir

6. Contents of the pack and other information

1. What Lormetazepam Vir is and what it is used for

Lormetazepam Vir contains lormetazepam, which belongs to a group of medicines called benzodiazepines. It is indicated for the short-term treatment of insomnia.

Benzodiazepines are only indicated for the treatment of severe disorders that significantly impair the patient's daily activities or subject them to considerable stress.

2. What you need to know before taking Lormetazepam Vir

Do not take Lormetazepam Vir

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

• If you suffer from myasthenia gravis (very weak or fatigued muscles).

• If you have severe respiratory insufficiency.

• If you suffer from sleep apnoea syndrome.

• If you have a history of alcohol or drug dependence.

In cases of acute intoxication with alcohol, sleeping medicines, painkillers, or psychotropic medicines (neuroleptics, antidepressants, lithium salts).

Warnings and precautions

Talk to your doctor or pharmacist before starting to take lormetazepam:

If any of the following apply to you, inform your doctor. Your doctor will take these into account during treatment with lormetazepam.

• If you suffer from spinal or cerebellar ataxia (lack of coordination of movements).
• If you have any liver or kidney disorder.
• If you have closed-angle glaucoma.
• If your doctor has prescribed long-term treatment, periodic blood tests and liver function tests are advisable.
• If you become pregnant during treatment, you must inform your doctor.
• Its use is not recommended in children or adolescents.
• If you are being treated with opioids, as this may cause breathing difficulties, sedation, coma, and even death.

Please note that you may experience the following reactions:

Tolerance

After continuous use for several weeks, a certain degree of loss of efficacy regarding hypnotic effects may be observed.

Amnesia

Benzodiazepines, including lormetazepam, may induce amnesia (memory impairment). This is more likely to occur several hours after administration of the medicine; therefore, to reduce the associated risk, patients should ensure they can sleep uninterrupted for 7–8 hours after taking the tablet.

Dependence and abuse

Treatment with benzodiazepines may lead to physical and psychological dependence. This risk increases with dose and duration of treatment, but dependence may also occur during short-term treatment within the therapeutic dose range.

To minimize this risk as much as possible, the following precautions should be observed:

• Benzodiazepines should only be taken on medical prescription (never because they worked for someone else), and you should never recommend them to others.
• Do not increase the dose prescribed by your doctor or extend the treatment beyond the recommended duration.
• In patients with a history of drug and/or alcohol abuse, there may be potential for misuse of the medicine.
• Consult your doctor regularly so they can decide whether treatment should continue.

Rebound insomnia and anxiety

When treatment is stopped, the symptoms that led to taking the medicine may reappear, along with mood changes, anxiety, insomnia, restlessness, and others. Therefore, your doctor will give you precise instructions on how to gradually reduce the dose.

Abrupt discontinuation of lormetazepam should be avoided, and a gradual dose reduction process should be followed.

Psychiatric and paradoxical reactions

During treatment with benzodiazepines, including lormetazepam, pre-existing depression may reappear or worsen. In addition, suicidal tendencies in depressed patients may be unmasked, which should be closely monitored.

The medicine should be discontinued if these reactions occur.

Use of Lormetazepam Vir with other medicines

Tell your doctor or pharmacist if you are currently using, have recently used, or might need to use any other medicines.

The simultaneous use of lormetazepam with opioids (analgesics, medicines for substitution therapy, and some antitussives) increases the risk of drowsiness, breathing difficulties (respiratory depression), coma, and can be life-threatening. For this reason, combined administration should only be considered when no other alternative treatments are possible.

However, if your doctor prescribes lormetazepam together with opioids, the dosage and duration of simultaneous treatment should be limited by your doctor.

Please inform your doctor of all opioids you are taking, and carefully follow the dosage recommendations provided by your doctor. It may be helpful to inform friends or family members so they are aware of the signs and symptoms mentioned above. Contact your doctor if you experience such symptoms.

Alcohol increases the sedative effect of this medicine, so alcohol consumption should be avoided.

Certain medicines may interact with lormetazepam and cause increased drowsiness. These are medicines known as central nervous system depressants, including those used to treat mental illnesses such as antipsychotics (neuroleptics), hypnotics, anxiolytics/sedatives, antidepressants; those used to relieve severe pain (narcotic analgesics); those used to treat seizures/epileptic attacks (antiepileptics); anaesthetics; barbiturates; and medicines used to treat allergies (sedating antihistamines).

Concomitant administration of lormetazepam with other medicines such as theophylline or aminophylline, beta-blockers, cardiac glycosides, oral contraceptives, and some antibiotics may alter the effect of lormetazepam, prolonging or reducing its activity. The effect of muscle relaxants may be enhanced.

Taking Lormetazepam Vir with food, drinks and alcohol

Avoid alcohol consumption during treatment with lormetazepam, as it increases the sedative effect of this medicine.

Pregnancy and 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.

Pregnancy

The use of benzodiazepines, including lormetazepam, appears to be associated with a possible increased risk of congenital malformations during the first trimester of pregnancy. Passage of benzodiazepines and their metabolites across the placenta has been demonstrated.

If, due to strict medical necessity, the product is administered during the late stages of pregnancy or at high doses during labour, effects on the neonate may be expected, such as hypoactivity, hypothermia, hypotonia (low muscle tone), apnoea (breathing difficulty), moderate respiratory depression, feeding problems, and impaired metabolic response to cold stress.

Infants born to mothers who have taken benzodiazepines chronically for several weeks during pregnancy or during the last stage of pregnancy may develop physical dependence and experience withdrawal syndrome in the postnatal period.

Breastfeeding

Lormetazepam should not be used during breastfeeding, as benzodiazepines, including lormetazepam, are excreted in breast milk. Cases of sedation and inability to suckle have been reported in neonates whose mothers were being treated with benzodiazepines. These newborns should be monitored for any of the mentioned pharmacological effects (including sedation and irritability).

Use in children and adolescents:

Benzodiazepines are not indicated in children or adolescents, except for premedication prior to diagnostic or surgical procedures (anaesthesiology, intensive care). In these cases, a single dose of 1 mg is recommended.

Use in elderly and debilitated patients

Elderly and debilitated patients should receive a lower dose, as they are more susceptible to the effects of the medicine. Follow your doctor's instructions carefully.

Due to the muscle-relaxant effect, there is a risk of falls and consequently fractures in elderly patients, especially in those who get up during the night.

Use in patients with respiratory insufficiency

Lormetazepam is contraindicated in patients with severe respiratory insufficiency.

Use in patients with hepatic insufficiency

Lormetazepam should be used with caution in patients with severe hepatic insufficiency and/or encephalopathy.

Grief or bereavement

In cases of grief or bereavement, psychological adjustment may be inhibited by benzodiazepines.

Driving and using machines

Lormetazepam is a medicine that causes drowsiness. Do not drive or operate machinery if you feel sleepy or if your attention or reaction ability is reduced. Pay special attention at the beginning of treatment or when the dose is increased.

Lormetazepam Vir contains lactose

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

Lormetazepam Vir contains sodium

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

3. How to take Lormetazepam Vir

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

Your doctor will determine the duration of your treatment with lormetazepam. The treatment duration should be as short as possible.

Treatment should begin with the lowest dose, and the maximum dose must not be exceeded.

Adults:

The recommended dose is 1 tablet (1 mg of lormetazepam) daily, taken orally 15 to 30 minutes before bedtime.

The usual dose may be increased at the discretion of the physician in cases of severe or persistent insomnia unresponsive to the standard regimen, up to 2 tablets daily, meaning a maximum of 2 mg of lormetazepam.

Use in children and adolescents

Lormetazepam is not indicated for the treatment of insomnia in children and adolescents.

Elderly patients, debilitated patients, or patients with cerebrovascular disorders (arteriosclerosis), mild to moderate respiratory insufficiency, and/or renal and/or hepatic impairment:

The dose should be reduced to 0.5 mg of lormetazepam per day. Other formulations of lormetazepam are available to achieve this dosage.

For severe respiratory insufficiency, see section 2.

Do not stop treatment abruptly. Your doctor will advise you on the appropriate way to gradually reduce the dose, as symptoms that led to taking the medicine may reappear upon discontinuation.

The tablet may be divided into equal doses.

If you take more Lormetazepam Vir than you should

Symptoms of overdose with benzodiazepines generally manifest as varying degrees of central nervous system depression, ranging from drowsiness to coma.

In moderate cases, symptoms include drowsiness, confusion, lethargy, and dysarthria (speech disorders). In more serious cases, ataxia (lack of coordination of voluntary movements), paradoxical reactions, central nervous system depression, hypotonia, hypotension, respiratory depression (breathing difficulties), cardiac depression, coma, and death may occur.

Treatment of overdose: The clinical management of overdose with any medication should always consider the possibility that the patient may have ingested multiple substances.

Following a benzodiazepine overdose, vomiting should be induced (within one hour) if the patient is conscious. Inducing vomiting is not recommended if there is a risk of aspiration. If the patient is unconscious, gastric lavage should be performed while maintaining airway protection. If gastric emptying provides no benefit, activated charcoal should be administered to reduce absorption.

Particular attention should be paid to respiratory and cardiovascular functions. Hospital admission to an intensive care unit may be required for monitoring.

Use of antidote in overdose: Flumazenil (a benzodiazepine antagonist) may be used as an adjunctive treatment in hospitalized patients but should never replace the previously described supportive measures. Extreme caution must be exercised when administering flumazenil to patients on chronic benzodiazepine therapy or in cases of overdose involving cyclic antidepressants, as this combination may increase the risk of seizures.

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 medication and the amount ingested.

If you forget to take Lormetazepam Vir

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

If you stop taking Lormetazepam Vir

Do not stop treatment with lormetazepam unless your doctor tells you to do so.

If you stop taking lormetazepam, especially abruptly, you may experience mood changes, anxiety, insomnia, restlessness, and other symptoms.

Your doctor will explain how to gradually reduce the dose until treatment is completed.

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

4. Possible adverse effects

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

According to frequency, they are defined as follows:

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

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

Anxiety, libido disorders, and bradifrenia. Dizziness, sedation, somnolence, attention disturbance, amnesia, dysarthria (slurred speech), dysgeusia. Tachycardia. Vomiting, nausea, upper abdominal pain, constipation, dry mouth. Pruritus. Urinary disorders. Asthenia, hyperhidrosis, malaise.

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

Hypersensitivity. Inappropriate antidiuretic hormone secretion syndrome (SIADH), hyponatremia. Visual disturbances (including double vision and blurred vision). Hypotension (decrease in blood pressure). Respiratory failure, apnea, worsening of sleep apnea, worsening of chronic obstructive pulmonary disease (COPD). Increased liver transaminases and increased alkaline phosphatase in blood. Allergic dermatitis.

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

Angioedema. Completed suicide, suicide attempt (due to unmasking of pre-existing depression), acute psychosis, hallucinations, dependence, drug abuse, depression (due to unmasking of pre-existing depression), deception, withdrawal/insomnia rebound syndrome, agitation, aggression, irritability, restlessness, anger, nightmares, decreased level of consciousness, confusion, delirium, abnormal behavior, emotional disorder, psychomotor retardation. Ataxia, convulsion, tremor, extrapyramidal disorders. Nystagmus (involuntary eye movement). Urticaria, rash. Muscle weakness, muscle cramps. Fatigue, hypothermia, paradoxical reactions.

Due to the muscle relaxation effect, there is a risk of falls and consequently fractures in elderly individuals.

Reporting of adverse effects

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

5. Storage of Lormetazepam Vir

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

Store below 30°C. Keep in the original packaging to protect from light.

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.

Medicines should not be disposed of via wastewater or household waste. Dispose of unused medicines and their containers at a SIGRE 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 Lormetazepam Vir 1 mg tablets

• The active substance is lormetazepam. Each tablet contains 1 mg of lormetazepam.

• The other components (excipients) are monohydrate lactose, microcrystalline cellulose, heavy magnesium carbonate, pregelatinized corn starch, sodium croscarmellose, sodium lauryl sulfate and magnesium stearate.

Appearance of the product and contents of the pack

Lormetazepam Vir 1 mg is presented in boxes containing 30 tablets. The tablets are white, round, bevelled, marked with a "1" on one side and scored on the other. The tablet can be divided into equal doses.

Marketing Authorization Holder and Manufacturer

INDUSTRIA QUÍMICA Y FARMACÉUTICA VIR, S.A.

C/Laguna 66-68-70. Polígono Industrial Urtinsa II

28923 – Alcorcón (Madrid)

Spain

Date of the most recent revision 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 Medical Devices (AEMPS) http://www.aemps.gob.es/.