Manidon Retard 180 mg prolonged-release tablets

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Manidón retard 180 mg prolonged-release tablets

verapamil 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, ask your doctor, pharmacist or nurse.

• 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, pharmacist or nurse, even if these effects are not listed in this leaflet. See section 4.

Leaflet contents:

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

1. What Manidon is and what it is used for

Manidon belongs to a group of medicines called calcium channel blockers, with predominantly cardiac action. These medicines are used to treat angina pectoris, high blood pressure, or irregular heart rhythm.

Manidon is used for:

• Prevention and treatment of angina pectoris.
• Treatment of high blood pressure.
• Prevention of paroxysmal supraventricular tachycardia, after intravenous treatment.
• Control of patients with flutter and/or chronic atrial fibrillation, except when associated with the presence of accessory conduction pathways.

Secondary prevention post-myocardial infarction in patients without heart failure during the acute phase.

2. What you need to know before starting to take Manidón

Do not take Manidón

• If you are allergic to verapamil hydrochloride or to any of the other ingredients of this medicine (listed in section 6).
• If you have any of the following heart conditions:
• Cardiogenic shock (the heart is unable to pump enough blood to meet the body's needs).
• Second- or third-degree atrioventricular block (a disorder in the electrical conduction between the heart's atria and ventricles), unless a pacemaker is implanted.
• Sick sinus syndrome (heart rhythm problems), unless a pacemaker is implanted.
• Left ventricular failure.
• Atrial flutter or atrial fibrillation (abnormal heart rhythms).
• If you are taking a medicine containing ivabradine for the treatment of certain heart conditions.

Warnings and precautions

Consult your doctor, pharmacist, or nurse before starting to take Manidón.

Your doctor must exercise special care when administering this medicine:

• If you have any of the following heart problems: acute phase of myocardial infarction complicated by bradycardia, marked hypotension, or left ventricular dysfunction; cardiac block, first-degree atrioventricular block, bradycardia, or asystole.
• If you are taking a beta-blocking medicine for heart arrhythmias.
• If you are taking digoxin together with Manidón.
• If you have heart failure.
• If you have any of the following conditions causing muscle weakness: myasthenia gravis, Lambert-Eaton syndrome, or advanced Duchenne muscular dystrophy.
• If you have any kidney disease.
• If you have severe liver disease.

Other medicines and Manidón

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

Some medicines may alter their effect when taken together with Manidón. If you are using or have used any of the following medicines, consult your doctor:

• Prazosin, terazosin (for treating high blood pressure).
• Flecainide, quinidine, disopyramide (for heart arrhythmias).
• Theophylline (for bronchial asthma).
• Carbamazepine (for seizures), phenytoin (antiepileptic).
• Imipramine (for treating depression).
• Glibenclamide (for diabetes).
• Metformin: Verapamil may reduce the hypoglycemic effect of metformin.
• Colchicine (for gout).
• Clarithromycin, erythromycin, rifampicin, telithromycin (antibiotics).
• Doxorubicin (for cancer).
• Phenobarbital (for seizures and as a sedative).
• Buspirone, midazolam (sedatives used for insomnia and anxiety).
• Metoprolol, propranolol (for treating hypertension and heart disorders).
• Digitoxin, digoxin (for heart disorders).
• Cimetidine (for treating stomach ulcers).
• Cyclosporine, everolimus, sirolimus, tacrolimus (immunosuppressants to reduce the body's immune defenses).
• Atorvastatin, lovastatin, simvastatin (medicines to lower elevated cholesterol levels).
• Almotriptan (for migraine symptoms).
• Sulfinpyrazone (for gouty arthritis).
• Grapefruit juice.
• St. John's wort (herbal remedy for treating depression).
• Medicines for HIV/AIDS such as ritonavir.
• Lithium (for mood disorders).
• Neuromuscular blocking agents (used as adjuncts in anesthesia).
• Acetylsalicylic acid (aspirin).
• Alcohol.
• Antihypertensives (to lower high blood pressure), diuretics (medicines to increase urination), vasodilators (medicines for circulatory disorders).
• Inhalational anesthetics.
• Dabigatran (medicine to prevent blood clot formation).
• Other direct oral anticoagulants (medicines to prevent blood clot formation).

Taking Manidón with food, drinks, and alcohol

Grapefruit juice has been shown to increase plasma levels of verapamil; therefore, Manidón should not be taken together with grapefruit juice.

Consumption of alcohol together with Manidón may enhance the hypotensive effect.

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.

There is no experience with the use of Manidón during pregnancy. Consult your doctor if you become pregnant while taking Manidón.

Verapamil is excreted in breast milk in small amounts. Limited data from human studies suggest that the use of verapamil may be compatible with breastfeeding. However, Manidón will only be administered during breastfeeding if essential for the mother’s health due to the potential for serious adverse reactions in infants.

Driving and use of machines

Exercise caution when driving or operating dangerous tools or machinery, as Manidón may reduce reaction capability, especially at the beginning of treatment, when the dose is increased, when switching from another medicine, and when consuming alcohol.

Manidón retard 180 mg prolonged-release tablets contain sodium alginate

This medicine contains 25.55 mg of sodium (a main component of table/cooking salt) per tablet. This corresponds to 1.27% of the maximum daily sodium intake recommended for an adult.

3. How to take Manidón

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

The appropriate dose of this medicine may be different for each patient.

Remember to take your medicine.

Your doctor will tell you how long to take treatment with Manidón.

The most frequently recommended doses are those listed below, but if your doctor has prescribed a different dose, do not change it without consulting your doctor or pharmacist:

Adults

Angina pectoris and secondary prevention after myocardial infarction:

360 mg per day. The optimal daily dose ranges between 240 and 480 mg.

Arterial hypertension:

240 mg per day. If necessary, this may be increased after one week to 360 mg per day and subsequently up to a maximum of 480 mg per day.

Prophylaxis of supraventricular tachycardias:

240 to 480 mg per day for non-digitalized patients and 120 to 360 mg per day for digitalized patients.

Use in children and adolescents

Children: maximum 10 mg/kg body weight per day in several doses.

It is important that you continue taking this medicine until your doctor tells you to stop.

If you think that the effect of Manidón is too strong or too weak, inform your doctor or pharmacist.

If you take more Manidón than you should

You may experience one or more of the following symptoms: feeling of fatigue, shortness of breath, dizziness, weakness, chest pain, feeling faint, difficulty thinking, intense thirst, dry and pasty mouth, increased urge to urinate, drowsiness, blurred vision, difficulty speaking or moving, nausea, vomiting, diarrhea, disorientation. In case of severe intoxication, the doctor will take the necessary measures.

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 ingested, as severe intoxication may potentially lead to death.

If you forget to take Manidón

It is important that you take your Manidón tablets regularly. If you forget to take your scheduled dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose at your usual time. Do not take a double dose to make up for a missed one. Please consult your doctor before continuing your treatment.

4. Possible adverse effects

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

The following adverse effects come from clinical studies with verapamil or from post-marketing surveillance.

The adverse effects most frequently reported are headache, dizziness, gastrointestinal disorders: nausea, constipation, and abdominal pain, as well as bradycardia (decreased heart rate), tachycardia (increased heart rate), palpitations, hypotension (low blood pressure), flushing, peripheral edema (swelling in feet, legs, and ankles), and fatigue.

The following adverse effects have been observed with the following frequencies:

Frequent adverse effects: (may affect up to 1 in 10 people)

• Constipation
• Nausea
• Bradycardia
• Flushing
• Dizziness
• Headache
• Peripheral edema
• Hypotension (low blood pressure)

Uncommon adverse effects: (may affect up to 1 in 100 people)

• Abdominal pain
• Tachycardia
• Palpitations
• Fatigue

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

• Vomiting
• Somnolence
• Burning sensation
• Tingling or pricking (paresthesia)
• Tremor
• Tinnitus
• Excessive sweating

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

• Intestinal obstruction
• Gum overgrowth (gingival hyperplasia)
• Abdominal discomfort
• Bronchospasm
• Involuntary movements (extrapyramidal disorder)
• Paralysis (tetraparesis)*
• Seizures
• Abnormal enlargement of breasts
• Impotence
• Milk secretion
• Dizziness
• Allergic reactions
• Muscle weakness
• Muscle pain
• Joint pain
• Angioedema
• Skin redness (erythema multiforme)
• Stevens-Johnson syndrome (more severe erythema)
• Maculopapular rash (skin rash with spots and papules)
• Hair loss
• Urticaria
• Purpura (purple spots on skin and mucous membranes)
• Pruritus (itching)
• Increased liver enzymes
• Increased blood prolactin levels (a hormone that stimulates breast development and milk production)
• First-, second-, and third-degree atrioventricular block (heart conduction block)
• Heart failure
• Sinus pause
• Sinus bradycardia
• Asystole
• Hyperkalemia
• Dyspnea (difficulty breathing)
• Renal failure

*There has been one report of paralysis when verapamil was taken with colchicine; therefore, combined use is not recommended.

Reporting of adverse effects

If you experience any type of adverse effect, consult your doctor, pharmacist, or nurse, 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 Manidón

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

Do not store above 25°C.

Do not use Manidón after the expiry date stated on the packaging after CAD. or EXP. The expiry date is the last day of the month indicated.

Medicines must not be disposed of via wastewater or household waste. Dispose of unused medicines and their packaging at the SIGRE collection point at your pharmacy. If you are unsure, ask your pharmacist how to dispose of unused medicines and packaging. This will help protect the environment.

6. Contents of the pack and other information

Composition of Manidón

The active substance is verapamil (as hydrochloride). Each prolonged-release tablet contains 180 mg of active substance.

The other components (excipients) are:

Core ingredients: microcrystalline cellulose, sodium alginate, povidone, magnesium stearate and purified water.

Coating ingredients: hypromellose, macrogol 400, macrogol 6000, talc, titanium dioxide (E-171), iron oxides and hydroxides E-172 (red iron oxide) and montanglycol wax.

Appearance of the medicine and pack contents

Manidón is packaged in PVC/PVDC/Aluminum blisters and presented in packs containing 60 prolonged-release, oblong, biconvex, pink, scored tablets marked with "KNOLL" on one side and "180SR" on the other. The score line is intended solely to facilitate breaking the tablet for easier swallowing and not to divide it into equal doses.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Viatris Healthcare Limited
Damastown Industrial Park
Mulhuddart, Dublin 15
Dublin
Ireland

Manufacturer:

AbbVie Deutschland GmbH & Co. KG.
Knollstrasse, 50.
67061 Ludwigshafen
Germany

or

Famar A.V.E., Anthoussa Plant
Anthoussa Avenue 7
Anthoussa - Attiki
15349, Greece

For further information about this medicine, please contact the local representative of the Marketing Authorization Holder:

Viatis Pharmaceuticals, S.L.
C/ General Aranaz, 86
28027 Madrid
Spain

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

Detailed information on this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) https://www.aemps.gob.es/