Parnido 9 mg prolonged-release tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the patient

Parnido 3 mg prolonged-release tablets EFG

Parnido 6 mg prolonged-release tablets EFG

Parnido 9 mg prolonged-release tablets EFG

paliperidone

Read the entire leaflet carefully before you start taking this medicine, as 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 must not be given to other people, even if they have the same symptoms as you, because it could be harmful to 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 Parnido is and what it is used for.
2. What you need to know before taking Parnido.
3. How to take Parnido.
4. Possible adverse effects.
5. How to store Parnido.
6. Contents of the pack and other information.

1. What Parnido is and what it is used for

Parnido contains the active substance paliperidone, which belongs to a class of medicines called antipsychotics.

Paliperidone is used to treat schizophrenia in adults and adolescents aged 15 years and older.

Schizophrenia is a disorder that causes symptoms such as hearing, seeing or feeling things that do not exist, having false beliefs, excessive mistrust, social withdrawal, disorganized speech and impaired control of behaviour and emotions. People with this disorder may also feel depressed, anxious, guilty or tense.

Paliperidone is also used to treat schizoaffective disorder in adults.

Schizoaffective disorder is a mental condition in which a person experiences several of the symptoms of schizophrenia (listed in the previous paragraph) as well as mood disorder symptoms (feelings of euphoria, sadness, agitation, distractibility, insomnia, excessive speech, loss of interest in everyday activities, excessive or reduced sleep, excessive or reduced food intake, and recurrent suicidal thoughts).

Paliperidone may help relieve the symptoms of your illness and help prevent them from returning.

2. Before taking Parnido

Do not take paliperidone

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

Warnings and precautions

Talk to your doctor or pharmacist before starting paliperidone.

• Patients with schizoaffective disorder treated with this medicine should be closely monitored for possible changes from manic symptoms to depressive symptoms.

• This medicine has not been studied in elderly patients with dementia. However, elderly patients with dementia who are treated with other similar medicines may have an increased risk of stroke or death (see section 4, Possible side effects).

• If you have Parkinson's disease or dementia.

• If you have ever been diagnosed with a condition whose symptoms include high body temperature and muscle stiffness (also known as Neuroleptic Malignant Syndrome).

• If you have ever experienced abnormal movements of the tongue or face (Tardive Dyskinesia).

• You should know that these two disorders may be caused by this type of medicine.

• If you have previously had low levels of white blood cells in the blood (which may or may not have been caused by other medicines).

• If you are diabetic or have a tendency towards diabetes.

• If you have heart disease or are receiving treatment for heart conditions that could make you more prone to low blood pressure.

• If you have epilepsy.

• If you have a swallowing disorder or a stomach or intestinal disorder that reduces your ability to swallow food or digest it with normal intestinal movements.

• If you have conditions associated with diarrhea.

• If you have kidney problems.

• If you have liver problems.

• If you experience a prolonged and/or painful erection.

• If you have difficulty controlling your body temperature or feel overheated.

• 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 someone in your family has a history of blood clots, as antipsychotics have been associated with blood clot formation.

If you have any of these conditions, please consult your doctor, as a dose adjustment or monitoring may be necessary.

Because, very rarely, a dangerously low number of a type of white blood cells necessary to fight infections has been observed in patients treated with paliperidone, your doctor may check your white blood cell count.

Paliperidone may cause weight gain. Significant weight gain can negatively affect your health. Your doctor will regularly monitor your weight.

Diabetes mellitus or worsening of pre-existing diabetes mellitus has been observed in patients treated with paliperidone. Your doctor should check for signs of increased blood sugar. In patients with pre-existing diabetes mellitus, blood sugar should be monitored regularly.

During cataract surgery (clouding of the lens), the pupil (the black circle in the middle of the eye) may not dilate as needed. In addition, the iris (the colored part of the eye) may become flaccid during surgery, which could cause eye damage. If you are considering eye surgery, make sure to inform your ophthalmologist that you are taking this medicine.

Children and adolescents

Paliperidona must not be given to children and adolescents under 15 years of age for the treatment of schizophrenia.

Paliperidona must not be given to children and adolescents under 18 years of age for the treatment of schizoaffective disorder.

This is because it is unknown whether paliperidone is safe or effective in this age group.

Other medicines and paliperidone

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

Abnormalities in the electrical function of the heart may occur when this medicine is taken together with other medicines used to control heart rhythm or other medicines such as antihistamines, antimalarials, or antipsychotics.

Since this medicine acts mainly on the brain, it may interact with other medicines (or alcohol) that also act on the brain, due to additive effects on brain function.

This medicine may lower blood pressure, so you should be cautious if taking it with other medicines that also lower blood pressure.

This medicine may reduce the effect of medicines used for Parkinson's disease and restless legs syndrome (e.g., levodopa).

The effects of this medicine may be altered if you take medicines that influence intestinal motility (e.g., metoclopramide).

Dose reduction of this medicine should be considered when administered concomitantly with valproate.

The use of oral risperidone together with this medicine is not recommended, as this combination may lead to an increase in adverse effects.

Parnido should be used with caution with medicines that increase central nervous system activity (psychostimulants such as methylphenidate).

Taking paliperidona with alcohol

You should avoid consuming alcohol during treatment with this medicine.

Pregnancy and breastfeeding

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.

Do not take this medicine during pregnancy unless discussed with your doctor.

The following symptoms may occur in newborn babies whose mothers have been treated with paliperidone during the last trimester of pregnancy (last three months of pregnancy): tremors, muscle stiffness and/or weakness, drowsiness, agitation, breathing difficulties, and feeding problems. If your baby develops any of these symptoms, contact your doctor immediately.

You must not breastfeed while taking this medicine.

Driving and using machines

During treatment with this medicine, dizziness and vision problems may occur (see section 4, Possible side effects). This should be taken into account when full attention is required, for example, when driving or operating machinery.

Parnido contains sodium

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

3. How to take Parnido

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

Use in adults

The recommended dose for adults is 6 mg once daily in the morning. Your doctor may increase or decrease your dose within the dosage range of 3 mg to 12 mg once daily in the case of schizophrenia, or 6 mg to 12 mg once daily in the case of schizoaffective disorder. This depends on how well the medicine works for you.

Use in adolescents

The recommended starting dose for the treatment of schizophrenia in adolescents aged 15 years and older is 3 mg once daily taken in the morning.

For adolescents weighing 51 kg or more, the dose may be increased within the range of 6 mg to 12 mg once daily.

For adolescents weighing less than 51 kg, the dose may be increased to 6 mg once daily.

Your doctor will decide how much to prescribe. The dose you take depends on how well the medicine works for you.

How and when to take paliperidone

This medicine must be taken orally, swallowed whole with water or other liquids. It must not be chewed, broken, or crushed.

This medicine should be taken in the morning with breakfast or on an empty stomach, but always in the same way each day. Do not alternate between taking the medicine with breakfast one day and on an empty stomach the next.

The active substance, paliperidone, dissolves after swallowing, and the tablet coating is eliminated from the body through the faeces.

Patients with kidney problems

Your doctor may adjust the dose of this medicine according to your kidney function.

Elderly patients

Your doctor may reduce your dose if your kidney function is reduced.

If you take more paliperidone than you should

In case of overdose or accidental ingestion, consult your doctor, pharmacist, or go immediately to the nearest hospital, or call the Toxicology Information Service. Telephone: 91 562 04 20, indicating the medicine and the amount ingested. You may experience drowsiness, fatigue, abnormal body movements, difficulty standing or walking, dizziness due to low blood pressure, and changes in heart rhythm.

If you forget to take paliperidone

Do not take a double dose to make up for missed doses. If you miss a dose, take the next dose the following day. If you miss two or more doses, contact your doctor.

If you stop taking paliperidone

Do not stop taking this medicine, as you will lose the medicine's effects. You should not discontinue this medicine unless instructed by your doctor, as your symptoms may return.

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

4. Possible adverse effects

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

Contact your doctor immediately if:

• You develop blood clots in the veins, especially in the legs (symptoms include swelling, pain and redness in the leg), which may travel through blood vessels to the lungs causing chest pain and difficulty breathing. If you notice any of these symptoms, seek medical advice immediately.
• You have dementia and experience a sudden change in mental state or sudden weakness or numbness of the face, arms or legs, especially on one side, or have difficulty speaking even for a short period of time. These may be signs of a stroke.
• You experience fever, muscle stiffness, sweating, or decreased level of consciousness (a condition known as "Neuroleptic Malignant Syndrome"). Immediate medical treatment may be required.
• You are male and have a prolonged or painful erection. This is known as priapism. Immediate medical treatment may be needed.
• You experience involuntary rhythmic movements of the tongue, mouth or face. Discontinuation of paliperidone may be necessary.
• You have a severe allergic reaction characterized by fever, swelling of the mouth, face, lips or tongue, difficulty breathing, itching, skin rash, and sometimes a drop in blood pressure (i.e., an "anaphylactic reaction").

Very common adverse effects: may affect more than 1 in 10 patients

• Difficulty falling or staying asleep
• Parkinsonism: This condition may include slow or altered movement, a feeling of stiffness or tightness in the muscles (causing jerky movements), and sometimes a sensation of "freezing" of movement that then restarts. Other signs of parkinsonism include shuffling while walking slowly, resting tremor, increased saliva and/or drooling, and loss of facial expression
• Restlessness
• Feeling drowsy or less alert/awake
• Headache

Common adverse effects: may affect up to 1 in 10 patients

• Chest infection (bronchitis), symptoms of a common cold, nasal infection, urinary tract infection, feeling as if you have the flu
• Weight gain, increased appetite, weight loss, decreased appetite
• Euphoria (mania), irritability, depression, anxiety
• Dystonia: A condition involving slow or continuous involuntary muscle contractions. Although any part of the body may be affected (and may result in abnormal postures), dystonia often affects facial muscles, including abnormal eye, mouth, tongue or jaw movements
• Dizziness
• Dyskinesia: A condition involving involuntary muscle movements, which may include repetitive, spasmodic or twisting movements, or spasms
• Tremor (agitation)
• Blurred vision
• Conduction block between the upper and lower chambers of the heart, abnormalities in the heart's electrical conduction, QT interval prolongation in the heart, slow heartbeat, fast heartbeat
• Decreased blood pressure upon standing (as a result, some people taking paliperidone may feel weak, dizzy or lose consciousness when standing up or sitting down suddenly), increased blood pressure
• Sore throat, cough, nasal congestion
• Abdominal pain or discomfort, vomiting, nausea, constipation, diarrhea, indigestion, dry mouth, toothache
• Increased liver transaminases in blood
• Itching, skin rash
• Bone or muscle pain, back pain, joint pain
• Loss of menstrual periods
• Fever, weakness, fatigue (tiredness)

Uncommon adverse effects: may affect up to 1 in 100 patients

• Pneumonia, respiratory tract infection, bladder infection, ear infection, tonsillitis
• Decreased number of white blood cells, decreased platelets (blood cells that help stop bleeding), anemia, decreased number of red blood cells
• Paliperidone may increase levels of a hormone called "prolactin" detectable in blood tests (which may or may not cause symptoms). When symptoms of elevated prolactin occur, they may include: (in men) breast swelling, difficulty achieving or maintaining erections or other sexual dysfunction; (in women) breast discomfort, milk secretion from the breasts, loss of menstrual periods or other cycle problems
• Diabetes or worsening of diabetes, increased blood sugar, increased waist circumference, loss of appetite leading to malnutrition and decreased body weight, increased blood triglycerides (a type of fat)
• Sleep disorder, confusion, decreased sexual desire, inability to achieve orgasm, nervousness, nightmares
• Tardive dyskinesia (spasms or uncontrollable spasmodic movements of the face, tongue or other body parts). Inform your doctor immediately if you experience involuntary rhythmic movements of the tongue, mouth or face. Discontinuation of paliperidone may be necessary
• Seizures (epileptic fits), fainting, restlessness causing movement of body parts, dizziness upon standing, attention disturbance, speech problems, loss or changes in taste, decreased skin sensitivity to pain or touch, tingling, prickling or numbness of the skin
• Light sensitivity of the eyes, eye infection or "red eye", dry eyes
• Sensation of spinning (vertigo), ringing in the ears, ear pain
• Irregular heartbeat, abnormal electrical activity of the heart (electrocardiogram or ECG), sensation of fluttering or pounding in the chest (palpitations)
• Decreased blood pressure
• Difficulty breathing, wheezing (whistling sounds in the chest), nosebleeds
• Swelling of the tongue, stomach or intestinal infection, difficulty swallowing, excess gas or flatulence
• Increased GGT (a liver enzyme called gamma-glutamyl transferase) in blood, increased liver enzymes in blood
• Hives (or "urticaria"), hair loss, eczema, acne
• Increased CPK (creatine phosphokinase) in blood, an enzyme sometimes released during muscle breakdown, muscle spasms, joint stiffness, joint swelling, muscle weakness, neck pain
• Urinary incontinence (loss of control), frequent urination, inability to pass urine, pain when urinating
• Erectile dysfunction, ejaculation disorder
• Loss of menstrual periods or other cycle problems (women), milk secretion from the breasts, sexual dysfunction, breast pain, breast discomfort
• Swelling of the face, mouth, eyes or lips, body swelling, arms or legs
• Chills, increased body temperature
• Change in walking pattern
• Feeling thirsty
• Chest pain, chest discomfort, feeling unwell
• Falls

Rare adverse effects: may affect up to 1 in 1,000 patients

• Eye infection, fungal infection of the nails, skin infection, skin inflammation caused by mites
• Dangerously low number of a type of white blood cells needed to fight infections
• Decreased number of a type of white blood cells that help fight infections, increased eosinophils (a type of white blood cell) in blood
• Severe allergic reaction characterized by fever, swelling of the mouth, face, lips or tongue, breathing difficulty, itching, skin rash, and sometimes drop in blood pressure, allergic reaction
• Sugar in urine
• Inappropriate secretion of a hormone controlling urine volume
• Life-threatening complications of uncontrolled diabetes
• Dangerously excessive water intake, decreased blood sugar, excessive water intake, increased blood cholesterol
• Sleepwalking
• Not moving or not responding while awake (catatonia)
• Absence of emotions
• Neuroleptic Malignant Syndrome (confusion, decreased or loss of consciousness, high fever, and severe muscle rigidity)
• Loss of consciousness, balance disorder, abnormal coordination
• Problems in brain blood vessels, coma due to uncontrolled diabetes, no response to stimuli, decreased level of consciousness, head tremor
• Glaucoma (increased pressure in the eyeball), increased tearing, eye redness, eye movement problems, eye rolling
• Atrial fibrillation (abnormal heart rhythm), fast heartbeat upon standing
• Blood clots in the veins, especially in the legs (symptoms include leg swelling, pain and redness), which may travel through blood vessels to the lungs causing chest pain and breathing difficulty. If you experience any of these symptoms, seek medical help immediately
• Decreased oxygen in parts of the body (due to reduced blood flow), flushing
• Breathing problems during sleep (sleep apnea), rapid, shallow breathing
• Pneumonia caused by aspiration of food, airway congestion, voice disorder
• Intestinal obstruction, fecal incontinence, very hard stools, absence of intestinal movement causing obstruction
• Yellowing of the skin and eyes (jaundice)
• Pancreatitis (inflammation of the pancreas)
• Severe allergic reaction with swelling, which may affect the throat causing breathing difficulty
• Skin thickening, dry skin, skin redness, skin discoloration, scaly and itchy skin or scalp, dandruff
• Muscle fiber breakdown and muscle pain (rhabdomyolysis), abnormal posture
• Priapism (a prolonged erection that may require surgical treatment)
• Breast development in males, enlarged mammary glands, milk secretion from breasts, vaginal secretion
• Delayed menstrual periods, breast enlargement
• Very low body temperature, decreased body temperature
• Medication withdrawal symptoms

Not known: frequency cannot be estimated from available data

• Lung congestion
• Increased insulin (a hormone that controls blood sugar levels) in blood

The following adverse effects have been reported with use of another medicine called risperidone, which is very similar to paliperidone; therefore, they are also expected to occur with paliperidona: sleep-related eating disorder, other types of brain blood vessel problems, crackling lung sounds, and severe or life-threatening skin rash with blisters and skin peeling that may start inside and around the mouth, nose, eyes and genitals and spread to other body areas (Stevens-Johnson Syndrome/toxic epidermal necrolysis). Eye problems may also occur during cataract surgery. During cataract surgery, a disturbance called intraoperative floppy iris syndrome (IFIS) may occur if you are taking or have taken paliperidone. If you need to undergo cataract surgery, make sure to inform your ophthalmologist if you are taking or have taken this medicine.

Additional adverse effects in adolescents

Adolescents generally experienced adverse effects similar to those found in adults, except for the following effects, which occurred more frequently:

• Feeling drowsy or less attentive
• Parkinsonism: This condition may include slow or altered movement, a feeling of stiffness or tightness in the muscles (causing jerky movements), and sometimes a sensation of "freezing" of movement that then restarts. Other signs of parkinsonism include shuffling while walking slowly
• Resting tremor, increased saliva and/or drooling, and loss of facial expressiveness
• Weight gain
• Common cold symptoms
• Restlessness
• Tremor (agitation)
• Stomach pain
• Milk secretion from breasts in girls
• Breast swelling in boys
• Acne
• Speech problems
• Stomach or intestinal infection
• Nosebleeds
• Ear infection
• High blood triglycerides (a type of fat)
• Sensation of movement (vertigo)

Reporting of adverse effects

If you experience any adverse effect, talk to your doctor or pharmacist, even if it is a possible adverse effect 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 effects, you can help provide more information on the safety of this medicine.

5. Parnido Storage

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

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.

Store in the original packaging to protect it from moisture.

Medicines should not be disposed of via wastewater or household waste. Dispose of unused medicines and their containers at the SIGRE collection point at your pharmacy. Ask your pharmacist how to dispose of medicines and containers you no longer need. This will help protect the environment.

6. Contents of the pack and other information

Composition of Parnido

• The active substance is paliperidone.

Each prolonged-release tablet contains 3 mg, 6 mg or 9 mg of paliperidone.

• The other components are:

Core: macrogol 200 000, macrogol 7 000 000, macrogol 4 000, hydroxybutyltoluene, povidone, sodium chloride, microcrystalline cellulose, magnesium stearate, iron oxide red (E172), hydroxypropylcellulose and cellulose acetate.

Coating: hypromellose, titanium dioxide (E171), talc, propylene glycol, iron oxide yellow (E172) – for 6 mg tablets only, and iron oxide red (E172) – for 9 mg tablets only.

Printed ink: shellac, iron oxide black (E172) and propylene glycol. See section 2 “Parnido contains sodium”.

Appearance of the product and contents of the pack

3 mg: Film-coated, biconvex, round tablets, white to greyish white in colour, possibly with an uneven surface, printed with the mark P3 on one side of the tablet. Diameter: approximately 9 mm.

6 mg: Film-coated, biconvex, round tablets, brownish yellow in colour, possibly with an uneven surface, printed with the mark P6 on one side of the tablet. Diameter: approximately 9 mm.

9 mg: Film-coated, biconvex, round tablets, light pink in colour, possibly with an uneven surface, printed with the mark P9 on one side of the tablet. Diameter: approximately 9 mm.

Parnido is available in packs of 28, 30, 56, 60, 84, 90 or 98 prolonged-release tablets in blisters.

Only certain pack sizes may be marketed.

Marketing Authorisation Holder

TAD Pharma GmbH, Heinz-Lohmann‑Straße 5, 27472 Cuxhaven, Germany

Manufacturer

KRKA d.d. Novo mesto
Smarjeska cesta 6
8501 Novo mesto
Slovenia

For further information on this medicinal product, please contact the local representative of the Marketing Authorisation Holder:

KRKA Farmacéutica, S.L., C/ Anabel Segura 10, 28108 Alcobendas, Madrid, Spain

This medicinal product is authorised in the Member States of the European Economic Area under the following names:

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

Detailed information about this medicine is available on the website of the Spanish Agency of Medicines and Medical Devices (AEMPS) http://www.aemps.gob.es/