Quetiapine Teva-Ratio 50 mg prolonged-release tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Quetiapine Teva-ratio 50 mg prolonged-release tablets EFG

quetiapine

Read the entire leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet; 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 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 Quetiapine Teva-ratio is and what it is used for
2. What you need to know before taking Quetiapine Teva-ratio
3. How to take Quetiapine Teva-ratio
4. Possible side effects
5. How to store Quetiapine Teva-ratio
6. Contents of the pack and other information

1. What Quetiapina Teva-ratio is and what it is used for

Quetiapina Teva-ratio contains a substance called quetiapine. It belongs to a group of medicines known as antipsychotics. Quetiapina Teva-ratio can be used to treat several conditions, such as:

• Bipolar depression and major depressive episodes in major depressive disorder: where you feel sad. You may find that you feel depressed, guilty, lack energy, lose your appetite, or are unable to sleep.
• Mania: where you may feel extremely excited, euphoric, agitated, enthusiastic or hyperactive, or have poor judgment, which may include being aggressive or violent.
• Schizophrenia: where you may hear or sense things that are not there, believe things that are not true, or feel abnormally suspicious, anxious, confused, guilty, tense or depressed.

When Quetiapina Teva-ratio prolonged-release tablets are used to treat major depressive episodes in major depressive disorder, they are taken in addition to another medicine you are already using to treat this condition.

Your doctor may continue prescribing Quetiapina Teva-ratio even after you start feeling better.

2. What you need to know before taking Quetiapine Teva-ratio

Do not take Quetiapine Teva-ratio:

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

• if you are taking any of the following medicines:

• Some medicines for HIV

• Azole-type medicines (for fungal infections)

• Erythromycin or clarithromycin (for infections)

• Nefazodone (for depression).

If you have any doubts, consult your doctor or pharmacist before taking Quetiapine Teva-ratio.

Warnings and precautions

Consult your doctor or pharmacist before starting Quetiapine Teva-ratio:

• if you, or a family member, have or have had any heart problems, for example, heart rhythm problems, weakening of the heart muscle, or inflammation of the heart, or if you are taking any medicine that may affect your heartbeat.
• if you have low blood pressure.
• if you have had a stroke, especially if you are elderly.
• if you have liver problems.
• if you have ever had a seizure (convulsion).
• if you suffer from depression or other conditions treated with antidepressants. The use of these medicines together with quetiapine may cause serotonin syndrome, a potentially life-threatening condition (see "Use of Quetiapine Teva-ratio with other medicines").
• if you have diabetes or are at risk of developing diabetes. If so, your doctor may monitor your blood sugar levels while you are taking quetiapine.
• if you know you have previously had low levels of white blood cells (which may or may not have been caused by other medicines).
• if you are an elderly person with dementia (loss of brain functions). In this case, you should not take quetiapine, because the group of medicines to which Quetiapine Teva-ratio belongs may increase the risk of stroke, or in some cases the risk of death, in these people with dementia.
• if you are an elderly person with Parkinson's disease/parkinsonism.
• if you or a family member has a history of blood clots, as medicines like this have been associated with blood clot formation.
• if you have or have had a condition in which your breathing stops for short periods during normal sleep (called "sleep apnea") and you are taking medicines that reduce normal brain activity ("depressants").
• if you have or have had a condition in which you cannot completely empty your bladder (urinary retention), have an enlarged prostate, intestinal obstruction, or increased pressure inside your eye. These conditions can sometimes be caused by medicines (called "anticholinergics") that affect how nerve cells function, used to treat certain medical conditions.
• if you have a history of alcohol or drug abuse.

Inform your doctor immediately if, after taking Quetiapine Teva-ratio, you experience any of the following:

• A combination of fever, severe muscle stiffness, sweating, or decreased level of consciousness (a disorder known as "neuroleptic malignant syndrome"). Immediate medical treatment may be necessary.
• Rapid or irregular heartbeats, even at rest, palpitations, breathing difficulties, chest pain, or unexplained fatigue. Your doctor should examine your heart and, if necessary, refer you immediately to a cardiologist.
• Uncontrolled movements, mainly of your face or tongue.
• Dizziness or feeling very drowsy. This may increase the risk of accidental injury (falls) in elderly patients.
• Seizures (convulsions).
• A prolonged and painful erection (priapism).

These disorders may be caused by this type of medicine.

Inform your doctor as soon as possible if you have:

• Fever, flu-like symptoms, sore throat, or any other infection, as this could be due to a very low count of white blood cells and may require stopping treatment with quetiapine and/or additional treatment.
• Constipation along with persistent abdominal pain, or constipation that has not responded to treatment, as this could lead to a more serious intestinal blockage.

Suicidal thoughts and worsening of your depression

If you are depressed, you may sometimes think about harming yourself or committing suicide. This risk may increase at the beginning of treatment, as all these medicines take time to work, usually about two weeks but sometimes longer. These thoughts may also increase if you stop your medication abruptly. You may be more likely to have such thoughts if you are a young adult. Clinical trial data have shown an increased risk of suicidal thoughts and/or suicidal behaviour in young adults under 25 years of age with depression.

If at any time you think about harming yourself or committing suicide, contact your doctor or go to a hospital immediately. It may help to tell a close family member or friend that you are depressed and ask them to read this leaflet. You may ask them to inform you if they think your depression is getting worse or if they are concerned about changes in your behaviour.

Serious skin adverse reactions (SCARs)

Very rarely, serious skin adverse reactions (SCARs), which may be life-threatening or fatal, have been reported with the use of this medicine. These commonly present as:

• Stevens-Johnson syndrome (SJS), a widespread rash with blisters and skin peeling, particularly around the mouth, nose, eyes, and genitals.
• Toxic epidermal necrolysis (TEN), a more severe form causing extensive skin peeling.
• Drug reaction with eosinophilia and systemic symptoms (DRESS), consisting of flu-like symptoms with rash, fever, swollen lymph nodes, and abnormal blood test results (including increased white blood cell count (eosinophilia) and elevated liver enzymes).
• Acute generalized exanthematous pustulosis (AGEP), small pustules filled with pus.
• Erythema multiforme (EM), skin rashes with irregular red spots that itch.

If you develop any of these symptoms, stop using Quetiapine Teva-ratio and contact your doctor or seek immediate medical attention.

Weight gain

Weight gain has been observed in patients taking quetiapine. You and your doctor should monitor your weight regularly.

Children and adolescents

Quetiapine Teva-ratio must not be used in children and adolescents under 18 years of age.

Taking Quetiapine Teva-ratiowith other medicines

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

Do not take Quetiapine Teva-ratio if you are using any of the following medicines:

• Some medicines for HIV.
• Azole-type medicines (for fungal infections).
• Erythromycin or clarithromycin (for infections).
• Nefazodone (for depression).

Inform your doctor if you are using any of the following medicines:

• Medicines for epilepsy (such as phenytoin or carbamazepine).
• Medicines for high blood pressure.
• Barbiturates (for difficulty sleeping).
• Thioridazine or lithium (other antipsychotic medicines).
• Antidepressants. These medicines may interact with Quetiapine Teva-ratio and you may experience symptoms such as involuntary and rhythmic muscle contractions, including muscles controlling eye movement, agitation, hallucinations, coma, excessive sweating, tremor, exaggerated reflexes, increased muscle tension, and body temperature above 38°C (serotonin syndrome). Contact your doctor if you experience these symptoms.
• Medicines that affect your heartbeat, for example, medicines that may cause an electrolyte imbalance (low potassium or magnesium levels) such as diuretics (medicines to increase urination) or certain antibiotics (medicines to treat infections).
• Medicines that may cause constipation.
• Medicines (called "anticholinergics") that affect how nerve cells function, used to treat certain medical conditions.

Before stopping any of your medicines, consult your doctor first.

Taking Quetiapine Teva-ratiowith food, drinks and alcohol

• Quetiapine Teva-ratio may be affected by food, and therefore you should take your tablets at least one hour before a meal or before bedtime.
• Be cautious about the amount of alcohol you consume. This is because the combined effect of Quetiapine Teva-ratio and alcohol may make you drowsy.
• Do not drink grapefruit juice while taking Quetiapine Teva-ratio. It may affect how the medicine works.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to become pregnant, consult your doctor before using this medicine. You should not take Quetiapine Teva-ratio during pregnancy unless advised by your doctor. You should not use Quetiapine Teva-ratio if you are breastfeeding.

The following symptoms, which may represent withdrawal syndrome, may occur in newborns of mothers who have taken quetiapine during the third trimester (last three months of pregnancy): tremor, muscle rigidity and/or weakness, drowsiness, agitation, breathing difficulties, and feeding problems. If your newborn develops any of these symptoms, you may need to contact your doctor.

Driving and using machines

These tablets may make you feel drowsy. Do not drive or operate tools or machinery until you know how the tablets affect you.

Effect on urine drug screening tests

If you are undergoing a urine drug screening test, taking quetiapine may produce positive results for methadone or certain antidepressant medicines called tricyclic antidepressants (TCAs) when certain testing methods are used, even though you may not be taking methadone or TCAs. If this occurs, a more specific test can be performed.

Quetiapine Teva-ratio contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per tablet, i.e., essentially "sodium-free".

3. How to take Quetiapine Teva-ratio

Follow exactly the instructions for using this medicine as given by your doctor. If in doubt, consult your doctor or pharmacist again. Your doctor will determine your starting dose. The maintenance dose (daily dose) will depend on your condition and individual needs, but will usually be between 150 mg and 800 mg.

• Take your tablets once daily.

• Do not split, chew, or crush the tablets.

• Swallow the tablets whole with water.

• Take the tablets without food (at least one hour before a meal or at bedtime; your doctor will tell you when).

• Do not drink grapefruit juice while taking Quetiapine Teva-ratio. It may affect how the medicine works.

• Do not stop taking your tablets even if you feel better, unless your doctor tells you to do so.

Liver problems

If you have liver problems, your doctor may adjust your dose.

Elderly patients

If you are an elderly patient, your doctor may adjust your dose.

Use in children and adolescents

Quetiapine Teva-ratio must not be used in children and adolescents under 18 years of age.

If you take more Quetiapine Teva-ratio than you should

If you take more Quetiapine Teva-ratio than prescribed by your doctor, you may feel drowsy, dizzy, or experience abnormal heartbeats. Contact your doctor or nearest hospital immediately. Take the medicine pack with you.

You may also call the Toxicology Information Service at: 91 562 04 20, stating the name of the medicine and the amount taken.

If you forget to take Quetiapine Teva-ratio

If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, wait until then. Do not take a double dose to make up for the missed tablet.

If you stop taking Quetiapine Teva-ratio

If you stop taking Quetiapine Teva-ratio abruptly, you may have difficulty sleeping (insomnia), or may experience nausea, headache, diarrhea, vomiting, dizziness, or irritability. Your doctor may recommend gradually reducing the dose before stopping treatment.

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.

If you experience any of the following serious adverse effects, stop taking Quetiapine Teva-ratio and go immediately to your doctor or nearest hospital:

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

• Suicidal thoughts and worsening of depression.

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

• Sudden fever, especially with sore throat and flu-like symptoms. These may be signs of a very low white blood cell count.
• Signs of skin reactions such as rash, hives, welts, redness, itching, possibly with swelling of the face, eyelids, and lips. This could also cause difficulty breathing, dizziness, or shock.
• Seizures or epileptic fits.
• Uncontrollable movements, mainly of the face or tongue (tardive dyskinesia).
• Feeling that your heart is pounding strongly or beating very fast, together with dizziness or fainting. This may indicate serious heart rhythm problems and, in severe cases, may be fatal.

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

• Severe pain or swelling and redness in one of your legs; sudden severe chest pain that may radiate to the left arm or sudden difficulty breathing. These may be signs of blood clots in the veins.
• Severe upper abdominal pain, often radiating to the back, sometimes with nausea and vomiting. This may be a sign of inflammation of the pancreas.
• Constipation together with persistent abdominal pain or constipation that has not responded to treatment, as this may lead to a more serious intestinal blockage.
• Yellowing of the skin and eyes (jaundice), dark urine, especially together with unusual tiredness or fever (signs of hepatitis).
• A prolonged and painful erection.
• A combination of fever, sweating, rigid muscles, and feeling drowsy or fainting (a disorder called "neuroleptic malignant syndrome").

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

• Severe rash, blisters, or red spots on the skin.
• Severe allergic reaction (called anaphylaxis) that may cause difficulty breathing or shock.
• Rapid swelling of the skin, usually around the eyes, lips, and throat (angioedema).
• A serious condition with blisters on the skin, mouth, eyes, and genitals (Stevens-Johnson syndrome). See section 2.
• Inappropriate secretion of a hormone that controls urine volume.
• Breakdown of muscle fibers and muscle pain (rhabdomyolysis).

Adverse effects not known (frequency cannot be estimated from available data)

• Skin rashes with irregular red patches (erythema multiforme). See section 2.
• Rapid appearance of areas of red skin dotted with small pustules (small blisters filled with white/yellow fluid known as Acute Generalized Exanthematous Pustulosis (AGEP). See section 2.
• Sudden and severe allergic reaction with symptoms such as fever, skin blisters, and skin peeling (toxic epidermal necrolysis). See section 2.
• Heart muscle disorder (cardiomyopathy)
• Inflammation of the heart muscle (myocarditis)
• Stroke

Drug reaction with eosinophilia and systemic symptoms (DRESS). Widespread rash, elevated body temperature, elevated liver enzymes, blood abnormalities (eosinophilia), enlarged lymph nodes, and involvement of other organs (drug reaction with eosinophilia and systemic symptoms, also known as DRESS). If you develop these symptoms, stop using quetiapine and contact your doctor or seek immediate medical attention.

Other possible adverse effects

Do not be alarmed if you see a tablet in your faeces after taking Quetiapine Teva-ratio. As the tablet passes through your gastrointestinal tract, quetiapine is slowly released. The tablet's shape remains undissolved and is eliminated in the faeces. Therefore, although you may see a tablet in your faeces, your dose of quetiapine has been absorbed.

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

• Dizziness (could lead to falls), headache, dry mouth.
• Drowsiness (which may disappear over time as you continue taking quetiapine), (could lead to falls).
• Withdrawal symptoms (symptoms that occur when you stop taking quetiapine), including inability to sleep (insomnia), nausea, headache, diarrhoea, vomiting, dizziness, and irritability. Gradual withdrawal over a period of at least 1 to 2 weeks is recommended.
• Weight gain.
• Abnormal muscle movements. These include difficulty initiating muscle movements, tremor, restlessness, or painless muscle stiffness.
• Decreased levels of haemoglobin (the protein in red blood cells that carries oxygen).
• Changes in levels of certain fats (triglycerides and total cholesterol).

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

• Fast heartbeat.

• Feeling that your heart is pounding, beating rapidly, or having irregular beats.

• Constipation, upset stomach (indigestion).

• Feeling weak.

• Swelling of arms or legs.

• Low blood pressure when standing. This may make you feel dizzy or faint (could lead to falls).

• Increased blood sugar levels.

• Blurred vision.

• Abnormal dreams and nightmares.

• Increased appetite.

• Feeling irritable.

• Speech and language disorders.

• Shortness of breath.

• Vomiting (mainly in elderly people).

• Fever.

• Changes in levels of thyroid hormones in the blood.

• Changes in the number of certain types of blood cells.

• Increases in liver enzyme levels measured in blood.

• Increases in the amount of prolactin hormone in blood. Increases in prolactin hormone could, in rare cases, lead to the following:

• In both men and women: breast enlargement and unexpected milk production.

• In women: absence of menstrual periods or irregular periods.

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

• Unpleasant sensations in the legs (also known as restless legs syndrome).
• Difficulty swallowing.
• Sexual dysfunction.
• Diabetes.
• Slower than normal heart rate, which may occur at the beginning of treatment and may be associated with low blood pressure and fainting.
• Difficulty urinating.
• Fainting (could lead to falls).
• Stuffy nose.
• Decrease in the number of red blood cells in the blood.
• Decrease in the amount of sodium in the blood.
• Worsening of pre-existing diabetes.
• Confusion.

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

• Breast enlargement and unexpected milk production (galactorrhoea).
• Menstrual disorder.
• Walking, talking, eating, or other activities while asleep.
• Decrease in body temperature (hypothermia).
• A condition (called “metabolic syndrome”) where you may experience a combination of 3 or more of the following effects: increased abdominal fat, decreased “good cholesterol” (HDL-C), increased levels of a type of fat in the blood called triglycerides, increased blood pressure, and increased blood sugar.
• Intestinal obstruction.
• Increased creatine phosphokinase in blood (a substance from muscles).

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

• Inappropriate secretion of a hormone that controls urine volume.

Not known (frequency cannot be estimated from available data)

• Withdrawal symptoms may occur in newborns of mothers who have used quetiapine during pregnancy.
• Inflammation of blood vessels (vasculitis), often with a skin rash showing small red or purple spots.

Some adverse effects are only detected through blood tests. These include changes in levels of certain fats (triglycerides and total cholesterol) or blood sugar, changes in thyroid hormone levels in the blood, increased liver enzymes, decreases in the number of certain types of blood cells, decreased number of red blood cells, increased creatine phosphokinase in blood (a substance found in muscles), decreased sodium levels in blood, and increased levels of prolactin hormone in blood. Increases in prolactin hormone could, in rare cases, lead to the following:

• In both men and women: breast enlargement and unexpected milk production.
• In women: absence of menstrual periods or irregular periods.

Your doctor may ask you to have blood tests from time to time.

Adverse effects in children and adolescents

The same adverse effects that may occur in adults may also occur in children and adolescents.

The following adverse effects have been observed more frequently in children and adolescents or have not been observed in adults:

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

• Increase in the amount of a hormone called prolactin in the blood. Increases in prolactin hormone could, in rare cases, lead to the following:

• In both boys and girls: breast enlargement and unexpected milk production.

• In girls: absence of menstrual periods or irregular periods.

  • Increased appetite.
  • Vomiting.
  • Abnormal muscle movements. These include difficulty initiating muscle movements, tremors, restlessness, or painless muscle stiffness.
  • Increased blood pressure.

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

• Feeling weak, fainting (could lead to falls).
• Stuffy nose.
• Feeling irritable.

Reporting of adverse effects

If you experience any adverse effect, talk to your doctor, pharmacist, or nurse, 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. Storage of Quetiapine Teva-ratio

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

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

Store in the original packaging to protect it from moisture.

Quetiapine Teva-ratio does not require any special storage temperature conditions.

Medicines must not be disposed of via wastewater drains or household waste. Unused medicines and their packaging should be returned to the SIGRE Point at your pharmacy. If you are unsure, ask your pharmacist how to dispose of medicines and packaging you no longer need. This will help protect the environment.

6. Contents of the pack and other information

Composition of Quetiapine Teva-ratio

The active substance is quetiapine. Quetiapine Teva-ratio tablets contain 50 mg of quetiapine (as quetiapine fumarate).

The other components are:

Tablet core: hypromellose, microcrystalline cellulose, anhydrous sodium citrate, magnesium stearate.

Tablet coating: titanium dioxide (E171), hypromellose, macrogol/PEG 400, polysorbate 80, yellow iron oxide (E172), red iron oxide (E172) and black iron oxide (E172).

Appearance of Quetiapine Teva-ratio and contents of the pack

The tablets are brown, biconvex, oblong, film-coated and marked with "Q 50" on one side.

They are available in packs of 10, 10x1 (unit dose perforated blister), 20, 30, 30x1 (unit dose perforated blister), 50, 50x1 (perforated unit dose blister) (hospital pack), 56 (calendar pack), 60, 60x1 (perforated unit dose blister), 90, 100 or 100x1 (perforated unit dose blister) tablets.

Only certain pack sizes may be commercially available.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Teva Pharma, S.L.U.

C/ Anabel Segura 11. Edificio Albatros B, 1st floor.

28108 Alcobendas. Madrid

Manufacturer

TEVA Pharmaceutical Works Private Limited Company

Pallagi út 13, 4042 Debrecen

Hungary

Pharmachemie B.V.

Swensweg 5, 2031 GA Haarlem

The Netherlands

Teva Czech Industries s.r.o.

Ostravska 29, c.p. 305, 74770 Opava-Komarov

Czech Republic

PLIVA Krakow Zaklady Farmaceutyczne S.A.

ul. Mogilska 80, 31-546 Krakow

Poland

Teva Pharma, S.L.U.

C/C, n. 4, Polígono Industrial Malpica, 50016 Zaragoza

Spain

Merckle GmbH

Ludwig-Merckle-Straße 3, 89143 Blaubeuren

Germany

Adamed Pharma S.A.

Pienków, ul. Mariana Adamkiewicza 6A

05-152 Czosnów

Poland

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

“Detailed and up-to-date information on this medicine is available on the website of the Spanish Agency of Medicines and Health Products (AEMPS) http://www.aemps.gob.es/ ”

You can access detailed and up-to-date information on this medicine by scanning with your mobile phone (smartphone) the QR code included in the packaging. You can also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/75279/P_75279.html