Ticagrelor Teva 90 mg film-coated tablets EFG

Patient Information Leaflet

Introduction

Patient Information Leaflet

Ticagrelor Teva 90 mg film-coated 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, consult 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 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 Ticagrelor Teva is and what it is used for
2. What you need to know before taking Ticagrelor Teva
3. How to take Ticagrelor Teva
4. Possible side effects
5. How to store Ticagrelor Teva
6. Contents of the pack and other information

1. What Ticagrelor Teva is and what it is used for

What Ticagrelor Teva is

Ticagrelor Teva contains an active substance called ticagrelor. It belongs to a group of medicines known as antiplatelet agents.

What Ticagrelor Teva is used for

Ticagrelor, in combination with acetylsalicylic acid (another antiplatelet agent), should only be used in adults. Your doctor has prescribed this medicine because you have had:

• a myocardial infarction (heart attack),
  • or unstable angina (unstable chest pain or chest discomfort not adequately controlled).

This medicine reduces the risk of having another heart attack, stroke, or dying from a heart or blood vessel-related disease.

How Ticagrelor Teva works

Ticagrelor acts on blood cells called 'platelets' (also known as thrombocytes). These very small blood cells help stop bleeding by clumping together to plug small holes in cut or damaged blood vessels.

However, platelets can also form clots inside damaged blood vessels in the heart and brain. This can be very dangerous because:

• the clot may completely block blood flow; this can lead to a heart attack (myocardial infarction) or a stroke, or
• the clot may partially block blood vessels supplying the heart; this reduces blood flow to the heart and may cause intermittent chest pain (known as 'unstable angina').

Ticagrelor Teva helps prevent platelets from clumping together. This reduces the likelihood of a blood clot forming, which could otherwise reduce blood flow.

2. What you need to know before taking Ticagrelor Teva

Do not take Ticagrelor Teva if:

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

• you are currently experiencing bleeding.

• you have had a stroke caused by bleeding in the brain.

• you have severe liver disease.

• you are taking any of the following medicines:

• ketoconazole (used to treat fungal infections)

• clarithromycin (used to treat bacterial infections)

• nefazodone (an antidepressant)

• ritonavir and atazanavir (used to treat HIV infection and AIDS)

Do not take ticagrelor if any of the above apply to you. If you are unsure, consult your doctor or pharmacist before taking this medicine.

Warnings and precautions

Talk to your doctor or pharmacist before taking ticagrelor if:

• you have an increased risk of bleeding due to:
  • a recent serious injury
  • a recent surgical procedure (including dental procedures; consult your dentist about this)
  • a disorder affecting blood clotting
  • recent bleeding from the stomach or intestine (such as stomach ulcer or colon ‘polyps’)
• you are scheduled for surgery (including dental procedures) at any time while taking ticagrelor. This is because your risk of bleeding may increase. Your doctor may decide to stop treatment with this medicine 5 days before surgery.
• your heart rate is abnormally slow (normally less than 60 beats per minute) and you do not already have a device implanted to regulate your heart (pacemaker).
• you have asthma or other lung problems or difficulty breathing.
• you develop irregular breathing patterns, such as periods of faster, slower, or brief pauses in breathing. Your doctor will decide whether you need further evaluation.
• you have had liver problems or previously had a condition that may have affected your liver.
• you have had a blood test showing elevated levels of uric acid.

If any of the above apply to you (or if you are unsure), consult your doctor or pharmacist before taking this medicine.

If you are taking ticagrelor and heparin:

• Your doctor may require a blood sample for diagnostic testing if he or she suspects a rare platelet disorder caused by heparin. It is important that you inform your doctor that you are taking both ticagrelor and heparin, as ticagrelor may affect the diagnostic test.

Children and adolescents

Ticagrelor is not recommended for use in children and adolescents under 18 years of age.

Other medicines and Ticagrelor Teva

Inform your doctor or pharmacist if you are using, have recently used, or might need to use any other medicines. This is because ticagrelor may affect how some medicines work, and some medicines may affect ticagrelor.

Tell your doctor or pharmacist if you are taking any of the following medicines:

• Rosuvastatin (a medicine used to treat high cholesterol)
• more than 40 mg daily of simvastatin or lovastatin (medicines used to treat high cholesterol levels)
• rifampicin (an antibiotic)
• phenytoin, carbamazepine, and phenobarbital (used to control epileptic seizures)
• digoxin (used to treat heart failure)
• cyclosporine (used to suppress the immune system)
• quinidine and diltiazem (used to treat abnormal heart rhythms)
• beta-blockers and verapamil (used to treat high blood pressure)
• morphine and other opioids (used to treat acute pain)

In particular, inform your doctor or pharmacist if you are taking any of the following medicines that increase the risk of bleeding:

• ‘oral anticoagulants’, often called ‘blood thinners’, including warfarin.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), commonly taken as painkillers, such as ibuprofen and naproxen.
• Selective Serotonin Reuptake Inhibitors (SSRIs), taken as antidepressants, such as paroxetine, sertraline, and citalopram.
• other medicines such as ketoconazole (used to treat fungal infections), clarithromycin (used to treat bacterial infections), nefazodone (an antidepressant), ritonavir and atazanavir (used to treat HIV infection and AIDS), cisapride (used to treat stomach acid), and ergot alkaloids (used to treat migraines and headaches).

Also inform your doctor that, because you are taking ticagrelor, you may have an increased risk of bleeding if you are given fibrinolytic agents, often called ‘clot dissolvers’, such as streptokinase or alteplase.

Pregnancy and breastfeeding

The use of ticagrelor is not recommended if you are pregnant or may become pregnant. Women should use appropriate contraceptive methods to prevent pregnancy while taking this medicine.

Consult your doctor before taking this medicine if you are breastfeeding. Your doctor will explain the benefits and risks of taking ticagrelor during this period.

If you are pregnant or breastfeeding, think you may be pregnant, plan to become pregnant, or are currently pregnant, consult your doctor or pharmacist before taking this medicine.

Driving and using machines

Ticagrelor is unlikely to affect your ability to drive or use machines. However, if you feel dizzy or confused while taking this medicine, take care when driving or using machines.

Ticagrelor Teva contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per dose; hence, it is essentially ‘sodium-free’.

3. How to take Ticagrelor Teva

Follow exactly the instructions given by your doctor for taking this medicine. If you are unsure, check with your doctor or pharmacist again.

How much to take

• The initial dose is two tablets taken at once (a loading dose of 180 mg). This dose is usually administered in hospital.
• After this initial dose, the normal dose is one 90 mg tablet twice daily for 12 months, unless your doctor tells you otherwise.
• Take this medicine at the same time each day (for example, one tablet in the morning and one at night).

Taking Ticagrelor Teva with other blood-thinning medicines

Your doctor will usually also prescribe acetylsalicylic acid for you. This is a substance found in many medicines used to prevent blood clotting. Your doctor will tell you how much to take (usually between 75–150 mg daily).

How to take Ticagrelor Teva

• You may take this medicine with or without food.

• You can check when you last took a Ticagrelor Teva tablet by looking at the blister pack. A sun (for morning) and a moon (for night) are shown. This will indicate whether you have taken your dose.

If you have difficulty swallowing the tablet

If you have difficulty swallowing the tablet, you may crush it and mix it with water as follows:

• Crush the tablet into a fine powder.
• Pour the powder into half a glass of water.
• Stir and drink immediately.
• To ensure no medicine is left behind, rinse the empty glass with another half glass of water and drink it.

If you are in hospital, this tablet may be administered to you mixed with a small amount of water through a tube inserted through the nose (nasogastric tube).

If you take more Ticagrelor Teva than you should

If you take more ticagrelor than you should, consult your doctor or go to hospital immediately. Take the medicine pack with you. You may be at increased risk of bleeding.

In case of overdose or accidental ingestion, contact your doctor or pharmacist immediately, or call the Poison Information Service at 91 562 04 20, indicating the medicine and the amount taken. It is recommended to bring the medicine packaging and leaflet to the healthcare professional.

If you forget to take Ticagrelor Teva

• If you forget to take a dose, simply take your next dose at the usual time.
• Do not take a double dose (two doses at once) to make up for forgotten doses.

If you stop taking Ticagrelor Teva

Do not stop taking ticagrelor without consulting your doctor. Take this medicine regularly and for as long as your doctor tells you to. If you stop taking ticagrelor, your risk of having another heart attack or stroke, or of dying from a heart or blood vessel disease, may increase.

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 experiences them.

Ticagrelor affects blood clotting, so most adverse effects are related to bleeding. Bleeding may occur in any part of the body. Some degree of bleeding is common (such as bruising and nosebleeds). Serious bleeding is rare but can be potentially fatal.

Contact your doctor immediately if you notice any of the following – you may need urgent medical treatment

• Bleeding in the brain or within the skull is an uncommon adverse effect and may cause signs of a stroke such as:

  • sudden numbness or weakness in the arms, legs, or face, especially if affecting only one side of the body
  • sudden confusion, difficulty speaking or understanding others
  • sudden difficulty walking or loss of balance or coordination
  • sudden dizziness or sudden severe headache of unknown cause

• Signs of bleeding such as:

  • severe or uncontrollable bleeding
  • unexpected bleeding or bleeding that lasts a long time
  • pink, red, or brown urine
  • vomiting blood or vomit that looks like "coffee grounds"
  • black or red stools (resembling tar)
  • coughing or vomiting blood

• Fainting (syncope)

  • temporary loss of consciousness due to a sudden drop in blood flow to the brain (common)

• Signs of a blood clotting disorder called Thrombotic Thrombocytopenic Purpura (TTP) such as:

  • fever and purple spots (called purpura) on the skin and in the mouth, with or without yellowing of the skin or eyes (jaundice), unexplained extreme fatigue or confusion.

Contact your doctor if you notice any of the following:

• Shortness of breath – this is very common. It may be due to heart disease or another cause, or it may be a side effect of ticagrelor. Shortness of breath related to ticagrelor is usually mild and is characterized by a sudden, unexpected need for air, typically occurring at rest. It may appear during the first weeks of treatment and may resolve in many cases. If you feel your shortness of breath has worsened or persists, inform your doctor. Your doctor will decide whether you need treatment or further investigations.

Other possible adverse effects

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

• high level of uric acid in the blood (as seen in blood tests)
• bleeding caused by blood disorders

Common (may affect up to 1 in 10 people)

• bruising
• headache
• dizziness or sensation of spinning
• diarrhea or indigestion
• feeling unwell (nausea)
• constipation
• rash
• itching
• severe joint pain and swelling – these are signs of gout
• dizziness, lightheadedness, or blurred vision – these are signs of low blood pressure
• nosebleeds
• heavier bleeding after surgery or cuts (e.g., while shaving) and wounds
• bleeding from the stomach lining (ulcer)
• bleeding from gums

Uncommon (may affect up to 1 in 100 people)

• allergic reaction – skin rash, itching, or swelling of the face or swelling of the lips/tongue may be signs of an allergic reaction
• confusion
• vision problems caused by bleeding in the eye
• heavier vaginal bleeding, or bleeding occurring at different times than your usual menstrual period
• bleeding into joints and muscles causing painful swelling
• blood in the ear
• internal bleeding, which may cause dizziness or lightheadedness

Frequency not known (cannot be estimated from available data)

• abnormally slow heart rate (usually below 60 beats per minute)

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. Storage of Ticagrelor Teva

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 blister and on the outer packaging after EXP. The expiry date refers to the last day of the month indicated.

This medicine does not require any special storage conditions.

Medicines must not be disposed of via wastewater or household waste. Dispose of unused medicines and their containers at the SIGRE Point in your pharmacy. Ask your pharmacist how to dispose of medicines and containers you no longer need. This helps protect the environment.

6. Contents of the pack and other information

Composition of Ticagrelor Teva

• The active substance is ticagrelor. Each film-coated tablet contains 90 mg of ticagrelor.
• The other components are:

Tablet core: mannitol (E421), calcium hydrogen phosphate, povidone, sodium carboxymethyl starch type A (from potato), magnesium stearate (E470b).

Coating: hypromellose (E464), titanium dioxide (E171), macrogol 4000 (E1521), talc (E553b), yellow iron oxide (E172), and red iron oxide (E172).

Appearance of the product and contents of the container

The film-coated tablets are round, light yellow to yellow in colour, marked with "A91" on one side and flat on the other side, approximately 9 mm in size.

Available in packaging:

Standard blister and calendar blister with sun/moon symbols OPA/Al/PVC-Al and PVC/PVDC-Al

Single-dose perforated blister OPA/Al/PVC-Al and PVC/PVDC-Al

Pack sizes of 14, 56, 60, 60x1, 100, 168 and 196 tablets.

Only certain pack sizes may be commercially available.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Teva Pharma, S.LU.

Anabel Segura, 11 Edificio Albatros B 1st floor

Alcobendas 28108, Madrid

Spain

Manufacturer

Pliva Hrvatska d.o.o.

Prilaz baruna Filipovica 25

HR-10000 ZAGREB

Croatia

Date of the most recent review of this leaflet: October 2022

Other sources of information

Detailed 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/).

You can access detailed and up-to-date information about 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 web address: https://cima.aemps.es/cima/dochtml/p/86457/P_86457.html

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