Topiramate Viatris 25 mg film-coated tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Topiramate Viatris 25 mg film-coated tablets EFG

This medicinal product is subject to additional monitoring, which will allow for rapid identification of new safety information. You can help by reporting any side effects you may experience. Information on how to report side effects is included at the end of section 4.

Read this 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 must not be given to other people, even if they have the same symptoms as you, since it could harm them.

• If you experience any side effects, consult your doctor, pharmacist, or nurse, even if they are side effects not listed in this leaflet. See section 4.

Contents of the leaflet

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

1. What Topiramate Viatris is and what it is used for

Topiramate Viatris belongs to a group of medicines called "antiepileptic medicines". It is used for:

• Treating seizures in adults and children over 6 years of age when given alone.
• Treating seizures in adults and children aged 2 years when given together with other medicines.
• Preventing migraine in adults.

2. What you need to know before starting to take Topiramate Viatris

Do not take Topiramate Viatris

If you are allergic to topiramate or any of the other components of this medicine (listed in section 6).

• Prevention of migraines

• You must not take topiramate if you are pregnant.

• If you are a woman of childbearing potential, you must not take topiramate unless you are using a highly effective method of contraception during treatment. See below under “Pregnancy, breastfeeding and fertility – Important advice for women”.

• Treatment of epilepsy

• You must not use topiramate if you are pregnant, unless no other treatment provides sufficient seizure control.

• If you are a woman of childbearing potential, you must not take topiramate unless you are using a highly effective method of contraception during treatment. The only exception is if topiramate is the only treatment that provides sufficient seizure control and you are planning to become pregnant. You should consult your doctor to ensure you have received information about the risks of taking topiramate during pregnancy and the risks of seizures during pregnancy. See below under “Pregnancy, breastfeeding and fertility – Important advice for women”.

Make sure to read the patient guide you will receive from your doctor.

A patient card is provided with the Topiramate Viatris package to remind you of the risks during pregnancy.

If you are unsure whether any of the above applies to you, consult your doctor or pharmacist before using topiramate.

Warnings and precautions

Before starting treatment with this medicine, consult your doctor or pharmacist if:

• You have kidney problems, especially kidney stones, or are undergoing dialysis.

• You have a history of blood or body fluid disorders (metabolic acidosis).

• You have liver problems.

• You have eye problems, especially glaucoma.

• You have growth problems.

• You are on a high-fat diet (ketogenic diet).

• You are a woman who could become pregnant. Topiramate can harm an unborn baby when taken during pregnancy. Highly effective contraceptive methods must be used during treatment and for at least 4 weeks after the last dose of topiramate. See section “Pregnancy and breastfeeding” for more information.

• You are pregnant. Topiramate can harm an unborn baby when taken during pregnancy.

If you are unsure whether any of the above applies to you, consult your doctor or pharmacist before using topiramate.

It is important that you do not stop taking your medication without first consulting your doctor.

You should consult your doctor before taking any other medication containing topiramate that may be given to you as an alternative to this medicine.

You may lose weight while taking this medicine, so your weight should be monitored regularly during treatment. If you lose too much weight, or if a child taking this medicine does not gain sufficient weight, you should consult your doctor.

A small number of people being treated with antiepileptic medicines such as topiramate have had thoughts of harming themselves or committing suicide. If you experience such thoughts at any time, contact your doctor immediately. If you have epilepsy, it is important not to stop taking your medication without first consulting your doctor.

This medicine may cause serious skin reactions. Contact your doctor immediately if you develop a rash and/or blisters (see also section 4 "Possible side effects"). This medicine may, rarely, cause high levels of ammonia in the blood (detected in blood tests), which may lead to changes in brain function, especially if you are also taking a medicine called valproic acid or sodium valproate. Since this may be a serious condition, speak to your doctor immediately if you experience any of the following symptoms (see also section 4 "Possible side effects"):

• Difficulty thinking, remembering information, or solving problems.
• Decreased level of alertness or consciousness.
• Feeling drowsy with low energy.

The risk of developing these symptoms may increase at higher doses of this medicine.

Other medicines and Topiramato Viatris

Inform your doctor or pharmacist if you are taking, have recently taken, or might need to take any other medicines. Topiramate and certain medicines may affect each other. Sometimes, the dose of one of the other medicines or of this medicine may need to be adjusted.

Especially inform your doctor or pharmacist if you are taking:

• Other medicines that impair or reduce your thinking, concentration, or muscle coordination (e.g., central nervous system depressants such as muscle relaxants and sedatives).
• Hormonal contraceptives. Topiramate may reduce the effectiveness of hormonal contraceptives. An additional barrier contraceptive method such as a condom or diaphragm should be used. You should consult your doctor about the most appropriate contraceptive method to use while taking topiramate.

Tell your doctor if you experience changes in your menstrual bleeding while taking hormonal contraceptives and topiramate. Irregular bleeding may occur. In this case, continue taking your hormonal contraceptives and inform your doctor.

Keep a list of all the medicines you are taking. Show this list to your doctor and pharmacist before starting a new medicine.

Other medicines about which you should consult your doctor or pharmacist include other antiepileptic medicines, risperidone, lithium, hydrochlorothiazide, metformin, pioglitazone, glibenclamide, amitriptyline, propranolol, diltiazem, venlafaxine, flunarizine, St. John’s wort (Hypericum perforatum) (a herbal preparation used to treat depression), warfarin (used to prevent blood clotting).

If you are unsure whether any of the above applies to you, consult your doctor or pharmacist before taking this medicine.

Taking Topiramato Viatris with food and drink

You may take this medicine with or without food. Drink plenty of fluids throughout the day to help prevent kidney stone formation while taking topiramate. You should avoid drinking alcohol while taking this medicine.

Pregnancy and breastfeeding

Important advice for women of childbearing potential:

Topiramate may harm an unborn baby during pregnancy. If you are a woman of childbearing potential, consult your doctor about other possible treatments. Visit your doctor to review your treatment and discuss risks at least once a year.

Migraine prevention

• You should not take topiramate for migraine if you are pregnant.
• You should not use topiramate for migraine if you are a woman of childbearing potential unless you are using a highly effective contraceptive method.
• Before starting treatment with topiramate, a pregnancy test must be performed in women of childbearing potential.

Epilepsy treatment

• You should not take topiramate for epilepsy if you are pregnant, unless no other treatment provides sufficient seizure control.
• You should not use topiramate for epilepsy if you are a woman of childbearing potential unless you are using a highly effective contraceptive method. The only exception is if topiramate is the only treatment providing sufficient seizure control and you are planning a pregnancy. You should consult your doctor to ensure you have received information about the risks of taking topiramate during pregnancy and about the risks of seizures during pregnancy, which may endanger you or your unborn baby.
• Before starting treatment with topiramate, a pregnancy test must be performed in women of childbearing potential.

Risks of taking topiramate during pregnancy (regardless of the condition for which topiramate is used):

There is a risk of harm to the unborn baby if topiramate is used during pregnancy.

• If you take topiramate during pregnancy, your child has a higher chance of having birth defects. In women taking topiramate, about 4 to 9 children out of 100 will have birth defects. This compares with 1–3 children out of 100 born to women who do not have epilepsy and are not taking antiepileptic medicines. In particular, cleft lip (a split in the upper lip) and cleft palate (a split in the roof of the mouth) have been observed. Newborn boys may also have a malformation of the penis (hypospadias). These defects may develop early in pregnancy, even before you know you are pregnant.
• If you take topiramate during pregnancy, your child may have a 2 to 3 times higher risk of developing autism spectrum disorders, intellectual disabilities, or attention deficit hyperactivity disorder (ADHD) compared to children born to women with epilepsy who are not taking antiepileptic medicines.
• If you take topiramate during pregnancy, your child may be smaller and weigh less than expected at birth. In one study, 18% of babies born to mothers taking topiramate during pregnancy were smaller and weighed less than expected at birth, compared to 5% of babies born to mothers without epilepsy who were not taking antiepileptic medicines.
• Consult your doctor if you have questions about these pregnancy risks.
• There may be other medicines available to treat your condition with a lower risk of birth defects.

Need for contraceptive methods in women of childbearing potential:

• If you are a woman of childbearing potential, consult your doctor about other possible treatments instead of taking topiramate. If the decision is made to use topiramate, highly effective contraceptive methods must be used during treatment and for at least 4 weeks after the last dose of topiramate.
• A highly effective contraceptive method (such as an intrauterine device) or two complementary contraceptive methods (such as a contraceptive pill together with a barrier method such as a condom or diaphragm) should be used. Consult your doctor about the most appropriate contraceptive methods for you.
• If you are taking hormonal contraceptives, there is a possibility of reduced effectiveness of the hormonal contraceptive due to topiramate. Therefore, an additional barrier contraceptive method (such as a condom or diaphragm) should be used.
• Inform your doctor if you experience irregular menstrual bleeding.

Use of topiramate in girls:

If you are the parent or caregiver of a girl being treated with topiramate, you should consult your doctor immediately once your daughter experiences her first menstrual period (menarche). The doctor will inform you about the risks to an unborn baby due to exposure to topiramate during pregnancy and the need to use highly effective contraceptive methods.

If you plan to become pregnant while taking topiramate:

• Schedule an appointment with your doctor.
• Do not stop using your contraceptive method until you have discussed this with your doctor.
• If you are taking topiramate for epilepsy, do not stop taking it until you have discussed this with your doctor, as your condition could worsen.
• Your doctor will reassess your treatment and evaluate alternative treatment options. The doctor will advise you about the risks of topiramate during pregnancy and may refer you to another specialist.

If you become pregnant or think you may be pregnant while taking topiramate:

• Schedule an urgent appointment with your doctor.
• If you are taking topiramate to prevent migraines, stop taking the medicine immediately and consult your doctor to evaluate whether you need an alternative treatment.
• If you are taking topiramate for epilepsy, do not stop taking this medicine until you have discussed this with your doctor, as your condition could worsen. Worsening epilepsy may endanger you or your unborn baby.
• Your doctor will reassess your treatment and evaluate alternative treatment options. The doctor will advise you about the risks of topiramate during pregnancy and may refer you to another specialist.
• If topiramate is used during pregnancy, you will be monitored closely to check your baby’s development.

Make sure to read the patient guide you will receive from your doctor. A patient card is provided with the Topiramato Viatris packaging to remind you of the risks of topiramate during pregnancy.

Driving and using machines

Dizziness, fatigue, and visual disturbances may occur during treatment with this medicine: Do not drive or operate tools or machinery without first speaking to your doctor.

Excipient with known effect

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

3. How to take Topiramate Viatris

Follow exactly the instructions for use of this medicine given by your doctor. If you have any doubts, consult your doctor or pharmacist.

• Take this medicine exactly as prescribed for you. Your doctor will usually start with a low dose of topiramate and slowly increase your dose until the best dose for you is reached.

• Swallow the topiramate tablets whole. Avoid chewing the tablets, as they may leave a bitter taste.

• You may take this medicine before, during, or after a meal. Drink plenty of fluids throughout the day to help prevent kidney stone formation while taking this medicine.

Girls and women of childbearing potential:

Treatment with topiramate should be initiated and continued under the supervision of a physician experienced in the treatment of epilepsy or migraine. Visit your doctor to review your treatment at least once a year.

If you take more Topiramate Viatris than you should

• Contact your doctor immediately. Take the medicine with you.

• You may feel drowsy, tired, or less alert; experience lack of coordination; have difficulty speaking or concentrating; experience double or blurred vision; feel dizzy due to low blood pressure; feel depressed or agitated; have abdominal pain, or seizures (attacks).

• You may experience an overdose if you are taking another medicine together with topiramate.

• In case of overdose or accidental ingestion, you may also contact the Toxicology Information Service, Telephone 91 5620420.

If you forget to take Topiramate Viatris

• If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Consult your doctor if you forget two or more doses.
• Do not take a double dose (two doses at the same time) to make up for a missed dose.

If you stop taking Topiramate Viatris

Do not stop treatment without first consulting your doctor. Your symptoms may return. If your doctor decides that you should stop taking this medicine, your dose will be gradually reduced over several days.

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.

Consult your doctor or seek immediate medical attention if you experience any of the following adverse effects:

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

• Depression (new or worsened).

Common (may affect up to 1 in 10 people)

• Seizures (attacks).
• Anxiety, irritability, mood changes, confusion, disorientation.
• Difficulty concentrating, slowed thinking, memory loss, memory problems (initial, sudden change, or increased severity).
• Kidney stones, frequent or painful urination.

Uncommon (may affect up to 1 in 100 people)

• Increased level of acid in the blood (which may cause breathing problems, including shortness of breath, loss of appetite, nausea, vomiting, excessive tiredness, and rapid or irregular heartbeat).
• Decreased or absent sweating (especially in young children exposed to high temperatures).
• Thoughts of self-harm or attempting to cause serious injury to oneself.
• Loss of part of the visual field.

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

• Glaucoma – blockage of fluid in the eye, causing increased pressure in the eye, pain, or reduced vision.
• Difficulty thinking, remembering information, or solving problems, decreased level of alertness or consciousness, feeling of numbness with low energy – these symptoms may be signs of high levels of ammonia in the blood (hyperammonemia), which may lead to altered brain function (hyperammonemic encephalopathy).
• Serious skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, which may appear as skin rashes with or without blisters. Skin irritation, ulcers, or inflammation in the mouth, throat, nose, eyes, or around the genitals. Skin rashes may progress to widespread damage of the skin (detachment of the epidermis and superficial mucous membranes), with potentially life-threatening consequences.

Frequency not known (cannot be estimated from available data)

• Inflammation of the eyes (uveitis) with symptoms such as redness and eye pain, light sensitivity, tearing, seeing small floating spots, or blurred vision.

Other adverse effects include the following. If they are severe, please consult your doctor or pharmacist:

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

• Nasal congestion, runny nose, or sore throat.
• Tingling, pain, and/or numbness in various parts of the body.
• Drowsiness, fatigue.
• Dizziness.
• Nausea, diarrhea.
• Weight loss.

Common (may affect up to 1 in 10 people)

• Anaemia (low blood count).
• Allergic reaction (such as skin rash, redness, itching, facial swelling, hives).
• Loss of appetite, decreased appetite.
• Aggression, agitation, anger, abnormal behavior.
• Difficulty falling or staying asleep.
• Problems with speech or speech disorders, poor pronunciation.
• Clumsiness or lack of coordination, feeling unsteady when walking.
• Reduced ability to complete routine tasks.
• Decreased, lost, or absent sense of taste.
• Tremors or involuntary shaking; rapid, uncontrollable eye movements.
• Vision disturbances, such as double vision, blurred vision, reduced vision, difficulty focusing.
• Sensation of spinning (dizziness), ringing in the ears, ear pain.
• Shortness of breath.
• Cough.
• Nosebleeds.
• Fever, general malaise, weakness.
• Vomiting, constipation, abdominal pain or discomfort, indigestion, stomach or intestinal infection.
• Dry mouth.
• Hair loss.
• Itching.
• Joint pain or swelling, muscle spasms or twitches, muscle pain or weakness, chest pain.
• Weight gain.

Uncommon (may affect up to 1 in 100 people)

• Decreased platelets (blood cells that help prevent bleeding), decreased white blood cells that help protect against infections, decreased blood potassium levels.
• Increased liver enzymes, increased eosinophils (a type of white blood cell) in blood.
• Swelling of lymph nodes in the neck, armpit, or groin.
• Increased appetite.
• Euphoric mood.
• Hearing, seeing, or feeling things that are not there, severe mental disorder (psychosis).
• Lack of emotional expression and/or feeling, unusual distrust, panic attack.
• Reading difficulties, speech disorder, handwriting problems.
• Restlessness, hyperactivity.
• Slowed thinking, decreased level of wakefulness or alertness.
• Slowed or reduced body movements, abnormal or repetitive involuntary muscle movements.
• Fainting.
• Abnormal sense of touch; altered touch sensation.
• Impaired, distorted, or absent sense of smell.
• Unusual feeling or sensation that may precede a migraine or certain types of seizures.
• Dry eyes, light sensitivity, eyelid twitching, watery eyes.
• Decreased or lost hearing, hearing loss in one ear.
• Slow or irregular heartbeat, awareness of heartbeat in the chest.
• Decreased blood pressure, decreased blood pressure upon standing (as a result, some people taking topiramate may faint, feel dizzy, or lose consciousness when standing up or sitting up suddenly).
• Flushing or feeling of warmth.
• Pancreatitis (inflammation of the pancreas).
• Excess gas or flatulence, stomach acidity, feeling of fullness or bloating.
• Bleeding gums, increased saliva, drooling, bad breath.
• Excessive fluid intake, thirst.
• Skin discoloration.
• Muscle stiffness, side pain.
• Blood in urine, incontinence (lack of control) when urinating, urgency to urinate, side or kidney pain.
• Difficulty achieving or maintaining an erection, sexual dysfunction.
• Flu-like symptoms.
• Cold hands and feet.
• Feeling of drunkenness.
• Learning difficulties.

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

• Abnormally elevated mood.
• Loss of consciousness.
• Blindness in one eye, temporary blindness, night blindness.
• Lazy eye.
• Swelling of the eyes and around the eyes.
• Numbness, tingling, and color changes (white, blue, then red) in fingers and toes when exposed to cold.
• Inflammation of the liver, liver failure.
• Abnormal skin odor.
• Discomfort in arms and legs.
• Kidney impairment.

Frequency not known (cannot be estimated from available data)

• Maculopathy is a disease of the macula, a small area in the retina where vision is sharpest. Consult your doctor if you notice any change or decrease in your vision.

Other adverse effects in children

In general, adverse effects observed in children are similar to those observed in adults, but the following adverse effects may be more frequent in children than in adults:

• Difficulty concentrating.
• Increased level of acid in the blood.
• Thoughts of self-harm.
• Fatigue.
• Decreased or increased appetite.
• Aggression, abnormal behavior.
• Difficulty falling or staying asleep.
• Feeling of unsteadiness when walking.
• General malaise.
• Decreased blood potassium levels.
• Lack of emotional expression and/or feeling.
• Watery eyes.
• Slow or irregular heartbeat.

Other adverse effects that may occur in children include:

Common (may affect up to 1 in 10 people)

• Sensation of spinning (dizziness).
• Vomiting.
• Fever.

Uncommon (may affect up to 1 in 100 people)

• Increased eosinophils (a type of white blood cell) in blood.
• Hyperactivity.
• Feeling of warmth.
• Learning difficulties.

Reporting of adverse effects

If you experience any 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 Topiramate Viatris

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

Store in the original packaging.

Do not use this medicine after the expiry date stated on the container after EXP or CAD. 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 containers and medicines at the SIGRE collection point at your pharmacy. If you are unsure how to dispose of unused containers and medicines, ask your pharmacist for advice. This will help protect the environment.

6. Contents of the pack and other information

Composition of Topiramate Viatris

The active substance is topiramate.

Each Topiramate Mylan film-coated tablet contains 25 mg of topiramate.

The other components are:

Tablet core: microcrystalline cellulose (E-460), sodium carboxymethyl starch from potato (type A), povidone, magnesium stearate (E-572), anhydrous colloidal silica.

Tablet coating: Opadry White YS-1-7003 [contains: titanium dioxide (E-171), hypromellose 3cP, hypromellose 6cP, polyethylene glycol 400 and polysorbate 80 (E433)].

Appearance of the product and contents of the pack

Topiramate Viatris 25 mg is presented in packs containing 60 film-coated tablets, round, white, biconvex, with the imprint “G” on one side and “TO” / “25” on the other.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Viatris Pharmaceuticals, S.L.

C/ General Aranaz, 86

28027 - Madrid

Spain

Manufacturer:

McDermott Laboratories Ltd. t/a Gerard Laboratories

35/36 Baldoyle Industrial Estate, Grange Road, Dublin 13

Ireland

Or

Prasfarma, S.L.

C/Sant Joan, 11-15

08560 – Manlleu (Barcelona)

Spain

Or

Mylan Hungary Kft.

Mylan utca 1.

Komárom, 2900

Hungary

Date of the most recent revision of this leaflet: January 2024

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

Other sources of information

The most recently approved information on this medicine is available at the following web address (URL): https://www.aemps.gob.es/informa/topiramato-nuevas-medidas-para-evitar-la-exposicion-en-mujeres-embarazadas/