Algix

Package leaflet: Information for the user

ALGIX 30 mg film-coated tablets, 60 mg film-coated tablets, 90 mg film-coated tablets, 120 mg film-coated tablets

Etoricoxib
Please read all of this leaflet carefully before 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. Do not give it to other people, even if their symptoms are the same as yours, as it may be harmful. If you experience any side effects, including those not listed in this leaflet, talk to your doctor or pharmacist. See section 4.
• Contents of this leaflet:
  1. What ALGIX is and what it is used for
  2. What you need to know before taking ALGIX
  3. How to take ALGIX
  4. Possible side effects
  5. How to store ALGIX
  6. Contents of the pack and other information

1.1 What ALGIX is and what it is used for

What is ALGIX?

• ALGIX contains the active substance etoricoxib. ALGIX belongs to a group of medicines known as selective COX-2 inhibitors. These belong to a family of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).

What is ALGIX used for?

• ALGIX helps reduce pain and swelling (inflammation) in the joints and muscles of patients aged 16 years and older who have osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or gout.
• ALGIX is also used for the short-term treatment of moderate pain following dental surgery in patients aged 16 years and older.

What is osteoarthritis (OA)?
Osteoarthritis is a joint disease. It is caused by the progressive deterioration of the cartilage covering the ends of bones. This leads to swelling (inflammation), pain, tenderness, stiffness, and disability.
What is rheumatoid arthritis?
Rheumatoid arthritis is a chronic inflammatory joint disease. It causes pain, stiffness, swelling, and progressive loss of movement in affected joints. It may also cause inflammation in other parts of the body.
What is gout?
Gout is a disease characterized by sudden and recurrent attacks of very painful inflammation and redness in the joints. It is caused by the deposition of mineral crystals in the joints.
What is ankylosing spondylitis?
Ankylosing spondylitis is an inflammatory disease affecting the spine and large joints.

2. What you need to know before taking ALGIX

Do not take ALGIX:

• if you are allergic (hypersensitive) to etoricoxib or to any of the other ingredients of this medicine listed in section 6
• if you are allergic to non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and COX-2 inhibitors (see section 4, "Possible side effects")
• if you have an active stomach ulcer or active gastrointestinal bleeding
• if you have severe liver disease
• if you have severe kidney disease
• if you are pregnant or suspect you may be pregnant, or if you are breastfeeding (see "Pregnancy, breastfeeding and fertility")
• if you are under 16 years of age
• if you have inflammatory bowel disease, such as Crohn's disease, ulcerative colitis, or colitis
• if you have uncontrolled high blood pressure (consult your doctor or pharmacist if you are unsure whether your blood pressure is adequately controlled)
• if your doctor has diagnosed you with heart problems, including heart failure (moderate or severe), angina (chest pain)
• if you have had a heart attack, coronary artery bypass surgery, or peripheral arterial disease (reduced circulation in legs and feet due to narrowed or blocked arteries)
• if you have had any type of stroke (including mini-stroke, transient ischemic attack or TIA). Etoricoxib may slightly increase the risk of heart attack and stroke, and therefore should not be used in people who have already had heart problems or stroke.

If you think any of these conditions apply to you, do not take these tablets before consulting your doctor.

Warnings and precautions

Talk to your doctor or pharmacist before taking ALGIX if:

• you have a history of stomach bleeding or stomach ulcers.
• you are dehydrated, for example due to prolonged vomiting or diarrhea.
• you have swelling due to fluid retention.
• you have a history of heart failure or any other form of heart disease.
• you have a history of high blood pressure. In some people, ALGIX, especially at high doses, may increase blood pressure, and your doctor will periodically check your blood pressure.
• you have a history of liver or kidney disease.
• you are being treated for an infection. ALGIX may mask or hide fever, which is a sign of infection.
• you have diabetes, high cholesterol, or smoke. These are conditions that may increase your risk of heart disease.
• you are a woman trying to become pregnant.
• you are over 65 years of age.

If you have any doubts about any of the conditions listed above, discuss them with your doctor before taking ALGIX to determine whether this medicine is suitable for you.

If you are over 65 years of age, your doctor will monitor you appropriately. No dose adjustment is required for patients over 65 years of age.

Children and adolescents

Do not give this medicine to children and adolescents under 16 years of age.

Other medicines and ALGIX

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including those available without a prescription.

In particular, if you are taking any of the following medicines, your doctor may need to carry out checks to ensure these medicines remain effective after you start taking ALGIX:

• Medicines that thin the blood (anticoagulants) such as warfarin
• rifampicin (an antibiotic)
• ciclosporin or tacrolimus (medicines used to suppress the immune system)
• lithium (a medicine used to treat certain types of depression)
• medicines used to help control high blood pressure and heart failure called ACE inhibitors and angiotensin receptor blockers, such as enalapril and ramipril, and losartan and valsartan
• diuretics
• digoxin (a medicine used to treat heart failure and irregular heartbeat)
• minoxidil (a medicine used to treat high blood pressure)
• salbutamol tablets or oral solution (a medicine used to treat asthma)
• oral contraceptives (combination therapy may increase the risk of adverse effects)
• hormone replacement therapy (combination therapy may increase the risk of adverse effects)
• aspirin: the risk of stomach ulcers is higher if you take ALGIX with aspirin.
• aspirin for prevention of heart attacks or strokes: ALGIX may be taken with low-dose aspirin. If you are taking low-dose aspirin for prevention of heart attacks or strokes, do not stop taking it without consulting your doctor.
• aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs):

You must not take high-dose aspirin or other NSAIDs while taking ALGIX.

ALGIX with food and drink

The onset of ALGIX's effect may be faster when taken without food.

Pregnancy, breastfeeding and fertility

ALGIX tablets must not be taken during pregnancy. If you are pregnant, suspect you may be pregnant, or think you could become pregnant, do not take the tablets. If you become pregnant, stop taking the tablets and consult your doctor. If you are unsure or need further information, consult your doctor.

Breastfeeding

It is not known whether ALGIX is excreted in human milk. If you are breastfeeding or planning to breastfeed, contact your doctor before taking ALGIX. You must not breastfeed while taking ALGIX.

Fertility

ALGIX is not recommended for women intending to become pregnant.

Driving or using machinery

Some patients taking ALGIX have reported dizziness and drowsiness.

Do not drive if you experience dizziness or drowsiness.

Do not operate tools or machinery if you experience dizziness or drowsiness.

ALGIX contains lactose

If your doctor has told you that you are intolerant to certain sugars, contact your doctor before taking this medicine.

3. How to take ALGIX

Take this medicine exactly as prescribed by your doctor. If in doubt,
consult your doctor or pharmacist.
Do not take more than the recommended dose for the treatment of your condition. Your doctor will
periodically evaluate the treatment. It is important that you use the lowest effective dose capable of controlling your
pain and that you do not take ALGIX longer than necessary. This is because the risk of heart attacks and
strokes may increase after prolonged treatment, especially with high doses.
The recommended dose is:
Osteoarthritis
The recommended dose is 30 mg once daily, which may be increased, if necessary, up to a maximum
dose of 60 mg once daily.
Rheumatoid arthritis
The recommended dose is 60 mg once daily, which may be increased, if necessary, up to a maximum
dose of 90 mg once daily.
Ankylosing spondylitis
The recommended dose is 60 mg once daily, which may be increased, if necessary, up to a maximum
dose of 90 mg once daily.
Acute pain conditions
Etoricoxib should be used only for the duration of acute pain.
Gout
The recommended dose is 120 mg once daily, which should be used only for the duration of acute pain,
limited to a maximum of 8 days of treatment.
Postoperative dental surgery pain
The recommended dose is 90 mg once daily, limited to a maximum of 3 days of treatment.
Patients with liver problems

• If you have mild liver disease, you must not take more than 60 mg per day.
• If you have moderate liver disease, you must not take more than 30 mg per day.

Use in children and adolescents
ALGIX tablets must not be taken by children or adolescents under 16 years of age.
Elderly
Dose adjustment is not required in elderly patients. As with other medicines, caution should be
exercised in elderly patients.
Method of administration
ALGIX is for oral use. Take the tablets once daily. ALGIX can be taken with or without food.
If you take more ALGIX than you should
Never take more tablets than those recommended by your doctor. If you take too many
tablets of ALGIX, you must contact a doctor immediately.
If you forget to take ALGIX
It is important to follow the ALGIX dose prescribed by your doctor. If you forget a dose,
simply resume your usual dosing schedule the next day. Do not take a double dose
to make up for the missed tablet.
If you have any doubts about how to use this medicine, consult your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody will experience them.
If you experience any of the following symptoms, you must stop treatment with ALGIX and must
contact your doctor immediately (see "What you should know before taking ALGIX", paragraph 2):

• shortness of breath, chest pain, or swelling of the ankles that develop or begin to worsen
• yellowing of the skin or eyes (jaundice) – these are symptoms of liver problems
• severe or persistent stomach pain or black stools
• an allergic reaction which may include skin problems such as ulcers or blistering, or swelling of the face, lips, tongue, or throat which may make breathing difficult.

The frequency of the possible side effects listed below is defined using the following convention:
Very common (affects more than 1 in 10 people)
Common (affects 1 to 10 in 100 people)
Uncommon (affects 1 to 10 in 1,000 people)
Rare (affects 1 to 10 in 10,000 people)
Very rare (affects less than 1 in 10,000 people)

The following side effects may occur during treatment with ALGIX:
Very common:

• stomach pain

Common:

• alveolitis (inflammation and pain following a tooth extraction)
• swelling of the legs and/or feet due to fluid retention (oedema)
• dizziness, headache
• palpitations (fast or irregular heartbeat), irregular heart rhythm (arrhythmia)
• increased blood pressure
• wheezing or shortness of breath (bronchospasm)
• constipation, flatulence (excess gas), gastritis (inflammation of the inner lining of the stomach), heartburn, diarrhoea, indigestion (dyspepsia)/stomach discomfort, nausea, vomiting, inflammation of the oesophagus, mouth ulcers
• changes in certain blood tests related to liver function
• bruising
• weakness and fatigue, flu-like illness

Uncommon:

• gastroenteritis (inflammation of the gastrointestinal tract involving both the stomach and small intestine), upper respiratory tract infection, urinary tract infection
• changes in laboratory test values (decreased number of red blood cells, decreased number of white blood cells, decreased platelets)
• hypersensitivity (an allergic reaction including hives, which may be severe enough to require immediate medical attention)
• increased or decreased appetite, weight gain
• anxiety, depression, reduced mental alertness, visual, sensory or auditory perceptions not caused by real stimuli (hallucinations)
• altered taste, difficulty sleeping, tingling or numbness, drowsiness
• blurred vision, eye irritation and redness
• ringing in the ears, vertigo (persistent sensation of dizziness)
• abnormal heart rhythm (atrial fibrillation), increased heart rate, heart failure, feeling of tightness, pressure or heaviness in the chest (angina pectoris), heart attack
• hot flushes, stroke, mini-stroke (transient ischaemic attack), severe increase in blood pressure, inflammation of blood vessels
• cough, breathlessness, nosebleeds
• stomach or intestinal bloating, changes in bowel habits, dry mouth, stomach ulcer, inflammation of the inner lining of the stomach which may become severe and may lead to bleeding, irritable bowel syndrome, inflammation of the pancreas
• facial swelling, skin rash or itching, skin redness
• muscle cramps/spasms, muscle pain/stiffness
• elevated potassium levels in the blood, changes in certain blood or urine tests related to kidney function, severe kidney problems
• chest pain

Rare:

• angioedema (an allergic reaction with swelling of the face, lips, tongue and/or throat which may cause difficulty breathing and swallowing, which may be severe enough to require immediate medical attention), anaphylactic/anaphylactoid reactions including shock (a serious allergic reaction requiring immediate medical attention)
• confusion, restlessness
• liver problems (hepatitis)
• low sodium levels in the blood
• liver failure, yellowing of the skin and/or eyes (jaundice)
• severe skin reactions

Reporting of side effects
If you experience any side effect, including those not listed in this leaflet, talk to your doctor or pharmacist. You can also report side effects directly via the national reporting system at the following website:
www.agenziafarmaco.gov.it/it/responsabili.
By reporting side effects, you can help provide more information on the safety of this medicine.
If you experience any side effect, including those not listed in this leaflet, talk to your doctor or pharmacist.

5. How to store ALGIX

Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date stated on the pack. The expiry date refers to the last day of that month.
Bottle: keep the container tightly closed to protect the medicine from moisture.
Blister pack: store in the original packaging to protect the medicine from moisture.
Do not dispose of any medicine via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Package contents and other information

What ALGIX contains

• The active substanceThe active ingredient is etoricoxib. Each film-coated tablet contains 30, 60, 90, or 120 mg of etoricoxib.
• The other components are: Tablet core: calcium hydrogen phosphate anhydrous, croscarmellose sodium, magnesium stearate, microcrystalline cellulose. Film coating: carnauba wax, lactose monohydrate, hypromellose, titanium dioxide (E171), triacetin. The 30, 60, and 120 mg tablets also contain yellow iron oxide (colourant E172) and indigotine lake (colourant E132).

What ALGIX looks like and contents of the pack
ALGIX tablets are available in four formulations:
30 mg tablets: biconvex, apple-shaped, blue-green in colour, with ‘ACX 30’ engraved on one side and ‘101’ on the other;
60 mg tablets: biconvex, apple-shaped, dark green in colour, with ‘200’ engraved on one side and smooth on the other;
90 mg tablets: biconvex, apple-shaped, white in colour, with ‘202’ engraved on one side and smooth on the other;
120 mg tablets: biconvex, apple-shaped, light green in colour, with ‘204’ engraved on one side and smooth on the other.

Pack sizes:
30 mg:
Blister packs containing 2, 7, 14, 20, 28, 49, 98 tablets or multi-packs containing 98 tablets (2 packs of 49) in blisters.
60 mg:
Blister packs containing 2, 5, 7, 10, 14, 20, 28, 30, 50, 84, 98, 100 tablets or multi-packs containing 98 tablets (2 packs of 49) in blisters; or bottles containing 30 and 90 tablets, with desiccant containers.
The desiccant (1 or 2 containers) inside the bottle, used to keep the tablets dry, must not be swallowed.
90 and 120 mg:
Blister packs containing 2, 5, 7, 10, 14, 20, 28, 30, 50, 84, 100 tablets or multi-packs containing 98 tablets (2 packs of 49) in blisters; or bottles containing 30 and 90 tablets, with desiccant containers.
The desiccant (one or two containers) inside the bottle, used to keep the tablets dry, must not be swallowed.
60, 90 and 120 mg
Aluminium/aluminium blisters (single dose) in packs of 50 and 100 tablets.
Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
NEOPHARMED GENTILI S.r.l.
Via San Giuseppe Cottolengo, 15 – 20143 Milano, Italy

Manufacturers
30, 60, 90 and 120 mg
Waarderweg 39
2031 BN Haarlem
The Netherlands

60, 90 and 120 mg
Merck Sharp & Dohme Ltd.
Shotton Lane
Cramlington
Northumberland NE23 3JU
United Kingdom

This medicinal product is authorised in the European Economic Area countries
under the following names:
Belgium: RANACOX
Finland: TUROX
France: TUROX
Germany: EXINEF
Italy: ALGIX, EXINEF, TAUXIB
Luxembourg: RANACOX
The Netherlands: AUXIB
Portugal: EXXIV, TUROX
Spain: EXXIV, ACOXXEL
Sweden: TUROX
United Kingdom: AUXIB, EXXIV, TUROX, ACOXXEL

This patient information leaflet has been updated on