Canacid

Package leaflet: Information for the patient

CANACID 100 mg hard capsules, 150 mg hard capsules, 200 mg hard capsules

Fluconazole
Generic medicine
Please read 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 others, even if their symptoms are the same as yours, as it may be harmful.
• If you experience any adverse reactions, including those not listed in this leaflet, contact your doctor or pharmacist. See section 4.

Contents of this leaflet:

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

1. What CANACID is and what it is used for

CANACID belongs to a group of medicines called "antifungals". The active substance is
fluconazole.
CANACID is used to treat fungal infections and can also be used to prevent
Candida infections. The most common cause of fungal infections is a yeast called Candida.
Adults
Your doctor may prescribe this medicine to treat the following fungal infections:

• Cryptococcal meningitis – a fungal infection of the brain;
• Coccidioidomycosis – a disease affecting the bronchopulmonary system;
• Infections caused by Candida found in the bloodstream, organs (e.g. heart, lungs), or urinary tract;
• Mucosal candidiasis – infection of the oral mucosa, throat infection, and denture-related stomatitis;
• Genital candidiasis – infection of the vagina or penis;
• Skin infections – e.g. athlete’s foot, ringworm, genital itching, nail infections.

CANACID may be prescribed to you for:

• Preventing recurrence of cryptococcal meningitis;
• Preventing recurrence of mucosal candidiasis;
• Reducing recurrences of vaginal candidiasis;
• Preventing Candida infections (if your immune system is weakened or not functioning properly).

Children and adolescents (from 0 to 17 years of age)
Your doctor may prescribe this medicine to treat the following fungal infections:

• Mucosal candidiasis – infection of the oral mucosa, throat infection;
• Infections caused by Candida found in the bloodstream, organs (e.g. heart, lungs), or urinary tract;
• Cryptococcal meningitis – a fungal infection of the brain.

CANACID may be prescribed to you for:

• Preventing Candida infections (if your immune system is weakened or not functioning properly);
• Preventing recurrence of cryptococcal meningitis.

2. What you need to know before taking CANACID

Do not take CANACID

• if you are allergic to fluconazole, to other medicines used to treat fungal infections, or to any of the other ingredients of this medicine (listed in section 6). Symptoms may include itching, skin redness, or difficulty breathing;
• if you are taking astemizole or terfenadine (antihistamine medicines used to treat allergies);
• if you are taking cisapride (used to treat stomach disorders);
• if you are taking pimozide (used to treat mental disorders);
• if you are taking quinidine (used to treat cardiac arrhythmias);
• if you are taking erythromycin (an antibiotic used to treat bacterial infections).

Warnings and precautions
Talk to your doctor or pharmacist before taking CANACID:

• if you have liver or kidney problems;
• if you suffer from heart conditions, including cardiac arrhythmia;
• if you have abnormal levels of potassium, calcium, or magnesium in your blood;
• if severe skin reactions occur (such as itching, skin redness, or difficulty breathing);
• if symptoms of "adrenal insufficiency" appear, caused by the adrenal glands’ inability to produce adequate amounts of certain steroid hormones such as cortisol (chronic or prolonged fatigue, muscle weakness, loss of appetite, weight loss, abdominal pain);
• if you have ever developed a severe skin rash, skin peeling, blisters, and/or mouth ulcers after taking fluconazole. Serious skin reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), have been reported with fluconazole treatment. Stop taking CANACID and contact your doctor immediately if you notice any of the symptoms related to serious skin reactions described in section 4.

Talk to your doctor or pharmacist if the fungal infection does not improve, as alternative antifungal therapy may be needed.
Other medicines and CANACID
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicine.
Inform your doctor immediately if you are taking:

• astemizole or terfenadine (antihistamines used to treat allergies);
• cisapride (used to treat stomach disorders);
• pimozide (used to treat mental disorders);
• quinidine (used to treat cardiac arrhythmias);
• erythromycin (an antibiotic used to treat bacterial infections), as these must not be taken with CANACID (see section: “Do not take CANACID”).

Some medicines may interact with CANACID. Inform your doctor if you are taking any of the following medicines, as dose adjustment or monitoring may be necessary to ensure the medicines continue to work as intended:

• rifampicin or rifabutin (antibiotics used to treat bacterial infections);
• abrocitinib (used to treat atopic dermatitis, also known as atopic eczema);
• hydrochlorothiazide (a diuretic);
• alfentanil, fentanyl (anesthetics);
• amitriptyline, nortriptyline (antidepressants);
• amphotericin B, voriconazole (antifungals);
• blood-thinning medicines used to prevent blood clots (warfarin or similar medicines);
• benzodiazepines (midazolam, triazolam, or similar medicines) used to help you sleep or for anxiety;
• carbamazepine, phenytoin (used to treat epileptic seizures);
• nifedipine, isradipine, amlodipine, verapamil, felodipine, and losartan (used to treat hypertension – high blood pressure);
• olaparib (used to treat ovarian cancer);
• ciclosporin, everolimus, sirolimus, or tacrolimus (used to prevent transplant rejection);
• cyclophosphamide, vinca alkaloids (vincristine, vinblastine, or similar medicines) used to treat cancer;
• halofantrine (used to treat malaria);
• amiodarone (used to treat "arrhythmias", irregular heartbeats);
• statins (atorvastatin, simvastatin, fluvastatin, or similar medicines) used to lower high cholesterol levels;
• methadone (used to treat pain);
• celecoxib, flurbiprofen, naproxen, ibuprofen, lornoxicam, meloxicam, diclofenac (Non-Steroidal Anti-Inflammatory Drugs – NSAIDs);
• oral contraceptives;
• prednisone (a steroid);
• zidovudine, also known as AZT;
• saquinavir (used in patients with HIV);
• diabetes medicines such as chlorpropamide, glibenclamide, glipizide, or tolbutamide;
• theophylline (used to control asthma);
• tofacitinib (used to treat rheumatoid arthritis);
• tolvaptan, used to treat hyponatremia (low sodium levels in the blood) or to slow the decline in kidney function;
• vitamin A (dietary supplement);
• ivacaftor (alone or in combination with other medicines used to treat cystic fibrosis);
• ibrutinib (used to treat blood cancer);
• lurasidone (used to treat schizophrenia).

CANACID with food and drink
You may take this medicine with or without food.
Pregnancy, breastfeeding, and fertility
If you are pregnant, think you may be pregnant, planning to become pregnant, or breastfeeding, consult your doctor or pharmacist before taking this medicine.
If you are planning a pregnancy, you should wait one week after a single dose of fluconazole before trying to conceive.
For longer treatment cycles with fluconazole, consult your doctor to assess the need for adequate contraception during treatment, which should continue for one week after the last dose.
Do not take fluconazole if you are pregnant, think you may be pregnant, or are trying to become pregnant, unless specifically instructed by your doctor. If you become pregnant while taking this medicine or within one week after the most recent dose, contact your doctor immediately.
Fluconazole taken during the first or second trimester of pregnancy may increase the risk of spontaneous abortion. Fluconazole taken during the first trimester may also increase the risk of birth defects affecting the baby’s heart, bones, and/or muscles.
Cases of babies born with craniofacial, ear, femur, and elbow bone malformations have been reported in women treated for three months or more with high doses (400–800 mg daily) of fluconazole for coccidioidomycosis. The causal relationship between fluconazole and these cases is not clear.
You may continue breastfeeding after a single 150 mg dose of CANACID. You should not breastfeed if you are taking repeated doses of CANACID.
Driving and using machines
Be aware that dizziness or seizures may occur while driving or operating machinery.
CANACID contains lactose
This medicine contains lactose. If your doctor has diagnosed you with an intolerance to certain sugars, contact them before taking this medicine.

3. How to take CANACID

Take this medicine exactly as directed by your doctor or pharmacist.
If you have any doubts, consult your doctor or pharmacist.
Swallow the capsule whole with a glass of water. It is best to take the capsules at the same time each day.
The recommended doses of CANACID to be taken depending on the infection are listed below:
Use in adults

Use in adolescents aged 12 to 17 years
Always take the dose prescribed by your doctor. Your doctor will decide whether to recommend the adult dose or the paediatric dose.
Use in children up to 11 years of age
The maximum dose in children is 400 mg per day.
The dose will be based on the child's weight in kilograms.

Use in children aged 0 to 4 weeks
Use in children aged 3 to 4 weeks:
The same dosage described above, but administered once every 2 days. The maximum dose is
12 mg per kg of body weight every 48 hours.
Use in children under 2 weeks of age:
The same dosage described above, but administered once every 3 days. The maximum dose is
12 mg per kg of body weight every 72 hours.
Your doctor may sometimes prescribe doses different from those listed here. Always take the medicine exactly
as directed by your doctor. If you have any doubts, consult your doctor or pharmacist.
Use in elderly patients
The same dose as that recommended for adults should be used, unless you have kidney problems.
Use in patients with renal impairment
Your doctor may adjust the dosage according to kidney function.
If you take more CANACID than you should
Taking too many capsules at once could cause you problems. Contact your doctor immediately or go to the nearest hospital.
In case of accidental overdose, symptoms may include experiencing sensations, seeing, hearing, or thinking things that are not real (hallucinations and paranoid behavior). Symptomatic treatment may be appropriate (with adequate supportive measures and, if necessary, gastric lavage).
If you forget to take CANACID
Do not take a double dose to make up for the missed dose. If you forget to take a dose, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and take the next one at the regular time.
If you have any questions 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 everyone experiences them.
Stop taking Canacid and contact your doctor immediately if you notice any of the following symptoms:

• widespread rash, high body temperature, and swollen lymph nodes (DRESS syndrome or drug hypersensitivity syndrome).

Some people may experience allergic reactions, although severe allergic reactions are rare.
If you experience any of the following symptoms, contact your doctor immediately:

• sudden shortness of breath, difficulty breathing, or chest tightness;
• swelling of the eyelids, face, or lips;
• itching all over the body, skin redness, or itchy red patches;
• skin rashes;
• severe skin reactions, for example rashes causing blisters (which may affect the mouth and tongue).

CANACID may affect the liver. Symptoms of liver problems include:

• fatigue;
• loss of appetite;
• vomiting;
• yellowing of the skin and whites of the eyes (jaundice).

If you experience any of these symptoms, stop taking CANACID and contact your doctor immediately.
Other side effects
If any of the side effects worsen, or if you notice any side effect not listed in this leaflet, inform your doctor or pharmacist.
Common side effects (may affect up to 1 in 10 people) are:

• headache;
• abdominal pain, diarrhoea, nausea, vomiting;
• increased liver function test values in blood tests;
• skin rash.

Uncommon side effects (may affect up to 1 in 100 people) are:

• reduction in red blood cells, which may cause paleness, weakness, or breathlessness;
• decreased appetite;
• insomnia, drowsiness;
• seizures, dizziness, tingling, prickling, or numbness, altered taste;
• vertigo;
• constipation, difficulty in digestion, flatulence, dry mouth;
• muscle pain;
• liver damage and yellowing of the skin and eyes (jaundice);
• drug-induced skin rashes, swellings, blisters (urticaria), itching, increased sweating;
• fatigue, general malaise, fever.

Rare side effects (may affect up to 1 in 1,000 people) are:

• lower than normal levels of white blood cells (which help defend against infections) and platelets (which enable blood clotting);
• abnormal skin colouration (red or purplish), which may be caused by a reduction in platelets, or other changes in blood cells;
• changes in blood chemistry (elevated cholesterol or fat levels);
• low potassium levels in the blood;
• tremor;
• abnormal electrocardiogram (ECG), changes in heart rhythm and rate;
• liver failure;
• allergic reactions (sometimes severe), including rashes with widespread blistering and peeling of the skin, severe skin reactions, swelling of the lips and face;
• hair loss.

Frequency not known, but possible (frequency cannot be estimated from the available data):

• hypersensitivity reaction with rash, fever, swollen glands, increase in a type of white blood cells (eosinophilia), and inflammation of internal organs (liver, lungs, heart, kidneys, and colon) (drug reaction or rash with eosinophilia and systemic symptoms (DRESS)).

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 website
https://www.aifa.gov.it/content/segnalazioni-reazioni-avverse. By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store CANACID

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 refers to the last day of that month.
Store below 30°C.
Do not dispose of any medicine via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. This will help protect the environment.

6. Package contents and other information

What CANACID contains

• The active substance is fluconazole.
• Each hard capsule contains 100 mg, 150 mg or 200 mg of fluconazole.
• The other components are: capsule contents:
• lactose
• starch
• anhydrous colloidal silica
• magnesium stearate
• sodium lauryl sulfate.

capsule shell contents:

• 100 mg hard capsules: gelatin, titanium dioxide (E171);
• 150 mg hard capsules: gelatin, titanium dioxide (E171), indigotine (E132);
• 200 mg hard capsules: gelatin, titanium dioxide (E171), indigotine (E132), black iron oxide (E172), erythrosine (E127)

Description of the appearance of CANACID and package contents

• CANACID 100 mg hard capsules have a white body and a white cap. Pack containing 10 capsules of 100 mg.
• CANACID 150 mg hard capsules have a blue body and a blue cap. Pack containing 2 capsules of 150 mg.
• CANACID 200 mg hard capsules have a white body and a purple cap. Pack containing 7 capsules of 200 mg.

Marketing Authorization Holder and Manufacturer
Marketing Authorization Holder
I.G. FARMACEUTICI di Irianni Giuseppe – Via San Rocco, 6 – 85033 Episcopia (Potenza)
Manufacturer
Special Product’s Line S.p.A - Via Fratta Rotonda Vado Largo, 1 - 03012 Anagni (FR)