Zitrobiotic

Patient Information Leaflet

ZITROBIOTIC 500 mg film-coated tablets

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

1. What ZITROBIOTIC is and what it is used for

ZITROBIOTIC contains the active substance azithromycin. Azithromycin is an antibiotic that belongs to the group of antibiotics known as “macrolides”, which block the growth of susceptible bacteria.
ZITROBIOTIC is used to treat the following infections:
Adults and adolescents weighing 45 kg or more:

• Infections of the tonsils (tonsillitis) or throat (pharyngitis) caused by streptococcal bacteria
• Bacterial infections of the paranasal sinuses (sinusitis)
• Bacterial infections of the middle ear (otitis media)
• Lung infection (community-acquired pneumonia, not contracted in hospital)
• Bacterial infections of the skin and underlying tissues
• Bacterial infections of the gums (periodontitis) or gum abscess (periodontal abscess)
• Infections of the urethra and cervix caused by the bacterium Chlamydia trachomatis
• Bacterial infections of the genitals with painful sores (chancroid)

Adults:

• Bacterial infections in patients with long-standing inflammation of the bronchi (chronic bronchitis).

2. What you should know before taking ZITROBIOTIC

Do not take ZITROBIOTIC

• if you are allergic to azithromycin, erythromycin, or to other antibiotics known as “macrolides” or “ketolides”, or to any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions
Talk to your doctor or pharmacist before taking ZITROBIOTIC if you have or have had any of the following conditions:

• heart problems (e.g. heart rhythm disorders or heart failure) or low levels of potassium or magnesium in the blood: these conditions may contribute to serious cardiac side effects caused by azithromycin;
• liver problems: your doctor may need to monitor liver function or discontinue treatment;
• severe diarrhoea after taking other antibiotics;
• localized muscle weakness (myasthenia gravis), as symptoms of this disease may worsen during treatment;
• or if you are taking ergot derivatives such as ergotamine (used to treat migraine), as these medicines should not be taken together with ZITROBIOTIC.

Stop taking this medicine and contact your doctor immediately (see also “Serious unwanted effects” in section 4):

• if you suspect you are having an allergic reaction (e.g. difficulty breathing, swelling of the face or throat, rash, blisters);
• if you notice any of the symptoms described in section 4 related to severe skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), reported in association with azithromycin treatment;
• if you experience an abnormal heartbeat or palpitations, dizziness or fainting while taking ZITROBIOTIC;
• if you develop signs of liver problems (e.g. dark urine, loss of appetite, or yellowing of the skin or whites of the eyes);
• if you develop severe diarrhoea during or after treatment. Do not take any medicine for diarrhoea without first consulting your doctor. If diarrhoea persists or recurs within the first few weeks of treatment, inform your doctor.

Superinfection
Your doctor may monitor symptoms of additional bacterial or fungal infections that cannot be treated with ZITROBIOTIC (superinfection).
Sexually transmitted infections
Your doctor may perform a test to rule out possible syphilis infection, a sexually transmitted disease that could otherwise progress undetected and be diagnosed late. Furthermore, in cases of bacterial sexually transmitted infections, your doctor will perform follow-up laboratory tests to monitor treatment success.
Children and adolescents
If your body weight is less than 45 kg, other azithromycin-containing medicines may be more suitable and easier for you to take.
Other medicines and ZITROBIOTIC
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.
Taking ZITROBIOTIC together with other medicines may cause unwanted effects.
Therefore, it is especially important that you inform your doctor if you are taking any of the following medicines:
atorvastatin and other medicines in the statin group (to lower blood cholesterol and prevent heart diseases, including heart attacks and strokes);
cyclosporine (to prevent rejection of transplanted organs by the body);
colchicine (for the treatment of gout and familial Mediterranean fever);
dabigatran (to prevent and treat blood clots (anticoagulant));
digoxin (for the treatment of heart conditions);
warfarin or similar medicines used to thin the blood (anticoagulants);
medicines that may cause the heart muscle to take longer than usual to contract and relax (QT interval prolongation), such as the following:

• quinidine, procainamide, dofetilide, amiodarone and sotalol (for the treatment of irregular heartbeat, including cases of heartbeat that is too fast or too slow - cardiac arrhythmia);
• pimozide (for the treatment of mental illnesses);
• citalopram (for the treatment of depression);
• moxifloxacin and levofloxacin (antibiotics);
• cisapride (for the treatment of gastrointestinal tract disorders);
• hydroxychloroquine or chloroquine (for the treatment of autoimmune diseases, including rheumatoid arthritis, or for treating or preventing malaria).

Pregnancy and breastfeeding
If you are pregnant, think you may be pregnant, planning a pregnancy, or breastfeeding, consult your doctor or pharmacist before taking this medicine.
Pregnancy
Your doctor will decide whether you can take this medicine during pregnancy, after ensuring that the benefits outweigh the potential risks.
Breastfeeding
ZITROBIOTIC passes into breast milk. Therefore, your doctor will decide whether to discontinue breastfeeding or avoid treatment with ZITROBIOTIC, taking into account both the benefit of breastfeeding for the child and the benefit of therapy for you.
Driving and using machines
ZITROBIOTIC may moderately affect the ability to drive and use machines. Dizziness, drowsiness, seizures, as well as vision and hearing problems have been reported in some people taking ZITROBIOTIC. These possible side effects may impair your ability to drive or operate machinery.
ZITROBIOTIC contains lactose and sodium
This medicine contains lactose. If your doctor has diagnosed you with an intolerance to certain sugars, consult them before taking this medicine.
This medicine contains less than 1 mmol (23 mg) of sodium per dose, i.e. essentially sodium-free.

3. How to take ZITROBIOTIC

Take this medicine exactly as directed by your doctor or pharmacist. If you have any doubts, consult your doctor or pharmacist.
The amount of ZITROBIOTIC you need to take each day depends on the bacterial infection being treated and the specific treatment course prescribed by your doctor or pharmacist.
Adults and adolescents with body weight equal to or greater than 45 kg

Use in children and adolescents
If your weight is less than 45 kg, or if you are unable to swallow this medicine, please consult your doctor or pharmacist, as other azithromycin-containing medicines are available which may be more suitable for you.

Method of administration
For oral use.
ZITROBIOTIC should be taken orally as a single daily dose. The break line on the tablets is intended only to facilitate splitting the tablet if you have difficulty swallowing it whole. Both halves should be taken one immediately after the other.
The tablets may be taken regardless of meals. Taking this medicine just before a meal may help improve gastrointestinal tolerability.

If you take more ZITROBIOTIC than you should
If you take more ZITROBIOTIC than you should, you may feel unwell. Typical signs of overdose include vomiting, diarrhoea, abdominal pain and nausea. Immediately contact your doctor or the emergency department of the nearest hospital.

If you forget to take ZITROBIOTIC
If you forget to take ZITROBIOTIC, take it as soon as possible, provided that at least 12 hours remain before the next dose. If less than 12 hours remain before the next dose, do not take the missed dose; instead, take the next dose at the usual time. Do not take a double dose to make up for a forgotten dose.

If you stop treatment with ZITROBIOTIC
If you stop treatment with ZITROBIOTIC too early, the infection may return. Continue taking ZITROBIOTIC for the full duration of the treatment, even if you start to feel better.
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 everyone experiences them.

Serious side effects
Stop using ZITROBIOTIC and contact your doctor immediately if you notice any of the following symptoms:

• sudden wheezing, difficulty breathing, swelling of the eyelids, face or lips, rash or itching affecting mainly the entire body (anaphylactic reaction, frequency not known);
• rapid or irregular heartbeat (cardiac arrhythmia or torsades de pointes, tachycardia, frequency not known);
• dark urine, loss of appetite, or yellowing of the skin or whites of the eyes, signs of liver problems (hepatic failure or hepatic necrosis, frequency not known);
• severe diarrhoea with abdominal cramps, blood in the stools and/or fever may indicate an infection of the large intestine (antibiotic-associated colitis, frequency not known). Do not take anti-diarrhoeal medicines that inhibit intestinal motility (antiperistaltics);
• red, flat spots on the trunk, target-shaped or circular rashes, often with central blisters, skin peeling, mouth, throat, nose, genital or eye ulcers. These serious skin reactions may be preceded by fever and flu-like symptoms (Stevens-Johnson syndrome or toxic epidermal necrolysis, frequency not known);
• widespread rash, high body temperature, and swollen lymph nodes [(DRESS syndrome or drug hypersensitivity syndrome, rare (may affect up to 1 in 1,000 people)];
• widespread, red, scaly rash with subcutaneous bumps and blisters, accompanied by fever. Symptoms usually appear at the beginning of treatment [(generalized exanthematous pustulosis, rare (may affect up to 1 in 1,000 people)].

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

• diarrhoea

Common (may affect up to 1 in 10 people)

• headache
• vomiting, stomach pain, feeling unwell (nausea)
• changes in blood test results (decreased lymphocyte count, increased eosinophil count, increased basophil count, increased monocyte count, increased neutrophil count, decreased blood bicarbonate)

Uncommon (may affect up to 1 in 100 people)

• candidiasis (a fungal infection of the mouth and vagina), other fungal infections
• lung infection, bacterial throat infection, gastrointestinal tract inflammation, respiratory disorder, inflammation of the nasal mucosa, vaginal infection
• changes in white blood cell count (leucopenia, neutropenia, eosinophilia)
• increased platelet count
• reduced percentage of all blood cells in total blood volume (reduced haematocrit)
• allergic reactions, swelling of the hands, feet and face (angioedema)
• loss of appetite
• nervousness, difficulty sleeping (insomnia)
• dizziness, drowsiness (somnolence), altered sense of taste (dysgeusia), tingling sensation (paraesthesia)
• visual impairment
• ear disorder
• sensation of dizziness (vertigo)
• awareness of heartbeat (palpitations)
• hot flush
• sudden wheezing, nosebleed
• constipation, intestinal gas, impaired digestion (dyspepsia), inflammation of the stomach lining (gastritis), difficulty swallowing (dysphagia), bloated stomach, dry mouth, belching, mouth ulceration, increased salivation
• rash, itching, urticaria, dermatitis, dry skin, abnormally increased sweating (hyperhidrosis)
• swelling and pain in the joints (osteoarthritis), muscle pain, back pain, neck pain
• painful urination (dysuria), kidney pain
• irregular menstrual bleeding (metrorrhagia), testicular disorder
• fluid retention causing swelling, particularly of the face, ankles and feet (oedema, facial oedema, peripheral oedema)
• weakness, fatigue, general feeling of malaise, fever
• chest pain, pain
• abnormal laboratory test results (e.g. blood or liver tests)
• post-procedural complication

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

• sensation of irritation
• liver problems, yellowing of the skin or eyes
• increased sensitivity to sunlight

Not known (frequency cannot be estimated from the available data)

• reduced number of red blood cells due to increased cell breakdown, which may cause fatigue and pale skin (haemolytic anaemia)
• reduced number of platelets, which may lead to bleeding and bruising (thrombocytopenia)
• feeling angry, aggressive, fearful or worried (anxiety), acute confusion (delirium)
• hallucination
• fainting (syncope)
• seizures (convulsions)
• reduced sensitivity to touch, pain and temperature (hypoesthesia)
• feeling overactive
• changes in the sense of smell (anosmia, parosmia)
• complete loss of taste (ageusia)
• muscle weakness (myasthenia gravis)
• abnormal electrocardiogram (ECG) (prolonged QT interval)
• deafness, reduced hearing or ringing in the ears (tinnitus)
• low blood pressure
• inflammation of the pancreas causing severe abdominal and back pain (pancreatitis)
• change in tongue colour
• joint pain (arthralgia)
• inflammation of the kidneys (interstitial nephritis) and impaired kidney function

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 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 ZITROBIOTIC

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 medicines 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 ZITROBIOTIC contains
The active substance is azithromycin dihydrate. Each tablet contains 524.1 mg of azithromycin dihydrate,
corresponding to 500 mg of azithromycin.
The other components are: anhydrous calcium hydrogen phosphate, pregelatinized starch, sodium lauryl sulfate,
sodium croscarmellose, sodium carmellose, anhydrous colloidal silica, magnesium stearate.
Tablet coating: hypromellose, titanium dioxide, triacetin, lactose monohydrate.

Description of the appearance of ZITROBIOTIC and contents of the pack
Pack containing 3 film-coated, oval-shaped tablets, white or almost white, with a score line, in PVC/AL blisters.

Marketing Authorization Holder
Epifarma S.r.l. - Via San Rocco, 6 - 85033 Episcopia (PZ)

Manufacturer

• Doppel Farmaceutici S.r.l. - Via Volturno, 48 - 20089 Quinto De’ Stampi - Rozzano (MI)
• Special Product’s Line S.p.A. - Via Fratta Rotonda Vado Largo, 1 - 03012 Anagni (FR)