Dexak

Patient Information Leaflet

Warning! Keep this leaflet! Information on the immediate packaging is in a foreign language.
Dexak (Nosatel)
25 mg, coated tablets
Dexketoprofen
Dexak and Nosatel are different brand names for the same medicine.
Please read all of this leaflet carefully before taking this medicine because it contains
important information for you.

• This medicine should always be taken exactly as described in this patient leaflet or as directed by your doctor or pharmacist.
• Keep this leaflet so that you can read it again if necessary.
• If you need advice or further information, please consult your pharmacist.
• If you experience any adverse effects, including any possible side effects not listed in this leaflet, inform your doctor or pharmacist. See section 4.
• If there is no improvement within 3–4 days, or if you feel worse, consult your doctor.

Table of Contents:

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

1. What Dexak is and what it is used for

Dexak is an analgesic medicine belonging to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).
It is used for symptomatic treatment of mild to moderate pain, such as muscle pain, painful menstruation (dysmenorrhoea), or toothache.
If there is no improvement within 3–4 days, or if you feel worse, consult your doctor.

2. Important information before using Dexak

When not to use Dexak:

• If the patient is allergic to dexketoprofen or any of the other ingredients of this medicine (listed in section 6);
• If the patient is allergic to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (NSAIDs);
• If the patient has asthma or previously experienced asthma attacks, acute allergic rhinitis (a short period of inflammation of the nasal lining), nasal polyps (nodules inside the nose caused by allergy), urticaria (blister-like rash), angioedema (swelling of the face, eyes, lips, tongue or throat, or breathing difficulties) or wheezing after taking acetylsalicylic acid or another NSAID;
• If the patient previously experienced photosensitivity reactions: photoallergic or phototoxic reactions (particularly as redness and/or blisters on skin exposed to sunlight) while taking ketoprofen (a non-steroidal anti-inflammatory drug) or fibrates (medicines used to lower blood lipid levels);
• If the patient has gastric and/or duodenal ulcer disease or gastrointestinal bleeding, or if there has been previous gastrointestinal bleeding, ulceration or perforation;
• If the patient has chronic digestive problems (e.g. indigestion, heartburn);
• If the patient previously experienced gastrointestinal bleeding or perforation due to prior use of NSAIDs used for pain relief;
• If the patient has inflammatory bowel diseases (Crohn's disease or ulcerative colitis);
• If the patient has severe heart failure, moderate or severe renal failure, or severe hepatic failure;
• If the patient has a tendency to bleed excessively or has coagulation disorders;
• If the patient is severely dehydrated (excessive fluid loss from the body) due to vomiting, diarrhoea, or inadequate fluid intake;
• If the patient is in the third trimester of pregnancy or breastfeeding.

Warnings and precautions
Before starting to take Dexak, consult your doctor or pharmacist if:

• The patient has allergies or has previously experienced allergy-related problems;
• The patient has kidney, liver or heart function disorders (hypertension and/or heart failure), fluid retention, or if any of these conditions occurred previously;
• In patients taking diuretics or in patients who are dehydrated and have reduced blood volume due to excessive fluid loss (e.g. excessive urination, diarrhoea or vomiting);
• If the patient has heart problems, has had a stroke, or is suspected of being at risk for these conditions (e.g. high blood pressure, diabetes, high cholesterol levels, or smoking). In such cases, consult a doctor before using Dexak. Use of medicines such as Dexak may be associated with a small increased risk of heart attack ("myocardial infarction") or stroke. This risk increases with long-term use of high doses. Do not use higher doses or longer treatment duration than recommended;
• If the patient is elderly: there is an increased risk of adverse effects (see section 4). In such cases, contact a doctor immediately;
• In women experiencing fertility problems or undergoing fertility investigations (this medicine may impair female fertility and is not recommended for women planning pregnancy or undergoing fertility treatment);
• If the patient has blood or blood cell formation disorders;
• If the patient has systemic lupus erythematosus or mixed connective tissue disease (immune system disorders affecting connective tissue);
• If the patient previously had chronic inflammatory bowel diseases (ulcerative colitis, Crohn's disease);
• If the patient has or previously had other stomach or intestinal disorders;
• If the patient has an infection – see below, section titled "Infections";
• If the patient is taking other medicines that increase the risk of gastric and/or duodenal ulcer disease or bleeding, e.g. oral corticosteroids, certain antidepressants (SSRI-class drugs, such as serotonin reuptake inhibitors), anticoagulants such as acetylsalicylic acid, or anticoagulant drugs such as warfarin. In such cases, consult a doctor before taking this medicine; the doctor may decide to prescribe an additional protective medicine (e.g. misoprostol or drugs that inhibit gastric acid production);
• If the patient has asthma, chronic rhinitis, chronic sinusitis and/or nasal polyps, the risk of allergy to acetylsalicylic acid and/or NSAIDs is higher than in the general population. Taking this medicine may trigger asthma attacks or bronchospasm, particularly in patients allergic to acetylsalicylic acid and/or NSAIDs.

Infections
Dexketoprofen may mask symptoms of infection such as fever and pain. Therefore, this medicine may delay appropriate treatment of infection and consequently increase the risk of complications. This has been observed in bacterial pneumonia and bacterial skin infections associated with chickenpox. If the patient takes this medicine during an infection and symptoms persist or worsen, consult a doctor immediately.
Avoid using this medicine during chickenpox.

Children and adolescents
The use of this medicine has not been studied in children and adolescents. The safety and efficacy have not been established, and therefore this medicine should not be used in children and adolescents.

Dexak and other medicines
Inform your doctor about all medicines currently or recently taken, as well as any medicines the patient plans to take. Some medicines should not be used together with Dexak, and in the case of others, dosage adjustments may be necessary when taken together with Dexak.
Always inform your doctor, dentist or pharmacist if you are taking any of the following medicines together with this one:

• Not recommended for concomitant use:

• Acetylsalicylic acid, corticosteroids or other anti-inflammatory drugs

• Warfarin, heparin or other anticoagulant drugs

• Lithium used to treat certain mood disorders

• Methotrexate (an anticancer or immunosuppressive drug) used in high doses of 15 mg per week

• Hydantoin derivatives and phenytoin used to treat epilepsy

• Sulfamethoxazole used to treat bacterial infections.

• Concomitant use requiring caution:

• ACE inhibitors, diuretics and angiotensin II antagonists used to treat high blood pressure and heart conditions

• Pentoxifylline and oxpentifylline used to treat ulcers in chronic venous insufficiency

• Zidovudine used to treat viral infections

• Aminoglycoside antibiotics used to treat bacterial infections

• Sulfonylurea derivatives (e.g. chlorpropamide and glibenclamide) used to treat diabetes

• Methotrexate used in low doses, below 15 mg per week.

• Concomitant use requiring special consideration:

• Quinolone antibiotics (e.g. ciprofloxacin, levofloxacin) used to treat bacterial infections

• Cyclosporine and tacrolimus used to treat immune system disorders and in transplant patients

• Streptokinase and other thrombolytic or fibrinolytic drugs, i.e. drugs used to dissolve blood clots

• Probenecid used to treat gout

• Digoxin used to treat chronic heart failure

• Mifepristone used as an abortion-inducing agent (terminates pregnancy)

• Selective serotonin reuptake inhibitor (SSRI) antidepressants

• Antiplatelet drugs used to reduce platelet aggregation and blood clot formation

• Beta-blockers used to treat high blood pressure and heart conditions

• Tenofovir, deferasirox, pemetrexed.

If you have any doubts regarding the use of Dexak, consult your doctor or pharmacist.

Taking Dexak with food and drink
Dexak tablets should be swallowed with sufficient water. Taking the tablets with food may reduce the risk of gastrointestinal adverse effects. However, in case of acute pain, it is recommended to take the medicine on an empty stomach, e.g. at least 30 minutes before a meal, to allow faster onset of action.

Pregnancy, breastfeeding and effects on fertility
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or is planning to have a child, she should consult a doctor or pharmacist before using this medicine.
Do not take this medicine if the patient is in the last three months of pregnancy or during breastfeeding. It may cause kidney and heart problems in the unborn child. It may increase the tendency to bleed in both the mother and the child and may delay or prolong labour.
During the first six months of pregnancy, this medicine should not be used unless the doctor considers it absolutely necessary. If treatment is required during this period or when trying to conceive, the lowest possible dose should be used for the shortest possible time.
From the 20th week of pregnancy, Dexak, if taken for longer than a few days, may cause:
impaired kidney function in the unborn child – this may lead to reduced amniotic fluid surrounding the baby (oligohydramnios) or narrowing of blood vessels (ductus arteriosus) in the baby's heart. If treatment for longer than a few days is necessary, the doctor may recommend additional monitoring.
This medicine is not recommended for women planning pregnancy or undergoing fertility investigations.
Information on potential effects on fertility is provided in section 2, "Warnings and precautions".

Driving and operating machinery
This medicine may cause dizziness and fatigue and therefore may have a minor or moderate effect on the ability to drive vehicles and operate machinery. If such symptoms occur, do not drive or operate mechanical equipment until symptoms resolve. If in doubt, consult a doctor.

Dexak contains sodium
This medicine contains less than 1 mmol (23 mg) of sodium per tablet, meaning the medicine is considered "sodium-free".

3. How to use Dexak

This medicine should always be taken exactly as described in the patient information leaflet or as directed by a doctor or pharmacist. If in doubt, consult a doctor or pharmacist.
The lowest effective dose for the shortest duration necessary to relieve symptoms should be used. If, during an infection, symptoms (such as fever and pain) persist or worsen, medical advice should be sought immediately (see section 2).
Tablets may be divided into equal doses by breaking them along the score line.
The recommended daily dose is usually half a tablet (12.5 mg) every 4 to 6 hours or one tablet (25 mg) every 8 hours, but not more than 3 tablets per day (75 mg).
If there is no improvement after 3 to 4 days, or if the patient feels worse, contact a doctor. The doctor will inform the patient how many tablets should be taken per day and for how long.
The dose of this medicine will depend on the type, severity, and duration of the patient's pain.
In elderly patients or those with kidney or liver disease, it is recommended to start treatment with a lower total daily dose corresponding to no more than 2 coated tablets (50 mg).
In elderly patients who tolerate the initial dose well, the dose may subsequently be increased to that recommended for the general population (75 mg).
In cases of acute pain when faster relief is required, it is recommended to take the medicine on an empty stomach (at least 30 minutes before a meal), which will result in faster absorption of the medicine (see section 2 "Taking this medicine with food and drink").
Use in children and adolescents
This medicine must not be used in children and adolescents under 18 years of age.
Taking more than the recommended dose of Dexak
If an overdose is suspected, inform a doctor or pharmacist or go to the nearest hospital emergency department. Remember to bring the medicine packaging or patient information leaflet with you.
Missing a dose of Dexak
Do not take a double dose to make up for a missed dose. The next dose should be taken according to the prescribed dosing schedule (see section 3 "How to use Dexak").
If there are any further doubts regarding the use of this medicine, consult a doctor or pharmacist.

4. Possible adverse reactions

Like all medicines, this medicine can cause adverse reactions, although not everyone will experience them.
The possible adverse reactions listed below are categorized according to the likelihood of their occurrence.

Common adverse reactions (may affect up to 1 in 10 people):
Nausea and/or vomiting, abdominal pain, mainly in the upper abdomen, diarrhoea, indigestion (dyspepsia).

Uncommon adverse reactions (may affect up to 1 in 100 people):
Vertigo (of labyrinthine origin), drowsiness, sleep disturbances, nervousness, headache, palpitations, facial flushing, inflammation of the stomach lining (gastritis), constipation, dryness of the oral mucosa, bloating with gas release, rash, fatigue, pain, feeling of fever and chills, malaise.

Rare adverse reactions (may affect up to 1 in 1000 people):
Peptic ulcer disease, gastrointestinal bleeding or perforation (which may present as vomiting blood or black stools), fainting, hypertension, reduced respiratory rate, fluid retention in limbs and peripheral oedema (e.g. swollen ankles), throat swelling, loss of appetite (anorexia), abnormal sensation, itchy rash, acne, increased sweating, back pain, increased urination, menstrual disorders, prostate gland disorders, abnormal liver function tests (blood tests), liver cell damage (hepatitis), acute kidney failure.

Very rare adverse reactions (may affect up to 1 in 10,000 people):
Anaphylactic reactions (acute hypersensitivity reactions which may lead to anaphylactic shock), skin, lip, eye and genital ulceration (Stevens-Johnson syndrome and Lyell’s syndrome), facial swelling or swelling of lips and throat (angioedema), breathlessness caused by respiratory muscle spasm (bronchospasm), shortness of breath, rapid heartbeat, low blood pressure, pancreatitis, blurred vision, tinnitus, skin hypersensitivity reactions and photosensitivity, itching, kidney damage, reduced white blood cell count (neutropia), reduced platelet count (thrombocytopenia).

Patients should inform their doctor immediately if they experience any adverse reactions affecting the stomach or intestines at the beginning of treatment (e.g. stomach pain, heartburn or bleeding), especially if they have previously experienced similar adverse reactions due to long-term use of anti-inflammatory drugs, particularly in elderly patients.

If a skin rash, any mucosal lesions (e.g. inside the mouth), or any allergic symptoms occur, treatment with this medicine should be stopped immediately.

During administration of non-steroidal anti-inflammatory drugs, fluid retention and oedema (particularly in ankles and legs), increased blood pressure and heart failure may occur.

Use of medicines such as this one may be associated with a small increased risk of heart attack ("myocardial infarction") or cerebrovascular events (stroke).

In patients with systemic lupus erythematosus or mixed connective tissue disease (immunological disorders affecting connective tissue), administration of anti-inflammatory drugs may rarely cause fever, headache and neck stiffness.

The most commonly observed adverse reactions involved gastrointestinal disturbances. Particularly in elderly patients, gastric or duodenal ulcer disease, perforation or bleeding may occur, sometimes with fatal outcome.

After administration of the drug, the following have been reported: nausea, vomiting, diarrhoea, bloating, constipation, indigestion, lower abdominal pain, tarry stools, vomiting blood, ulcerative inflammation of the oral mucosa, exacerbation of colitis and Crohn’s disease. Gastritis has been observed less frequently.

As with other NSAIDs, haematological reactions may occur (purpura, aplastic and haemolytic anaemia, rarely agranulocytosis and bone marrow hypoplasia).

Reporting of adverse reactions
If any adverse reactions occur, including any not listed in this leaflet, patients should inform their doctor or pharmacist. Adverse reactions can be reported directly to the Department of Monitoring of Adverse Drug Reactions at the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, Tel.: +48 22 49 21 301, Fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl.

Reporting adverse reactions helps to provide more information on the safety of the medicine.

5. How to store Dexak

Keep this medicine out of sight and reach of children.
Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the stated month.
There are no special requirements regarding storage temperature. Store in the original packaging to protect from light.
Store at a temperature below 30°C. Store in the original packaging to protect from light.
Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Contents of the pack and other information

What the medicine Dexak contains

• The active substance is dexketoprofen (in the form of dexketoprofen trometamol). Each coated tablet contains 25 mg of dexketoprofen.
• Other components are:
  Tablet core: maize starch, microcrystalline cellulose, sodium carboxymethyl starch, glycerol distearate.
  Coating: dry film coating (composed of hypromellose, titanium dioxide, polyethylene glycol 6000), propylene glycol.

What Dexak looks like and contents of the pack
Dexak tablets are white, round, film-coated tablets with a score line.
Dexak is available in packs containing 10, 20 or 30 film-coated tablets.
For more detailed information, please contact the marketing authorisation holder or the parallel importer.

Marketing Authorisation Holder in Greece, the country of export:
Menarini International Operations Luxembourg S.A.
1, Avenue de la Gare
L-1611 Luxembourg
Luxembourg

Manufacturer:
Laboratorios Menarini, S.A.
Alfonso XII, 587
08918 Badalona (Barcelona)
Spain

A. Menarini Manufacturing Logistics and Services Srl
C/Campo di Pile S/N
Loc. Campo Di Pile (L’Aquila)
Italy

Parallel Importer:
InPharm Sp. z o.o.
ul. Strumykowa 28/11
03-138 Warsaw
Poland

Repackaged in:
InPharm Sp. z o.o. Services sp. k.
ul. Chełmżyńska 249
04-458 Warsaw
Poland

Marketing Authorisation Number in Greece, the country of export: 6337/25.2.1998
Parallel Import Authorisation Number: 233/25

This medicine is authorised for sale in the European Economic Area countries and in the United Kingdom (Northern Ireland) under the following trade names:
Spain (RMS), Austria, Belgium, Finland, France, Italy, Luxembourg, Portugal: Ketesse
Cyprus, Greece: Nosatel
Czech Republic: Dexoket
Germany: Sympal
Estonia, Latvia, Lithuania: Dolmen
Hungary: Ketodex
Ireland, Malta, United Kingdom (Northern Ireland): Keral
Netherlands: Stadium
Poland: Dexak
Slovakia: Dexadol
Slovenia: Menadex