Escitalopram actavis

Package leaflet: Information for the patient

Warning! Keep this leaflet. The information on the immediate packaging is in a foreign language.
Escitalopram Actavis
20 mg, film-coated tablets
Escitalopramum
Please read this leaflet carefully before using this medicine, as it contains
important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any further questions, please ask your doctor or pharmacist.
• This medicine has been prescribed for a specific individual. Do not pass it on to others. It may harm someone else, even if their symptoms are the same.
• If you experience any adverse reactions, including any not listed in this leaflet, inform your doctor or pharmacist. See section 4.

Contents of the leaflet

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

1. What Escitalopram Actavis is and what it is used for

Escitalopram Actavis contains the active substance escitalopram. Escitalopram Actavis belongs
to a group of antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs).
Escitalopram Actavis is used to treat depression (major depressive episodes) and anxiety disorders
(such as panic disorder with or without agoraphobia, social phobia, generalized anxiety disorder,
and obsessive-compulsive disorder).
It may take several weeks of treatment before improvement begins. You should continue taking
Escitalopram Actavis even if it takes some time before your condition improves.
If no improvement occurs or if you feel worse, consult your doctor.

2. Important information before using Escitalopram Actavis

When not to use Escitalopram Actavis

• if the patient is allergic to escitalopram or any of the other ingredients of this medicine (listed in section 6);
• if the patient is currently taking medicines belonging to a group called MAO inhibitors, containing selegiline (used in the treatment of Parkinson's disease), moklobemide (used in the treatment of depression), or linezolid (an antibiotic);
• if the patient was born with an abnormal heart rhythm or has experienced episodes of irregular heart rhythm (visible on ECG; a test used to check how the heart works);
• if the patient is taking medicines used for heart rhythm disorders or medicines that may affect heart rhythm (see section 2 "Escitalopram Actavis with other medicines").

Warnings and precautions
Before starting treatment with Escitalopram Actavis, consult your doctor or
pharmacist.
Inform your doctor if the patient has any other disorders or diseases, as the doctor
should take such information into account. In particular, inform the doctor:

• if the patient has epilepsy. Treatment with Escitalopram Actavis should be discontinued if seizures occur for the first time or increase in frequency (see also section 4 "Possible side effects");
• if the patient has impaired liver or kidney function. Dose adjustment by the doctor may be required;
• if the patient has diabetes. Treatment with Escitalopram Actavis may interfere with blood glucose control. Adjustment of insulin and (or) oral glucose-lowering medicines may be required;
• if the patient has low sodium levels in the blood;
• if the patient has increased tendency to bleeding or bruising, or if the patient is pregnant (see "Pregnancy, breastfeeding and fertility");
• if the patient is undergoing electroconvulsive therapy;
• if the patient has ischemic heart disease;
• if the patient has heart disease or recently suffered a heart attack;
• if the patient has a slow resting heart rate and (or) knows they have salt deficiency due to prolonged, severe diarrhoea and vomiting or use of diuretics (water tablets);
• if the patient experiences rapid or irregular heartbeat, fainting, collapse, or dizziness upon standing, which may indicate abnormal heart function;
• if the patient has or has previously had eye problems, such as certain types of glaucoma (increased pressure inside the eyeball).

Note
In some patients with bipolar affective disorder, a manic phase may occur. It is characterized by unusual and rapidly changing ideas, unjustified feelings of happiness, and excessive physical activity. If these symptoms occur, consult a doctor.
During the first weeks of treatment, symptoms such as restlessness or difficulty sitting or standing still may also occur. If such symptoms appear, inform the doctor immediately.
Medicines such as Escitalopram Actavis (so-called SSRIs or SNRIs) may cause sexual dysfunction symptoms (see section 4). In some cases, these symptoms persisted after discontinuation of treatment.
Suicidal thoughts and worsening of depression or anxiety disorder
In cases of depression and (or) anxiety disorders, thoughts of self-harm or suicidal thoughts may sometimes occur. These symptoms or behaviors may worsen at the beginning of treatment with antidepressants, as these medicines usually take about 2 weeks, sometimes longer, to start working.
The likelihood of such thoughts occurring is higher if:

• the patient has previously experienced thoughts of suicide or self-harm,
• the patient is a young adult. Clinical trial data have shown an increased risk of suicidal behavior in adults under 25 years of age with psychiatric disorders treated with antidepressants. If thoughts of self-harm or suicidal thoughts occur, seek immediate medical attention or go to hospital.

It may be helpful to inform family members or friends about the depression or anxiety disorder and ask them to read this leaflet. The patient may ask them to inform them if they notice worsening depression or anxiety, or concerning changes in behavior.
Children and adolescents
Escitalopram Actavis must not be used in children and adolescents under 18 years of age.
It should also be emphasized that when taking medicines of this class, patients under 18 years of age are at increased risk of adverse reactions such as suicide attempts, suicidal thoughts, and hostility (particularly aggression, oppositional behaviors, and anger). Nevertheless, a doctor may prescribe Escitalopram Actavis to patients under 18 years of age if they determine it is in their best interest. If a patient under 18 years of age has been prescribed Escitalopram Actavis and you have any doubts, contact your doctor again. If any of the above-mentioned symptoms appear or worsen in a patient under 18 years of age taking Escitalopram Actavis, inform your doctor. Furthermore, the long-term impact of Escitalopram Actavis on growth, puberty, and cognitive development in this age group has not yet been established.

Escitalopram Actavis with other medicines
Inform your doctor or pharmacist about all medicines currently or recently taken, as well as any medicines the patient plans to take.
Inform the doctor if the patient is taking any of the following medicines:

• non-selective monoamine oxidase inhibitors (MAO inhibitors) containing active substances such as: phenelzine, iproniazid, isocarboxazid, nialamide, and tranylcypromine. If the patient has taken any of these medicines, they should wait 14 days before starting Escitalopram Actavis. After stopping Escitalopram Actavis, wait 7 days before taking any of these medicines;
• reversible, selective monoamine oxidase A (MAO-A) inhibitors containing moklobemide (a medicine used in the treatment of depression);
• irreversible monoamine oxidase B (MAO-B) inhibitors containing selegiline (used in the treatment of Parkinson's disease). These medicines increase the risk of adverse effects;
• the antibiotic linezolid;
• lithium (used in the treatment of bipolar affective disorder) and tryptophan;
• imipramine and desipramine (used in the treatment of depression);
• sumatriptan and similar medicines (used in the treatment of migraine) and tramadol and similar medicines (opioids, used for severe pain). These medicines may increase the risk of adverse effects;
• cimetidine, lansoprazole, omeprazole, and esomeprazole (used in the treatment of stomach ulcers), fluconazole (an antifungal medicine), fluvoxamine (an antidepressant), and ticlopidine (used to reduce the risk of stroke). These medicines may increase escitalopram blood levels;
• St John's wort (Hypericum perforatum) – an herbal remedy used for depression;
• acetylsalicylic acid and non-steroidal anti-inflammatory drugs (painkillers or blood-thinning medicines known as anticoagulants). These may increase the tendency to bleed;
• warfarin, dipyridamole, and phenprocouon (medicines used to thin the blood, known as anticoagulants). The doctor may order blood clotting time tests at the start and after stopping Escitalopram Actavis to determine whether the anticoagulant dose remains appropriate;
• mefloquine (used in the treatment of malaria), bupropion (used in the treatment of depression), and tramadol (used for severe pain) due to possible risk of lowering the seizure threshold;
• neuroleptics (medicines used in the treatment of schizophrenia, psychosis) and antidepressants (tricyclic antidepressants and SSRIs) due to possible risk of lowering the seizure threshold;
• flecainide, propafenone, and metoprolol (used in cardiovascular diseases), desipramine, clomipramine, and nortriptyline (antidepressants), and risperidone, thioridazine, and haloperidol (antipsychotics). Dose adjustment of Escitalopram Actavis may be required;
• medicines that lower potassium or magnesium levels in the blood, as they increase the risk of life-threatening heart rhythm disturbances.

DO NOT USE Escitalopram Actavis if the patient is taking medicines used for heart conditions or medicines that may affect heart rhythm, such as: antiarrhythmic class IA and III drugs, antipsychotics (e.g. phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, and certain antibacterial agents (e.g. sparfloxacin, moxifloxacin, intravenous erythromycin, pentamidine, antimalarials especially halofantrine), and certain antihistamines (astemizole, hydroxyzine, mizolastine). If the patient has any doubts about using the medicine, they should contact their doctor.
Escitalopram Actavis with food, drink, or alcohol
Escitalopram Actavis can be taken with or without food (see section 3 "How to use Escitalopram Actavis").
As with many medicines, it is not recommended to take Escitalopram Actavis together with alcohol, although interactions between Escitalopram Actavis and alcohol are not expected.
Pregnancy, breastfeeding and fertility
During pregnancy, breastfeeding, or if pregnancy is suspected or planned, the patient should consult a doctor or pharmacist before using this medicine.
The patient should not use Escitalopram Actavis during pregnancy or breastfeeding unless discussed with the doctor regarding risks and benefits of treatment.
If the patient takes Escitalopram Actavis during the last 3 months of pregnancy, they should be aware that the newborn may experience the following symptoms: breathing difficulties, bluish skin, seizures, temperature fluctuations, feeding difficulties, vomiting, low blood glucose, muscle stiffness or floppiness, increased reflexes, tremors, nervousness, irritability, lethargy, crying, drowsiness, and sleep difficulties. If any of these symptoms occur in the newborn, seek immediate medical attention.
Inform the doctor and (or) midwife about the use of Escitalopram Actavis. Taking medicines such as Escitalopram Actavis during pregnancy, especially during the last three months, may increase the risk of serious complications in the newborn called persistent pulmonary hypertension of the newborn (PPHN). This condition is characterized by rapid breathing and cyanosis and usually occurs within the first day after birth. If such symptoms occur in the newborn, contact the doctor and (or) midwife immediately.
Do not abruptly stop taking Escitalopram Actavis during pregnancy.
Taking Escitalopram Actavis towards the end of pregnancy may increase the risk of severe vaginal bleeding shortly after delivery, especially if the patient has a history of bleeding disorders. If the patient is taking Escitalopram Actavis, they should inform their doctor or midwife so appropriate advice can be provided.
Escitalopram is expected to pass into breast milk.
Animal studies have shown that citalopram, a medicine similar to escitalopram, affects sperm quality. This may theoretically affect fertility; however, no effect on fertility has been observed in humans to date.
Driving and operating machinery
The patient should not drive or operate machinery until they know how Escitalopram Actavis affects them.
Escitalopram Actavis contains sodium
This medicine contains less than 1 mmol (23 mg) of sodium per tablet, i.e. the medicine is considered "sodium-free".

3. How to use Escitalopram Actavis

This medicine should always be taken exactly as prescribed by your doctor. In case of doubt, consult your doctor or pharmacist.

Adult patients

Depression
The usual recommended dose of Escitalopram Actavis is 10 mg taken once daily as a single dose. The doctor may increase the dose up to a maximum of 20 mg per day.

Panic disorder
The initial dose of Escitalopram Actavis is 5 mg once daily during the first week of treatment. The dose is then increased to 10 mg per day. The doctor may further increase the dose, up to a maximum of 20 mg per day.

Social phobia
The usual recommended dose of Escitalopram Actavis is 10 mg taken once daily as a single dose. The dose may then be reduced by the doctor to 5 mg per day or increased up to a maximum of 20 mg per day, depending on the patient's response to the medicine.

Generalised anxiety disorder
The usual recommended dose of Escitalopram Actavis is 10 mg taken once daily as a single dose. The doctor may increase the dose up to a maximum of 20 mg per day.

Obsessive-compulsive disorder
The usual recommended dose of Escitalopram Actavis is 10 mg taken once daily as a single dose. The doctor may increase the dose up to a maximum of 20 mg per day.

Elderly patients (over 65 years of age)
The recommended starting dose of Escitalopram Actavis is 5 mg taken once daily as a single dose. The doctor may increase the dose to 10 mg per day.

Use in children and adolescents
Escitalopram Actavis should normally not be used in children and adolescents. For further information, please refer to section 2 “Important information before using Escitalopram Actavis”.

Impaired kidney function
Caution is advised in patients with severe impairment of kidney function. The medicine should be used according to the doctor's instructions.

Impaired liver function
Patients with impaired liver function should not exceed a dose of 10 mg per day. The medicine should be used according to the doctor's instructions.

Patients who are poor metabolisers via the CYP2C19 isoenzyme
Patients with this known genotype should not exceed a dose of 10 mg per day. The medicine should be used according to the doctor's instructions.

The coated tablets should be taken once daily, swallowed whole with sufficient liquid (preferably a glass of water). Escitalopram Actavis may be taken with or without food.

If necessary, the tablet may be divided into two halves by placing it on a flat surface with the score side facing upwards. The tablet can then be split in half by pressing down with the index fingers on each end, as shown in the illustration.

Duration of treatment
Improvement may only be felt after several weeks of treatment. Therefore, continue taking Escitalopram Actavis even if it takes some time before you feel better. Do not change the dose without first consulting your doctor.

Continue taking Escitalopram Actavis for as long as your doctor recommends. If treatment is stopped too early, symptoms may return. It is therefore recommended to continue treatment for at least 6 months after regaining good well-being.

Taking more Escitalopram Actavis than prescribed
If you have taken more Escitalopram Actavis than prescribed, contact your doctor immediately or go to the emergency department of your nearest hospital. Do this even if you do not feel unwell.

Symptoms of overdose may include dizziness, tremors, agitation, somnolence, nausea, vomiting, cardiac arrhythmias, low blood pressure, and disturbances in water and electrolyte balance. Take the medicine pack with you to the doctor's appointment or hospital visit.

If you miss a dose of Escitalopram Actavis
Do not take a double dose to make up for a missed dose. If you forget to take a dose and remember before going to bed, take the missed dose immediately and take the next dose the following day. If you remember about the missed dose during the night or the next day, skip the missed dose and take the next dose at the usual time.

Stopping Escitalopram Actavis
Do not stop taking Escitalopram Actavis unless your doctor tells you to. When stopping treatment, your doctor will usually recommend gradually reducing the dose of Escitalopram Actavis over a period of several weeks.

After stopping Escitalopram Actavis, especially if stopped abruptly, you may experience withdrawal symptoms. These symptoms are common after discontinuation of Escitalopram Actavis. The risk is greater if the medicine has been taken for a long time, at high doses, or if the dose was reduced too quickly. In most patients, symptoms are mild and resolve spontaneously within two weeks. However, in some patients, symptoms may be more severe or persist longer (more than 2–3 months). If severe withdrawal symptoms occur, contact your doctor. The doctor may recommend restarting the medicine and tapering it more slowly.

Withdrawal symptoms may include: dizziness (unsteady gait, balance disturbances), tingling sensations, burning sensations, and (less commonly) electric shock-like sensations, also in the head, sleep disturbances (intense dreams, nightmares, insomnia), feelings of anxiety, headache, nausea and/or vomiting, sweating (including night sweats), psychomotor agitation or restlessness, tremors, feelings of disorientation, emotional instability or irritability, diarrhoea, visual disturbances, palpitations (fluttering or pounding heart).

If you have any further questions about the use of this medicine, consult your doctor or pharmacist.

4. Possible adverse reactions

Like all medicines, this medicine can cause adverse reactions, although not everybody will experience them.
Adverse reactions usually resolve within a few weeks of treatment. It is important to remember that some
of these reactions may also be symptoms of the underlying illness and may improve as the patient's condition gets better.
If any of the following adverse reactions occur during treatment, you should
contact your doctor or go to hospital immediately:
Uncommon (may affect up to 1 in 100 people):

• unusual bleeding, including from the gastrointestinal tract.

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

• swelling of the skin, tongue, lips, larynx or face, urticaria (hives), or difficulty breathing or swallowing (severe allergic reaction)
• high fever, agitation, confusion (disorientation), tremors, and sudden muscle contractions, which may be symptoms of a rare condition called serotonin syndrome.

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

• difficulty passing urine
• seizures, see also section “Warnings and precautions”
• yellowing of the skin and whites of the eyes, which may indicate liver dysfunction/hepatitis
• rapid, irregular heartbeat, fainting, which may be symptoms of a life-threatening condition called Torsades de Pointes
• suicidal thoughts and behaviour, see also section “Warnings and precautions”
• sudden swelling of the skin or mucous membranes (angioedema)

In addition to the reactions listed above, the following adverse reactions have also been reported:
Very common (may affect more than 1 in 10 people):

• nausea
• headache

Common (may affect up to 1 in 10 people):

• nasal congestion or runny nose (sinusitis)
• decreased or increased appetite
• anxiety, psychomotor agitation, unusual dreams, difficulty sleeping, drowsiness, dizziness, yawning, tremors, skin tingling
• diarrhoea, constipation, vomiting, dry mouth
• excessive sweating
• muscle and joint pain
• sexual disorders (delayed ejaculation, erectile dysfunction, decreased libido, and possible difficulty achieving orgasm in women)
• feeling of fatigue, fever
• weight gain

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

• urticaria (hives), rash, itching
• teeth grinding, agitation, nervousness, panic attack, confusion (disorientation)
• sleep disturbances, taste disturbances, fainting (syncope)
• pupil dilation, visual disturbances, ringing in the ears (tinnitus)
• hair loss
• heavy menstrual bleeding
• irregular menstruation
• weight loss
• rapid heartbeat
• swelling of the upper or lower limbs
• nosebleeds

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

• aggression, depersonalization (feeling of loss of self-identity, feeling detached from oneself), hallucinations
• slow heartbeat

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

• decreased sodium concentration in blood (manifesting as nausea, malaise, muscle weakness or confusion)
• dizziness upon standing due to low blood pressure (orthostatic hypotension)
• abnormal liver function test results (increased liver enzyme activity in blood)
• movement disorders (involuntary muscle movements)
• painful penile erection (priapism)
• symptoms of unusual bleeding in the skin and mucous membranes (petechiae) and low platelet count (thrombocytopenia)
• increased secretion of antidiuretic hormone (ADH), causing water retention, blood dilution, and reduced sodium levels (syndrome of inappropriate ADH secretion)
• elevated levels of prolactin hormone in blood
• milk production in men and women who are not breastfeeding (galactorrhea)
• severe vaginal bleeding occurring shortly after childbirth (postpartum haemorrhage), see additional information in subsection “Pregnancy, breastfeeding and fertility” in section 2
• mania
• in patients taking medicines of this class, an increased risk of bone fractures has been observed, as well as changes in heart rhythm (known as “QT interval prolongation”, visible on ECG, a test assessing heart function)
• furthermore, adverse reactions known with drugs having a similar mechanism of action to escitalopram (the active substance in Escitalopram Actavis) include:
• psychomotor agitation (akathisia)
• loss of appetite

Reporting of adverse reactions
If any adverse symptoms occur, including any adverse reactions not listed
in this leaflet, you should inform your doctor or pharmacist. Adverse reactions can be reported
directly to the Department for Monitoring of Adverse Drug Reactions of 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 this medicine.

5. How to store the medicine Escitalopram Actavis

Keep the 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.
Do not store above 25°C.
Medicines must not be disposed of via the sewage system or in household waste. Ask your pharmacist how to dispose of medicines no longer required. Such measures will help protect the environment.

6. Contents of the pack and other information

What Escitalopram Actavis contains
The active substance is escitalopram. Each film-coated tablet contains 20 mg of escitalopram
(in the form of oxalate).
Other components of the medicine are:
Tablet core: microcrystalline cellulose, colloidal anhydrous silica, sodium croscarmellose,
talc, magnesium stearate;
Tablet coating: hypromellose 6 mPa·s, titanium dioxide (E 171), macrogol 6000.

What Escitalopram Actavis looks like and contents of the pack
Oval, biconvex, white film-coated tablets (8 mm x 11.7 mm) with a score line on one side,
bevelled edges and marked with "E" on the other side. The tablet can be divided into equal
doses.
Escitalopram Actavis is available in blister packs containing 28, 30, 56 or 60 film-coated tablets,
packaged in a cardboard box.
For more detailed information, please contact the marketing authorisation holder or the parallel importer.

Marketing Authorisation Holder in Lithuania, country of export:
Teva B.V.
Swensweg 5
2031 GA Haarlem
The Netherlands

Manufacturer:
Actavis Ltd
BLB 015-016
Bulebel Industrial Estate
Zejtun ZTN 3000
Malta
Balkanpharma-Dupnitsa AD
3 Samokovsko Shosse Str.
Dupnitza 2600
Bulgaria
TjoaPack Netherlands B.V.
Nieuwe Donk 9
4879 AC Etten-Leur
The Netherlands

Parallel Importer:
Medezin Sp. z o.o.
ul. Zbąszyńska 3
91-342 Łódź
Poland

Repackaged by:
Medezin Sp. z o.o.
ul. Zbąszyńska 3
91-342 Łódź
Poland

Marketing Authorisation Numbers in Lithuania, country of export:
LT/1/09/1815/038
LT/1/09/1815/036
LT/1/09/1815/037
LT/1/09/1815/039
LT/1/09/1815/040
LT/1/09/1815/041
LT/1/09/1815/042
LT/1/09/1815/043
LT/1/09/1815/044
LT/1/09/1815/045

Parallel Import Authorisation Number: 355/25