Lafactin: detailed information

Package leaflet: Information for the user

Lafactin, 37.5 mg, prolonged-release capsules, hard
Lafactin, 75 mg, prolonged-release capsules, hard
Lafactin, 150 mg, prolonged-release capsules, hard
Venlafaxine
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 further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you personally. Do not share it with others. It may harm them, even if their symptoms are the same as yours.
If you experience any side effects, including any not listed in this leaflet, tell your doctor or pharmacist. See section 4.

Leaflet contents

What Lafactin is and what it is used for
What you need to know before taking Lafactin
How to take Lafactin
Possible side effects
How to store Lafactin
Contents of the pack and other information

1. What Lafactin is and what it is used for

Lafactin contains the active substance venlafaxine. Lafactin is an antidepressant medicine that
belongs to a group of medicines called serotonin and noradrenaline reuptake inhibitors (SNRIs).
Medicines in this group are used to treat depression and other conditions such as anxiety disorders.
It is believed that people with depression and/or anxiety have lower levels of serotonin and
noradrenaline in the brain. The exact mechanism of action of antidepressants is not fully understood,
but they may help by increasing the levels of serotonin and noradrenaline in the brain.
Lafactin is used to treat depression in adults. It is also indicated for the treatment of the following
anxiety disorders in adults: generalized anxiety disorder, social phobia (fear or avoidance of social
situations), and panic disorder (panic attacks). For the patient to feel better, it is important that
treatment of depression and social phobia is properly managed. If left untreated, the patient's
condition may not improve, may worsen, and may become more difficult to treat.

2. Important information before taking Lafactin

When not to take Lafactin:

If the patient is allergic to venlafaxine or any of the other ingredients of this medicine (listed in section 6).
If the patient is currently taking or has taken within the last 14 days any medicine from the group of irreversible monoamine oxidase inhibitors (MAOIs) used to treat depression or Parkinson's disease. Taking irreversible MAOIs together with other medicines, including Lafactin, may cause severe or even life-threatening adverse reactions. Also, before starting any medicine from the MAOI group, the patient should wait at least 7 days after stopping treatment with
Lafactin (see also section "Serotonin syndrome" and "Lafactin with other medicines").
Warnings and precautions
Before starting treatment with Lafactin, discuss this with your doctor or pharmacist.
If the patient is taking other medicines that, when taken together with Lafactin, may increase the risk of serotonin syndrome (see section "Lafactin with other medicines").
If the patient suffers from eye disorders, such as certain types of glaucoma (increased pressure in the eyeball).
If the patient has previously had high blood pressure.
If the patient has previously had heart diseases.
If the patient has previously had heart rhythm disorders.
If the patient has previously had seizures (epilepsy).
If the patient has previously had low sodium levels in the blood (hyponatraemia).
If the patient has a tendency to bruise easily or to bleeding (bleeding disorders in the past), or if the patient is pregnant (see "Pregnancy, breastfeeding and fertility"), or if taking medicines that may increase the risk of bleeding, e.g. warfarin (used to prevent blood clotting).
If the patient or any family member has previously experienced mania or bipolar disorder (feelings of excessive excitement or euphoria).
If the patient has previously exhibited aggressive behaviour.

Lafactin may cause feelings of restlessness or inability to sit still or remain
still during the first few weeks of treatment. If such symptoms occur, the
treating doctor should be informed.
Do not consume alcohol during treatment with Lafactin, as this may cause extreme
fatigue and loss of consciousness. Concurrent use with alcohol and (or) certain medicines
may worsen symptoms of depression and other medical conditions, such as
anxiety disorders.
Suicidal thoughts and worsening of depression or anxiety disorders
Patients with depression and (or) anxiety disorders may sometimes have
thoughts about self-harm or suicide. These thoughts or behaviours may worsen at the
beginning of treatment with antidepressants, as these medicines usually start to work after
about 2 weeks, sometimes later. Such thoughts may also occur when the dose is reduced or treatment with Lafactin is stopped.
The occurrence of suicidal thoughts, thoughts of self-harm or suicide is
more likely if:

the patient has previously had suicidal thoughts or a desire to self-harm;
the patient is a young adult; clinical data indicate an increased risk of suicidal behaviour in adults under 25 years of age with psychiatric disorders who were treated with antidepressant medicines.

If the patient experiences suicidal thoughts or thoughts of self-harm, they should immediately
contact their doctor or go to hospital.
It may be helpful to inform relatives or friends about the depression or anxiety
disorders and ask them to read the leaflet. The patient may ask for help from
relatives or friends and ask them to inform the patient if they notice that depression or anxiety has worsened or if there are disturbing changes in behaviour.
Dry mouth
Dry mouth is reported by 10% of patients treated with venlafaxine. This may increase the risk of
dental caries. Therefore, particular attention should be paid to oral hygiene.
Diabetes
Venlafaxine may cause changes in blood glucose levels. Therefore, adjustment of the doses of antidiabetic medicines may be necessary.
Sexual disorders
Medicines such as Lafactin (so-called SSRIs/SNRIs) may cause symptoms of sexual disorders (see
section 4). In some cases, these symptoms persist despite discontinuation of treatment.
Children and adolescents
Lafactin should not be used in children and adolescents under 18 years of age. It should also be emphasized that patients under 18 years of age who take medicines from this group are at increased risk of adverse reactions, such as suicide attempts, suicidal thoughts, and hostility (particularly aggression, defiant behaviour and manifestations of anger). Nevertheless, a doctor may prescribe Lafactin to patients under 18 years of age if they consider it beneficial for them.
If a doctor has prescribed Lafactin to a patient under 18 years of age,
in case of any doubts, the patient should consult the doctor again to discuss this.
The doctor should be informed if any of the above symptoms occur or worsen in patients
under 18 years of age taking Lafactin. The long-term safety regarding the impact on growth, maturation, and cognitive and behavioural development in this age group has not yet been established.
Lafactin with other medicines
Tell your doctor or pharmacist about all medicines currently taken or recently taken, as well as about medicines the patient plans to take.
The treating doctor decides whether Lafactin can be used together with other medicines.
Do not start or stop taking other medicines, including over-the-counter medicines, natural or herbal medicines, without first consulting your doctor or pharmacist.

Monoamine oxidase inhibitors used in the treatment of depression or Parkinson's disease must not be taken with Lafactin. Inform your doctor if you have taken these medicines within the last 14 days (MAOIs; see section "Important information before taking the medicine Lafactin").
Serotonin syndrome: During treatment with venlafaxine, a potentially life-threatening condition or reactions similar to neuroleptic malignant syndrome (see section "Possible side effects") may occur, especially when used concomitantly with medicines such as:
triptans (substances used for migraine headaches)
medicines used to treat depression, e.g. selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants or medicines containing lithium
medicines containing amphetamines (used to treat attention deficit hyperactivity disorder (ADHD), narcolepsy and obesity)
medicines containing linezolid, an antibiotic used to treat infections
medicines containing a reversible MAOI, moclobemide (a substance used to treat depression)
medicines containing sibutramine (a substance used for weight loss)
medicines containing tramadol, fentanyl, tapentadol, pethidine or pentazocine (substances used to treat severe pain)
medicines containing dextromethorphan (used to treat cough)
medicines containing methadone (used to treat opioid addiction or severe pain)
medicines containing methylene blue (used to treat high levels of methemoglobin in the blood)
medicines containing St. John's wort (Hypericum perforatum, natural or herbal medicines used to treat mild depression)
medicines containing tryptophan (used for sleep problems and depression)
antipsychotic medicines (used to treat diseases with symptoms such as hearing, seeing and feeling things that do not exist, delusions, unnatural suspiciousness, unclear thinking, withdrawal into oneself)
medicines containing buprenorphine. These medicines may interact with Lafactin and may cause symptoms such as involuntary, rhythmic muscle contractions, including muscles controlling eye movements, agitation, hallucinations, coma, excessive sweating, tremor, increased reflexes, increased muscle tension, body temperature above 38°C. If such symptoms occur, contact your doctor.

Subjective and objective symptoms of serotonin syndrome may include a combination
of the following symptoms: psychomotor agitation, hallucinations, loss of coordination,
increased heart rate, elevated body temperature, rapid changes in blood pressure, hyperreflexia,
diarrhoea, coma, nausea, vomiting.
The most severe form of serotonin syndrome may resemble neuroleptic malignant syndrome. Its subjective and objective symptoms include: fever, increased heart rate, sweating, muscle rigidity, disorientation, increased muscle enzyme activity (detected in blood tests).
If serotonin syndrome is suspected, inform your doctor immediately or go to the nearest hospital emergency department.
If the patient is taking medicines that may affect heart rhythm, inform the doctor.
Examples of such medicines:

Antiarrhythmic medicines, such as: quinidine, amiodarone, sotalol or dofetilide (used to treat heart rhythm disorders).
Antipsychotic medicines, such as thioridazine (see above - "Serotonin syndrome").
Antibiotics, such as: erythromycin or moxifloxacin (used to treat bacterial infections).
Antihistamine medicines (used to treat allergies).

The following medicines may also interact with Lafactin and therefore should be used with caution. It is particularly important to inform the doctor if the patient is taking medicines containing:

ketoconazole (an antifungal medicine)
haloperidol or risperidone (medicines used to treat psychiatric disorders)
metoprolol (a beta-blocker used to treat high blood pressure and heart diseases).

Lafactin with food, drink and alcohol
Lafactin should be taken with food (see section 3 "How to take Lafactin").
Do not consume alcohol during treatment with Lafactin. Concurrent use with alcohol may
cause extreme fatigue and loss of consciousness and may worsen symptoms of
depression and other medical conditions, such as anxiety disorders.
Pregnancy and breastfeeding
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or is planning to have a
child, she should consult her doctor or pharmacist before using this medicine. Lafactin
should only be used after discussing with the doctor the potential benefits and risks for
the unborn child.
Ensure that the midwife and (or) doctor know that the patient is taking Lafactin.
Medicines similar to it (from the group of serotonin reuptake inhibitors - SSRIs) used by
pregnant women may increase the risk of a serious condition in the child called persistent pulmonary hypertension of the newborn (PPHN), causing rapid breathing and skin cyanosis
in the child. These symptoms usually occur within the first day of the child's life. If this happens, contact the midwife and (or) doctor immediately.
If the patient takes this medicine during pregnancy, in addition to breathing difficulties in the newborn, another symptom may occur, such as difficulty feeding. If the patient is concerned about such symptoms in the newborn, contact the doctor and (or) midwife,
who will be able to provide appropriate advice.
If Lafactin is taken towards the end of pregnancy, there may be an increased risk of
severe vaginal bleeding shortly after delivery, especially if bleeding disorders occurred in the past. Your doctor or midwife should know that you are taking Lafactin so they can provide advice.
Venlafaxine passes into breast milk. There is a risk of affecting the child.
Therefore, this issue should be discussed with the doctor, and the doctor will decide whether to stop
breastfeeding or discontinue treatment with Lafactin.
Driving and operating machinery
Do not drive or operate machinery until the effect of the medicine on the patient's body is known.
Lafactin capsules contain sucrose
If the patient has been informed by a doctor that they have an intolerance to certain sugars, consult the doctor before taking this medicine.
Lafactin contains sodium
This medicine contains less than 1 mmol of sodium (23 mg) per dose unit, which means it is essentially "sodium-free".
3. How to take Lafactin
This medicine should always be taken according to the doctor's instructions. If in doubt, consult the
doctor or pharmacist.
The usual recommended starting dose for the treatment of depression, generalised anxiety disorders and social phobia is 75 mg per day. This dose may be gradually increased by the doctor, if necessary, up to a maximum dose of 375 mg per day in the case of depression.
For panic disorder, treatment should start with a lower dose (37.5 mg) and then gradually increased. The maximum dose for the treatment of generalised anxiety disorders, social phobia and panic disorder is 225 mg per day.
Lafactin should be taken daily at approximately the same time, regardless of whether the medicine
is taken in the morning or evening. The capsules should be swallowed whole with liquid. Do not split, crush, chew or dissolve them.
Lafactin should be taken with food.
Inform the doctor about any liver or kidney problems, as dose adjustment may be necessary.
Do not stop treatment with Lafactin without consulting the doctor (see section "Stopping
treatment with Lafactin").
Taking more than the recommended dose of Lafactin
If more than the recommended dose of Lafactin has been taken, contact the
doctor or pharmacist immediately.
Overdose may be life-threatening, especially when taken with alcohol and (or) certain medicines
(see section "Lafactin with other medicines").
Symptoms of possible overdose may include increased heart rate, disturbances of consciousness (from drowsiness to coma), visual disturbances, seizures or vomiting.
Missing a dose of Lafactin
If a dose is missed, take it as soon as possible. However, if it is almost time for the next dose, skip the missed dose and take only one dose at the usual time. Do not take a double dose to make up for a missed dose. Do not take more than the daily dose of Lafactin prescribed by the doctor in one day.
Stopping treatment with Lafactin
Do not stop treatment or reduce the dose of the medicine without consulting the doctor, even if well-being improves. If the doctor decides that Lafactin can be discontinued, they will inform the patient how to gradually reduce the dose before completely stopping treatment. Patients discontinuing Lafactin, especially those who stop treatment suddenly or reduce the dose too quickly, may experience adverse reactions such as suicidal thoughts, aggression, feelings of fatigue, dizziness, feeling of emptiness in the head, headache, insomnia, nightmares, dry mouth, loss of appetite, nausea, diarrhoea, nervousness, agitation, disorientation, ringing in the ears, tingling or numbness, or rarely, a sensation of electric shock, weakness, sweating, seizures or flu-like symptoms, vision problems and increased blood pressure (which may cause headaches, dizziness, ringing in the ears, sweating, etc.).
The doctor will advise on how to gradually discontinue Lafactin. This may take several weeks or months. For some patients, gradual discontinuation may be necessary over several months or longer. If any of the listed symptoms or other symptoms occur that are bothersome to the patient, consult the doctor.
If there are any further doubts regarding the use of this medicine, consult the doctor or pharmacist.

4. Possible adverse reactions

Like all medicines, this medicine can cause adverse reactions, although not everyone will experience them.
If any of the following adverse reactions occur, discontinue the medicine
Lafactin and contact your doctor immediately or go to the nearest hospital
Emergency Department:
Not very common (may occur in fewer than 1 in 100 people)

Swelling of the face, lips, tongue, throat, hands or feet, and (or) raised, itchy rash (urticaria), difficulty swallowing or breathing.

Rare (may occur in fewer than 1 in 1,000 people)

Chest tightness, wheezing, difficulty swallowing or breathing.
Severe skin rash, itching, urticaria (red or pale raised areas, often accompanied by itching).
Symptoms of serotonin syndrome may include: restlessness, hallucinations, loss of coordination, rapid heartbeat, elevated body temperature, rapid changes in blood pressure, hyperreflexia, diarrhea, drowsiness, nausea, vomiting.
The most severe form of serotonin syndrome may resemble neuroleptic malignant syndrome. Symptoms of neuroleptic malignant syndrome may include fever, rapid heartbeat, sweating, muscle rigidity, confusion, increased muscle enzyme activity (detected in blood tests).
Signs of infection such as high fever, chills, trembling, headache, sweating, flu-like symptoms. This may result from a blood disorder leading to increased risk of infection.
Severe rash, which may lead to formation of large blisters and peeling of the skin.
Muscle pain of unknown origin, tenderness or weakness. These may be symptoms of rhabdomyolysis (breakdown of skeletal muscle).

Frequency unknown (cannot be estimated from available data)

Signs and symptoms of a condition called "exercise-induced cardiomyopathy," which may include chest pain, shortness of breath, dizziness, fainting, irregular heartbeat.

If any of the following adverse reactions occur, contact your doctor (the frequency of these adverse reactions is listed below under
"Other adverse reactions"):

Cough, wheezing and shortness of breath, possibly accompanied by high fever.
Black (tarry) stools or blood in the stool.
Itching, yellowing of the skin or whites of the eyes, or dark urine, which may be signs of liver inflammation.
Heart problems such as rapid or irregular heartbeat, elevated blood pressure.
Vision disturbances such as blurred vision, dilated pupils.
Nervous system disorders such as dizziness, tingling sensations, movement coordination problems (muscle spasms or stiffness), seizures or convulsions.
Psychiatric disorders such as excessive restlessness and feelings of unnatural excitement.
Withdrawal symptoms (see sections "How to take Lafactin" and "Stopping Lafactin"). Prolonged bleeding time following injury; wounds may bleed slightly longer than usual.

While taking the medicine, patients may notice small white granules or beads in the stool.
Inside Lafactin capsules are granules (small white beads) that contain the
active substance, venlafaxine. These granules are released from the capsule into the gastrointestinal tract,
travel through its entire length, and slowly release venlafaxine. The granule matrix does not dissolve
and is excreted in the stool. Therefore, if granules are seen in the stool, there is no cause for concern—
the venlafaxine dose has been absorbed.
Other adverse reactions
Very common (may occur in more than 1 in 10 people)

Dizziness, headache, drowsiness
Insomnia
Nausea, dry mouth, constipation
Sweating (including night sweats).

Common (may occur in fewer than 1 in 10 people)

Decreased appetite
Confusion, feeling detached or separated from oneself, lack of orgasm, reduced sexual desire, agitation, nervousness, unusual dreams
Tremor, feeling of restlessness or inability to sit or stand still, tingling, taste disturbances; increased muscle tension
Vision disturbances, including blurred vision, dilated pupils, inability of the eye to accommodate (automatic focusing adjustment from distant to near objects)
Ringing in the ears (tinnitus)
Rapid heartbeat, palpitations
Increased blood pressure, sudden flushing
Shortness of breath, yawning
Vomiting, diarrhea
Mild rash, itching
Increased frequency of urination, urinary retention, difficulty urinating
Irregular menstruation, e.g. heavy bleeding or more frequent irregular bleeding, ejaculation/orgasm disorders (men), erectile dysfunction (impotence)
Weakness (asthenia), fatigue, chills
Weight gain, weight loss
Increased blood cholesterol levels.

Not very common (may occur in fewer than 1 in 100 people)

Excessive arousal, racing thoughts and reduced need for sleep (mania)
Hallucinations, feeling detached or separated from reality, orgasm disorders, apathy, feeling of excessive arousal, teeth grinding
Fainting, uncontrolled muscle movements, coordination and balance disturbances
Dizziness (especially upon standing too quickly), decreased blood pressure
Vomiting blood, black tarry stools (faeces) or blood in the stool, which may indicate internal bleeding
Light sensitivity, bruising, excessive hair loss
Urinary incontinence
Muscle stiffness, spasms and uncontrolled muscle movements
Slight changes in liver enzyme activity in blood.

Rare (may occur in fewer than 1 in 1,000 people)

Seizures
Cough, wheezing and shortness of breath, possibly accompanied by high fever
Confusion and disorientation, often with accompanying hallucinations (delirium)
Excessive fluid retention in the body
Decreased sodium concentration in blood
Severe eye pain and worsening or blurred vision
Irregular, rapid or irregular heartbeat, which may lead to fainting
Severe abdominal or back pain (which may indicate serious intestinal, liver or pancreatic problems), itching, yellowing of the skin or whites of the eyes, dark urine or flu-like symptoms, which are signs of liver inflammation.

Very rare (may occur in fewer than 1 in 10,000 people)
Prolonged bleeding, which may indicate reduced platelet count, meaning increased risk of bruising or bleeding
Unusual milk production in women
Unexpected bleeding, e.g. bleeding gums, blood in urine or vomit, appearance of unexpected bruises or broken blood vessels (broken veins).
Frequency unknown (cannot be estimated from available data)

Suicidal thoughts and behaviours: during treatment with venlafaxine or shortly after treatment discontinuation, cases of suicidal thoughts and behaviours have been reported (see section 2 "Important information before taking Lafactin")
Aggressive behaviour
Dizziness
Heavy vaginal bleeding soon after childbirth (postpartum haemorrhage); for more information, see section 2: "Pregnancy, breastfeeding and fertility".

Lafactin may sometimes cause adverse reactions that the patient may not be aware of,
such as increased blood pressure or abnormal heart function; slight changes
in liver enzyme activity, blood sodium or cholesterol levels.
In even rarer cases, Lafactin may impair platelet function, increasing the
risk of bruising or bleeding. Therefore, your doctor may recommend periodic blood tests,
especially during long-term treatment with Lafactin.
Reporting adverse reactions
If any adverse symptoms occur, including any adverse reactions
not listed in this leaflet, inform your doctor or pharmacist. Adverse reactions
can be reported directly to the Department of Monitoring 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
Adverse reactions can also be reported to the marketing authorization holder.
Reporting adverse reactions helps provide more information on the safety of this medicine.

5. How to store Lafactin
Keep the medicine out of sight and reach of children.
Do not use this medicine after the expiry date stated on the label, carton and bottle after EXP. The expiry date refers to the last day of the stated month.
No special storage conditions are required.
Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer in use. These measures will help protect the environment.

6. Package contents and other information

What Lafactin contains

The active substance is venlafaxine. Each prolonged-release capsule contains 37.5 mg of venlafaxine (as venlafaxine hydrochloride). Each prolonged-release capsule contains 75 mg of venlafaxine (as venlafaxine hydrochloride).

Each prolonged-release capsule contains 150 mg of venlafaxine (as venlafaxine
hydrochloride).

Other ingredients are: Sucrose pellets, hypromellose, talc, and ethylcellulose.
Capsule cap composition: Gelatin, iron oxide red (E 172) (only for 75 mg and 150 mg), iron oxide black (E 172) (only for 37.5 mg), titanium dioxide (E 171), sodium lauryl sulfate.
Capsule body composition: Gelatin, iron oxide red (E 172), titanium dioxide (E 171), sodium lauryl sulfate.
Printing ink composition: Shellac, iron oxide black (E172).

What Lafactin looks like and contents of the pack
Prolonged-release, hard capsules
Lafactin 37.5 mg prolonged-release capsules, hard
White to almost white, spherical to oval pellets contained in hard gelatin capsules, size “3”, with an opaque grey cap and an opaque peach-colored body, printed with “E” on the cap and “73” on the body in black edible ink.
Lafactin 75 mg prolonged-release capsules, hard
White to almost white, spherical to oval pellets contained in hard gelatin capsules, size “1”, with an opaque peach-colored cap and an opaque peach-colored body, printed with “E” on the cap and “74” on the body in black edible ink.
Lafactin 150 mg prolonged-release capsules, hard
White to almost white, spherical to oval pellets contained in hard gelatin capsules, size “0”, with an opaque dark orange cap and an opaque dark orange body, printed with “E” on the cap and “89” on the body in black edible ink.
Lafactin is available in the following pack sizes:
PVC/PE/PVDC/Aluminium blister packs:
Lafactin 37.5 mg/75 mg/150 mg: 7, 10, 14, 20, 28, 30, 50, 56, 60, 90, 98 and 100 capsules.
HDPE bottle with polypropylene screw cap:
Lafactin 37.5 mg/75 mg/150 mg: 30, 100 and 500 capsules.
Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
Aurovitas Pharma Polska Sp. z o.o.
ul. Sokratesa 13D lokal 27
01-909 Warszawa
Manufacturer/Importer
APL Swift Services (Malta) Limited
HF26, Hal Far Industrial Estate, Hal Far
Birzebbugia, BBG 3000
Malta
ARROW Génériques
26 avenue Tony Garnier
69007 Lyon
France

This medicinal product is authorised in the European Economic Area countries under the following names:
France VENLAFAXINE ARROW GÉNÉRIQUES LP 37.5 mg/ 75 mg/150 mg
gélule à libération prolongée
Germany Venlafaxin Aurobindo 37.5 mg/ 75 mg/150 mg Hartkapseln, retardiert
Ireland Vedixal XL75 mg/150 mg prolonged-release capsules, hard
Italy Venlafaxina Aurobindo
Malta Venlafaxine Aurobindo 37.5 mg/75 mg/150 mg prolonged-release capsules, hard
Netherlands Venlafaxine Aurobindo 37.5 mg/ 75 mg/150 mg, capsules met verlengde afgifte, hard
Poland Lafactin