Milurit

Package leaflet: Information for the user

Warning! Keep this leaflet. The information on the immediate packaging is in a foreign language.
Milurit, 200 mg, tablets
Allopurinolum
Please read the entire leaflet carefully before taking this medicine, as it contains
important information for the patient.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, please consult your doctor or pharmacist.
• This medicine has been prescribed for a specific individual. Do not share it with others. This medicine may harm other people, even if their symptoms are identical.
• If the patient experiences any adverse reactions, including any adverse reactions not listed in this leaflet, inform a doctor, pharmacist, or nurse. See section 4.

Contents of the leaflet

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

1. What Milurit is and what it is used for

The active substance in Milurit is allopurinol. Allopurinol belongs to a group of medicines known as
enzyme inhibitors. These substances are effective in controlling the rate of certain processes
occurring in the body.
Milurit is used long-term to prevent gout and may also be used in other conditions associated with excess uric acid in the body, such as kidney stones and other kidney diseases, as well as in patients receiving treatment for cancer or who have disorders in the function of certain enzymes.

2. Important information before using Milurit

When not to use Milurit

• If the patient is allergic to allopurinol or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions
Before starting treatment with Milurit, discuss this with your doctor.
Special caution and close medical monitoring may be necessary:

• If the patient belongs to the Han Chinese ethnic group or is of Thai or Korean descent.
• If the patient has liver or kidney disease. The doctor may recommend a lower dose or less frequent administration than daily. Closer monitoring will also be required.
• If the patient has heart disease or high blood pressure and is taking diuretics and/or blood pressure-lowering medicines called ACE inhibitors.
• If there is an acute attack of gout.
• If the patient or a close relative has haemochromatosis (a rare condition characterized by abnormally increased iron absorption from the gastrointestinal tract, leading to excessive iron storage, particularly in the liver).
• If the patient has thyroid disease.
• If the patient is being treated with azathioprine (an immunosuppressive medicine used to suppress the immune response) or mercaptopurine (a medicine used in leukaemias).

If in doubt whether any of the above situations apply, consult your doctor or pharmacist.
Severe skin rashes (hypersensitivity syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis) have been reported during treatment with allopurinol.
Skin rashes often involve ulceration of the mouth, throat, nose, genital organs, and conjunctivae (redness and swelling of the eyes).
These potentially life-threatening severe skin reactions are often preceded by influenza-like symptoms such as fever, headache, and body aches.
The rash may progress to widespread blistering and skin peeling.
These serious skin reactions may occur more frequently in patients of Chinese, Thai, or Korean descent.
Chronic kidney disease may further increase the risk in these patients.
If a skin rash or skin symptoms occur, stop taking Milurit immediately,
seek urgent medical advice, and inform the doctor that you are taking this medicine. If severe skin reactions such as hypersensitivity syndrome, Stevens-Johnson syndrome, or toxic epidermal necrolysis occur during treatment with Milurit, do not restart treatment with Milurit.
An acute attack of gouty arthritis may be expected early in treatment with Milurit. Therefore, the doctor may recommend prophylactic use of an appropriate anti-inflammatory medicine or colchicine for at least one month.
To monitor the safety and effectiveness of treatment with Milurit, the doctor may order one or more laboratory tests. These tests should be performed and the results shown to the doctor.
If the patient has been diagnosed with a tumour disease or Lesch-Nyhan syndrome, the amount of uric acid in the urine may increase. To prevent this, drink plenty of fluids to adequately dilute the urine.
If the patient has urinary stones, kidney stones may shrink during treatment and may move into the urinary tract.

Children and adolescents
Children and adolescents under 15 years of age should not use Milurit, except in cases of certain cancers (particularly leukaemias) or in the treatment of certain enzymatic disorders such as Lesch-Nyhan syndrome.

Milurit and other medicines
Tell your doctor if you are currently using, have recently used, or plan to use any of the following medicines:

• Salicylates (used to reduce pain, fever, or inflammation, e.g. acetylsalicylic acid),
• Theophylline, a medicine used for breathing problems. The doctor may recommend monitoring blood levels of theophylline, especially at the start of treatment with Milurit, or may adjust its dose.
• Medicines used to treat seizures (epilepsy) (phenytoin),
• Ampicillin or amoxicillin (used for bacterial infections). Since allergic reactions are more common, patients should, if possible, receive other antibiotics.
• Didanosine, used in the treatment of HIV infection,
• Vidarabine, used to treat viral infections. Caution: adverse effects of vidarabine may occur more frequently. Special precautions should be taken if they occur.
• Blood count disorders occur more frequently when allopurinol is taken together with cytostatic agents (e.g. cyclophosphamide, doxorubicin, bleomycin, procarbazine, alkylating halides) than when these active substances are taken separately. Therefore, regular blood count monitoring is necessary.
• If aluminium hydroxide is taken at the same time, allopurinol may be less effective. An interval of at least 3 hours should be maintained between taking the two medicines.
• Medicines used to suppress the immune response (immunosuppressive medicines), such as cyclosporine (adverse effects of cyclosporine may occur more frequently),
• Azathioprine (used to suppress immune system function) and 6-mercaptopurine (used in the treatment of blood cancer). Concomitant administration of 6-mercaptopurine or azathioprine with allopurinol should be avoided. If 6-mercaptopurine or azathioprine is used together with Milurit, the dose of 6-mercaptopurine or azathioprine should be reduced, as their effect will be prolonged. This may increase the risk of serious blood disorders. In such cases, the doctor will closely monitor blood cell counts during treatment. Seek immediate medical help if the patient notices any unexplained bruising, bleeding, fever, or sore throat.
• Medicines used to treat diabetes (chlorpropamide). A reduction in the dose of chlorpropamide may be necessary, especially in patients with impaired kidney function.
• Medicines used to treat heart disease or high blood pressure, such as ACE inhibitors (e.g. captopril, ramipril) or diuretics (particularly thiazide diuretics or furosemide),
• Medicines used to thin the blood (anticoagulants), such as warfarin, phenprocoumon, and acenocoumarol. The doctor will monitor blood clotting parameters more frequently and may reduce the dose of these medicines if necessary.
• Other medicines used to treat gout (probenecid).

Tell your doctor or pharmacist about all medicines the patient is currently taking or has recently taken, as well as any medicines the patient plans to take. This includes over-the-counter medicines, including herbal remedies. This is necessary because Milurit may affect the action of other medicines. Likewise, other medicines may affect the action of Milurit.

Pregnancy and breastfeeding

If the patient is pregnant, breastfeeding, suspects she may be pregnant, or is planning to become pregnant, she should consult her doctor or pharmacist before using this medicine.

Pregnancy
The safety of using Milurit during pregnancy is not sufficiently documented.
Milurit may be used during pregnancy only if no safer alternative is available and the disease itself poses a risk to the mother or unborn child.

Breastfeeding
Allopurinol is excreted in breast milk. Allopurinol is not recommended during breastfeeding.

Driving and operating machinery
Drowsiness, dizziness, or coordination disturbances may occur. If such symptoms occur, do not drive or operate machinery.

Milurit contains sodium
This medicine contains less than 1 mmol of sodium (23 mg) per tablet, i.e. essentially "sodium-free".

3. How to take Milurit

This medicine should always be taken exactly as prescribed by your doctor. If in doubt, consult your doctor or pharmacist.
Milurit should be taken once daily after a meal. While taking this medicine, the patient should drink plenty of fluids (2–3 litres per day). If the daily dose exceeds 300 mg and the patient experiences gastrointestinal adverse effects such as nausea and vomiting (see section 4), the doctor may prescribe allopurinol in divided doses to reduce these effects.
Dosage must always be individually determined by the doctor.

Recommended doses
Adults
The doctor usually starts treatment with a low dose of allopurinol (e.g. 100 mg/day) to reduce the risk of adverse effects. If necessary, the dose will be increased.
Recommended maintenance doses are:
100 to 200 mg daily for mild conditions, 300 to 600 mg daily for moderate conditions, and 700 to 900 mg daily for severe conditions.
If a dose in mg/kg body weight is required, a dose of 2 to 10 mg/kg body weight/day should be used.
During the initial phase of treatment, the doctor may prescribe an anti-inflammatory medicine or colchicine to be taken for at least one month to prevent attacks of gouty arthritis.

Use in children and adolescents (under 15 years of age)
In children under 15 years of age, Milurit is administered at a dose of 0.1 to 0.2 g/kg body weight per day, up to a maximum dose of 400 mg per day, divided into three doses. Use of this medicine in children is rarely indicated, except in neoplastic diseases (especially leukaemia) and certain enzymatic disorders such as Lesch-Nyhan syndrome.

Elderly patients (over 65 years of age)
The doctor will recommend the lowest dose of Milurit that effectively controls symptoms.

If the patient has severe kidney disease

• The patient may be advised to take a dose lower than 100 mg daily
• or to take a 100 mg dose at intervals longer than once daily.

If the patient is dialysed two or three times a week, the doctor may recommend a dose of 300 or 400 mg to be taken immediately after dialysis.
In case of kidney disease, the doctor may monitor kidney function, especially if the patient is also taking diuretics (diuretics, particularly thiazide diuretics).

If the patient has liver disease
The doctor may recommend lower doses. Periodic liver function tests may be necessary, especially at the beginning of treatment.

Treatment of conditions associated with increased uric acid turnover (e.g. neoplastic diseases, disorders of certain enzyme functions)
It is recommended to normalize elevated uric acid levels before starting cytotoxic therapy. Adequate fluid intake is important.

Skin reactions
If skin reactions occur, allopurinol must be discontinued immediately. After mild skin reactions have subsided, treatment may be resumed at a low dose (e.g. 50 mg/day) only after careful consideration of potential risks. The dose may then be gradually increased, monitoring for skin reactions and other possible adverse effects. If the rash recurs, the medicine must be permanently discontinued, considering the possibility of severe skin reactions (see section 4 Possible adverse effects).

Taking more than the recommended dose of Milurit
If more than the recommended dose of Milurit has been taken, or if a child has accidentally ingested the tablets, contact a doctor immediately or go to the nearest hospital emergency department. Bring this leaflet, any remaining tablets, and the medicine packaging so the doctor knows which tablets have been taken.
The most common symptoms of overdose include nausea, vomiting, diarrhoea, or dizziness.
Until medical help is received, ensure adequate fluid intake.

Missed dose of Milurit
If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped. Do not take a double dose to make up for a missed dose. Continue treatment as prescribed by the doctor.

Stopping Milurit
The duration of treatment is determined by the doctor.
Do not stop taking Milurit without first consulting your doctor, unless allergic reactions or other serious adverse effects occur (see section 4).
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 everyone will experience them.
Adverse reactions associated with the use of Milurit occur rarely in the treated patient population and in most cases are mild in severity. The frequency of adverse reactions increases in patients with concomitant kidney and/or liver disease.
Cases of potentially life-threatening skin rash (Stevens-Johnson syndrome, toxic epidermal necrolysis) have been reported (see section 2).
If any of the following adverse reactions occur during treatment with Milurit, the patient must stop taking the medicine immediately and contact a doctor without delay.

Uncommon (may affect up to 1 in 100 people)
Allergic reactions
Symptoms may include:

• skin rash, peeling skin, ulceration of the lips and oral cavity,
• swelling of the face, hands, lips, tongue or throat,
• difficulty swallowing or breathing,
• very rarely sudden wheezing, palpitations or chest tightness and collapse.

Do not take more tablets unless your doctor has specifically instructed you to do so.

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

• fever and chills, headache, muscle pain (flu-like symptoms) and general malaise,
• skin changes, such as ulceration of the mouth, throat, nose, genital organs and conjunctivitis (red and swollen eyes), widespread blisters or skin peeling,
• severe hypersensitivity reactions with fever, skin rash, joint pain and abnormal blood test results and liver function tests (these may be symptoms of multi-organ hypersensitivity).

Very rare (may affect up to 1 in 10,000 people)

• severe allergic reaction causing swelling of the face or throat,
• potentially life-threatening allergic reaction.

Frequency unknown (cannot be estimated from available data)

• aseptic meningitis (inflammation of the membranes surrounding the brain and spinal cord): symptoms include neck stiffness, headache, nausea, fever or altered consciousness. If such symptoms occur, seek immediate medical help.

Other possible adverse reactions
Common (may affect up to 1 in 10 people):

• rash,
• increased blood TSH levels (thyroid-stimulating hormone).

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

• nausea, vomiting and diarrhoea,
• abnormal liver function test results.

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

• joint pain or painful swelling in the groin, armpits or neck,
• jaundice (yellowing of the skin and whites of the eyes),
• liver disorders such as hepatitis,
• kidney disorders,
• formation of stones in the urinary tract; symptoms may include blood in the urine and abdominal, flank or groin pain.

Very rare (may affect up to 1 in 10,000 people):

• allopurinol tablets may sometimes affect the blood, which may manifest as bruising more easily than usual, sore throat or other signs of infection. These symptoms usually occur in patients who have liver or kidney problems. Inform your doctor as soon as possible. Milurit may affect the lymph nodes.
• high fever,
• blood in the urine, kidney failure,
• vomiting blood,
• high blood fat levels,
• general malaise,
• weakness, numbness of hands or feet, loss of balance, tingling, inability to move muscles (paralysis) or loss of consciousness,
• headache, dizziness, drowsiness or visual disturbances,
• chest pain, high blood pressure or slow heart rate,
• male infertility or inability to achieve or maintain an erection,
• breast enlargement in men and women,
• changes in bowel habits, presence of fat in the stool,
• taste disturbances,
• cataract (clouding of the eye lens), maculopathy (eye disease affecting the macula),
• hair loss or change in hair colour,
• seizures,
• depression,
• fluid retention leading to oedema, particularly around the ankles,
• excessive thirst, fatigue, weight loss (these may be symptoms of diabetes). Your doctor may recommend a blood glucose test to determine if this is the cause.
• acne (acneiform eruption, small tender red lumps on the skin),
• muscle pain.

Frequency unknown (cannot be estimated from available data):

• abdominal pain,
• lichenoid skin eruption (itchy reddish-purple rash and/or white lace-like lines on mucous membranes).

Reporting of adverse reactions
If any adverse reactions occur, including any not listed in this leaflet, inform your doctor, pharmacist or nurse. Adverse reactions can also be reported directly to the Department of Monitoring Adverse Reactions to Medicinal Products at the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products
Al. Jerozolimskie 181C
02-222 Warsaw
Phone: +48 (22) 49 21 301
Fax: +48 (22) 49 21 309
Website: https://smz.ezdrowie.gov.pl
Reporting adverse reactions helps provide more information on the safety of this medicine.

5. How to store Milurit

Keep this medicine out of the sight and reach of children.
No special storage instructions are required.
Do not use this medicine after the expiry date (month, year) stated on the packaging.
The expiry date refers to the last day of the specified month.
Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist
how to dispose of medicines no longer required. Such measures help protect
the environment.

6. Contents of the packaging and other information

What Milurit contains
The active substance is allopurinol.
200 mg tablets: each tablet contains 200 mg of allopurinol.
The other ingredients are: microcrystalline cellulose, sodium carboxymethyl starch (type A), gelatin,
colloidal anhydrous silica, magnesium stearate.

What Milurit looks like and contents of the pack
Appearance:
200 mg tablets: white or greyish, oval tablets, engraved with the code "E354" on one side and a SNAP division line on the other side. The tablet can be divided into equal doses.

Packaging
30 tablets in a brown glass bottle closed with a plastic cap with a tablet immobilizing insert and a tamper-evident seal, packed in a cardboard box.

For further information, please contact the Marketing Authorisation Holder or the Parallel Importer:

Marketing Authorisation Holder in Hungary, country of export:
Egis Gyógyszergyár Zrt.
1106 Budapest, Keresztúri út 30-38.
Hungary

Manufacturer:
Egis Gyógyszergyár Zrt.
9900 Körmend, Mátyás király utca 65.
Hungary

Parallel Importer:
Delfarma Sp. z o.o.
ul. Św. Teresy od Dzieciątka Jezus 111
91-222 Łódź
Poland

Repackaged in:
Delfarma Sp. z o.o.
ul. Św. Teresy od Dzieciątka Jezus 111
91-222 Łódź
Poland

Marketing Authorisation Number in Hungary, country of export: OGYI-T-3431/31
Parallel Import Authorisation Number: 127/25