Tranxene

Package leaflet: Information for the patient

Warning! Keep this leaflet! The information on the immediate packaging is in a foreign language.
Tranxene
10 mg, capsules, hard
Chlordiazepoxide dipotassium
Please read carefully all the information in this leaflet before using the medicine, as it contains
important information for the patient.

• Keep this leaflet so that you can read it again if necessary.
• If you have any doubts, please consult your doctor or pharmacist.
• This medicine has been prescribed for a specific individual. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same.
• If the patient experiences any adverse effects, including any adverse effects not listed in this leaflet, they should inform their doctor or pharmacist. See section 4.

Table of contents of the leaflet

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

1. What Tranxene is and what it is used for

Tranxene is available as hard capsules and contains the active substance chlordiazepoxide.
Chlordiazepoxide belongs to a group of medicines called benzodiazepines. It has anxiolytic, muscle relaxant, sedative, hypnotic, and anticonvulsant properties.
Tranxene is used:

• in short-term anxiety and nervousness, especially as temporary supportive treatment in neurosis,
• in alcohol withdrawal syndrome (alcoholic hallucinosis, states preceding delirium tremens). Pharmacological treatment is indicated only when symptoms are severe, interfere with normal functioning, or cause significant discomfort to the patient.

2. Important information before using Tranxene

When not to use Tranxene:

• if the patient is allergic to the active substance or any of the other ingredients of the medicine (listed in section 6),
• if the patient has severe respiratory insufficiency,
• if the patient has sleep apnoea syndrome,
• if the patient suffers from myasthenia (a disease characterized by rapid muscle fatigue and weakness),
• if the patient has severe hepatic insufficiency,
• in children:
  • 10 mg capsules must not be used in children.

Warnings and precautions

Any treatment with benzodiazepines may lead to the development of psychological and physical dependence. Factors predisposing to dependence include: duration of treatment, dose of the medicine, concomitant use of other psychotropic drugs, anxiolytics or hypnotics, concurrent alcohol consumption, history of drug or substance dependence.

Upon discontinuation of treatment, withdrawal symptoms may occur: insomnia, headache, increased anxiety, muscle pain, increased muscle tension, very rarely irritability, agitation, and even confusion. In exceptional cases, tremors, hallucinations and seizures may occur.

The duration of treatment should be as short as possible and should not exceed 4 to 12 weeks. The physician will inform the patient how to discontinue therapy (gradual dose reduction over several days to several weeks).

Discontinuation of treatment: abrupt discontinuation of chlordiazepoxide may lead to withdrawal symptoms, particularly after prolonged treatment or when drug dependence is suspected.

With prolonged use, tolerance to the drug may develop (reduced efficacy).

During treatment, anterograde amnesia may occur, especially when benzodiazepines are taken immediately before going to bed and sleep duration is short (early awakenings caused by external factors). To minimize the risk of amnesia, it is recommended to ensure conditions for continuous, uninterrupted 7–8 hour sleep.

During benzodiazepine treatment, the following may occur: anxiety, agitation, irritability, aggression, hallucinations, anger, nightmares, hallucinations, psychoses, unusual behavior, and other behavioral disturbances. These symptoms occur more frequently in children and elderly patients. If any of these symptoms occur, treatment should be discontinued.

Concomitant use of benzodiazepines, including chlordiazepoxide, and opioids may cause sedation, respiratory depression, coma, and death. Due to these risks, the physician will prescribe opioids and benzodiazepines together only for patients in whom other treatment options are insufficient.

If a decision is made to use chlordiazepoxide together with opioids, the medicines will be prescribed at the lowest effective dose and for the shortest possible duration of concomitant use.

Some studies have shown an increased risk of suicidal thoughts, suicide attempts, and suicides in patients taking certain sedative and hypnotic medicines, including this medicine. However, it has not been established whether this is caused by taking this medicine or whether there are other causes. If the patient has suicidal thoughts, they should contact their doctor as soon as possible to obtain further medical advice.

Benzodiazepines with anxiolytic action should not be used to treat depression and psychiatric disorders.

Benzodiazepines may mask symptoms of depression and should not be used as the sole treatment for depression (antidepressants should be used). Treatment with benzodiazepines alone may increase suicidal tendencies.

Benzodiazepines should be used with great caution in patients with a history of alcohol or drug (including narcotics) dependence, as they are at increased risk of developing physical and psychological dependence.

In elderly patients and patients with renal insufficiency, dose adjustment of the medicine may be necessary (see section 3. How to use Tranxene).

Benzodiazepines should be used very cautiously in patients with impaired liver function; hepatic encephalopathy may occur in patients with liver insufficiency.

In patients with respiratory insufficiency, the use of benzodiazepines may cause breathing problems (worsening of hypoxia may lead to anxiety and may require admission to an intensive care unit).

Concomitant use of multiple benzodiazepines is not beneficial and may increase the risk of dependence.

Benzodiazepines are not recommended for use in patients with psychosis.

Elderly patients are more susceptible to adverse effects such as drowsiness, dizziness, and muscle weakness, which may lead to falls and consequently to serious injuries. Dose reduction is recommended.

Tranxene with food, drink and alcohol

Food does not affect the absorption of the medicine from the gastrointestinal tract.

Tranxene may be taken during meals or on an empty stomach.

Alcoholic beverages should not be consumed during treatment with chlordiazepoxide.

Pregnancy, breastfeeding and fertility

Data on the use of chlordiazepoxide in pregnant women are limited. Therefore, the use of this medicine is not recommended during pregnancy or in women of childbearing potential who are not using contraception.

If the patient is pregnant, suspects she may be pregnant, or is planning to become pregnant, she should consult her doctor to reassess the need for treatment.

If the patient takes chlordiazepoxide in high doses during the last three months of pregnancy or during delivery, the newborn may experience drowsiness (sedation), breathing problems (respiratory depression), muscle weakness (hypotonia), low body temperature (hypothermia), and feeding difficulties (sucking problems leading to poor weight gain).

If the patient regularly takes chlordiazepoxide towards the end of pregnancy, the newborn may develop a withdrawal syndrome. In such cases, the newborn should be closely monitored in the postnatal period.

Tranxene should not be used during breastfeeding.

Driving and operating machinery

Patients should not drive vehicles or operate machinery while taking this medicine. The ability to drive and operate machinery may be impaired during chlordiazepoxide treatment due to concentration disturbances, drowsiness, and anterograde amnesia. Concomitant use of other medicines may enhance the sedative effect of chlordiazepoxide (see section Tranxene with other medicines).

Tranxene with other medicines

Inform your doctor about all medicines currently or recently taken, as well as any medicines the patient intends to take, including those available without a prescription.

The risk of withdrawal symptoms increases with concomitant use of other benzodiazepines used for anxiety and sleep.

Alcohol consumption and use of medicines containing alcohol should be avoided during treatment. Alcohol enhances the sedative effect of benzodiazepines.

Exercise caution when using Tranxene concomitantly with:

• medicines with central nervous system depressant effects, such as: opioids, morphine derivatives including buprenorphine (analgesics, antitussives, and medicines used in other therapies), neuroleptics, barbiturates, certain antidepressants, sedating antihistamines (antiallergic medicines), non-benzodiazepine sedatives, clonidine and medicines with similar effects;
• cisapride (a prokinetic agent) due to the possibility of enhanced sedative effects of benzodiazepines;
• clozapine (a neuroleptic medicine) due to increased risk of respiratory and/or cardiac arrest;
• curare and its derivatives (medicines that reduce skeletal muscle tension) due to additive effects.

Concomitant use of benzodiazepines and opioids increases the risk of sedation, respiratory depression, coma, and death due to enhanced central nervous system depression.

Concomitant use of benzodiazepines and sodium oxybate should be avoided due to increased risk of respiratory depression.

3. How to use Tranxene

This medicine should always be taken as prescribed by the doctor. In case of doubt, consult your doctor.
Tranxene is available in the following doses: 5 mg, 10 mg.
Treatment should begin with an initial dose, gradually increasing the dose to avoid adverse effects. The maximum daily dose of 30 mg must not be exceeded. The duration of treatment should be as short as possible and should not exceed 8 to 12 weeks, including the tapering period. During treatment, the patient should be monitored regularly so that the dose or frequency of administration may be reduced if necessary. Due to the risk of withdrawal symptoms, the medicine should be discontinued cautiously by gradually reducing the daily dose.

Adults:
The therapeutic dose ranges from 5 to 30 mg per day.
Treatment should be initiated at a dose of 5 mg per day.
The daily dose may be taken once daily, in the evening.

Use in children and adolescents
Due to limited data on use in children and adolescents for the treatment of anxiety, Tranxene is not recommended for this age group.
Only in exceptional cases may a specialist physician administer this medicine to children over 9 years of age at a dose of 0.5 mg/kg body weight per day, given in divided doses.
Tranxene 10 mg tablets are intended for use in adults only.
Elderly patients should receive a 50% reduced dose; treatment should be as short as possible.
Patients with impaired renal function should receive a 50% reduced dose.
Patients with impaired liver function must exercise caution when using this medicine; hepatic encephalopathy (neurological dysfunction due to toxins accumulating in the body as a result of liver damage) may occur in patients with liver insufficiency.
If you feel that the effect of Tranxene is too strong or too weak, consult your doctor.

Taking more Tranxene than prescribed
The main symptom of severe overdose is deep sleep, which may progress to coma depending on the amount ingested.
The prognosis is favorable if the patient has not taken other psychotropic drugs simultaneously and receives appropriate treatment.
The patient should be admitted to a hospital intensive care unit where respiratory and cardiovascular functions will be monitored.
If less than one hour has passed since ingestion and the patient is conscious, vomiting should be induced. If the patient is unconscious, the doctor should perform gastric lavage, remembering to secure the upper airways. If more than one hour has passed since overdose, activated charcoal may be administered to reduce drug absorption from the gastrointestinal tract.
After a mild overdose, symptoms include drowsiness, disorientation, and lethargy; after a more severe overdose: impaired body coordination, decreased muscle tone, hypotension, respiratory depression, rarely coma, and very rarely death.
The doctor may use flumazenil to diagnose and/or treat benzodiazepine overdose.
In case of overdose, seek medical help immediately.

Missed dose of Tranxene
If a dose is missed, take it as soon as possible unless the next scheduled dose is approaching. Do not take a double dose to make up for a missed dose. In case of doubt, consult your doctor.

4. Possible adverse reactions

Like any medicine, Tranxene may cause adverse reactions, although not everyone experiences them.
The frequency and severity of adverse reactions depend on the individual patient's sensitivity and the dose administered.
The following adverse reactions may occur:

Very common (may occur in more than 1 in 10 patients):

• drowsiness (especially in elderly patients)

Common (may occur in up to 1 in 10 patients):

• dizziness
• weakness

Uncommon (may occur in up to 1 in 100 patients):

• hypersensitivity reactions
• irritability, restlessness, confusion
• reduced muscle tone
• maculopapular and itchy skin rashes

Frequency unknown (frequency cannot be estimated from available data):

• slowing of mental processes
• paradoxical reactions (especially in children and elderly patients)
• aggression, hallucinations
• so-called rebound syndrome with increased anxiety compared to the level that prompted treatment initiation
• physical dependence with prolonged treatment (especially at high doses), and withdrawal symptoms after discontinuation of the medicine*
• cognitive disturbances such as memory impairment (anterograde amnesia*), attention disturbances, and speech disorders
• falls*

* see section 4.4 Warnings and precautions for use

Additionally, the following adverse reactions have been reported during benzodiazepine use in general:

• emotional blunting, reduced alertness, headache,
• disturbances in body movement coordination,
• double vision,
• gastrointestinal disturbances,
• decreased libido,
• occurrence of memory loss (amnesia), which may be associated with abnormal behaviour,
• psychiatric and paradoxical reactions including anxiety, hallucinations, rage attacks, nightmares, psychoses, abnormal behaviours, and other behavioural disturbances.

Use of benzodiazepines may unmask previously existing, undiagnosed depression.
Psychological dependence may occur. Cases of benzodiazepine abuse have been reported.

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

5. How to store Tranxene

No special storage instructions are required.
The medicine should be stored in a place that is 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.
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 Tranxene contains
Each hard capsule contains the active substance dipotassium clorazepate 10 mg and the following excipients: potassium carbonate, talc.
Capsule shell composition: gelatin, titanium dioxide (E 171), erythrosine (E 127).

What Tranxene looks like and contents of the pack
The pack contains 30 hard capsules.
The capsule is opaque, with a light pink cap and body, having a smooth, glossy surface, and contains a homogeneous powder of white or yellowish colour.

For further detailed information, please contact the marketing authorisation holder or the parallel importer.

Marketing authorisation holder in Portugal, country of export:
Neuraxpharm Portugal, Unipessoal Lda.
Avenida Dom João II, nº 35
Edifício Infante, 6º I
1990-083 Lisbon
Portugal

Manufacturer:
Sanofi Aventis, S.A. (Riells)
Carretera de la Batlloria a Hostalric km. 63, 09
17404 Riells i Viabrea Girona
Spain

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 Portugal, country of export: 5842497
Parallel import authorisation number: 237/16