AMOXICILLIN/CLAVULANIC ACID NORMON 1000 mg/200 mg POWDER FOR INJECTABLE SOLUTION AND FOR INFUSION

2. What you need to know before you use Amoxicillin/Clavulanic Acid Normon

Do not use Amoxicillin/Clavulanic Acid NORMON:

• if you are allergic to amoxicillin, clavulanic acid, penicillins, or any of the other components of this medicine (see section 6).
• if you have ever had a severe allergic reaction (hypersensitivity) to any other antibiotic. This could include skin rash or swelling of the face or throat.
• if you have ever had liver problems or jaundice (yellowing of the skin) when taking an antibiotic.

• Do not receive Amoxicillin/Clavulanic Acid NORMON if any of the above points apply to you. If you are not sure, consult your doctor, pharmacist, or nurse.

Warnings and precautions

Consult your doctor, pharmacist, or nurse before starting to use Amoxicillin/Clavulanic Acid if:

• you have infectious mononucleosis
• you are receiving treatment for liver or kidney problems
• you do not urinate regularly.

If you are not sure if any of the above symptoms affect you, inform your doctor, pharmacist, or nurse before receiving amoxicillin/clavulanic acid.

In some cases, your doctor may investigate the type of bacteria causing your infection. Depending on the results, you may be prescribed a different formulation of amoxicillin/clavulanic acid or another medicine.

Symptoms to be aware of

Amoxicillin/Clavulanic Acid can worsen certain existing conditions or cause serious side effects. These include allergic reactions, convulsions, and inflammation of the large intestine. You should be aware of certain symptoms while taking amoxicillin/clavulanic acid to reduce the risk of problems. See "Symptoms to be aware of" in section 4.

Blood and urine tests

If you are having blood tests (such as red blood cell status or liver function studies) or urine tests (to check glucose levels), inform your doctor or nurse that you are being given amoxicillin/clavulanic acid. This is because amoxicillin/clavulanic acid can alter the results of these types of tests.

Other medicines and Amoxicillin/Clavulanic Acid NORMON

Tell your doctor, pharmacist, or nurse if you are using or have recently used or might use any other medicines.

If you are taking allopurinol (used for gout) with Amoxicillin/Clavulanic Acid, you may be more likely to have a skin allergic reaction.

If you are taking probenecid (used for gout), your doctor may adjust the dose of amoxicillin/clavulanic acid. Concomitant use of probenecid can reduce the excretion of amoxicillin and is not recommended.

If you are taking anticoagulants (such as warfarin) with Amoxicillin/Clavulanic Acid, more blood tests will be needed.

Amoxicillin/Clavulanic Acid can affect the way metotrexate (a medicine used to treat cancer and severe psoriasis) works. Penicillins can reduce the excretion of metotrexate and cause a potential increase in side effects.

Amoxicillin/Clavulanic Acid can affect the way mycophenolate mofetil (a medicine used to prevent organ rejection in transplant patients) works.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor, pharmacist, or nurse for advice before using this medicine.

Driving and using machines

Amoxicillin/Clavulanic Acid can have side effects that may make you unfit to drive or use machines.

Do not drive or operate machinery unless you are feeling well.

Amoxicillin/Clavulanic Acid NORMON contains sodium and potassium

• this medicine contains 62.9 mg of sodium (main component of cooking/table salt) per vial. This is equivalent to 3.1% of the maximum recommended daily intake of sodium for an adult
• Patients with renal insufficiency or on low potassium diets should be aware that this medicine contains 39.2 mg (1.0 mmol) of potassium per vial.

3. How to use Amoxicillin/Clavulanic Acid Normon

You will never administer this medicine to yourself. A qualified person, such as a doctor or nurse, will administer it to you.

The recommended doses are:

Adults and children weighing 40 kg or more

Children weighing less than 40 kg

• All doses are calculated based on the child's body weight in kilograms.

Patients with kidney and liver problems

• If you have kidney problems, your dose may be changed. Your doctor may choose a different formulation or another medicine.
• If you have liver problems, you will have more frequent blood tests to check how your liver is working.

How Amoxicillin/Clavulanic Acid NORMON will be administered to you

• Amoxicillin/Clavulanic Acid will be administered to you as an injection into a vein or by intravenous infusion.
• Make sure you drink plenty of liquid while receiving amoxicillin/clavulanic acid.
• Amoxicillin/Clavulanic Acid NORMON will not be administered to you for more than 2 weeks without your doctor reviewing your treatment.

If you are given more Amoxicillin/Clavulanic Acid NORMON than recommended

It is very unlikely that you will be given too much amoxicillin/clavulanic acid, but if you think you have been given too much, tell your doctor, pharmacist, or nurse immediately. The symptoms may be stomach upset (nausea, vomiting, or diarrhea) or convulsions.

If you have any further questions on how this medicine is administered, ask your doctor, pharmacist, or nurse.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicological Information Service, telephone: 91 562 04 20, indicating the medicine and the amount ingested.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. The following side effects may occur with this medicine.

Symptoms to be aware of

Allergic reactions:

• skin rash
• inflammation of blood vessels (vasculitis) that can appear as red or purple spots on the skin but can affect other parts of the body
• fever, joint pain, swollen glands in the neck, armpits, or groin
• swelling sometimes of the face or throat (angioedema), which can cause difficulty breathing
• collapse
• chest pain in the context of allergic reactions, which can be a symptom of allergy-induced heart attack (Kounis syndrome).

• Contact your doctor immediatelyif you experience any of these symptoms. Stop using Amoxicillin/Clavulanic Acid NORMON.

Inflammation of the large intestine

Inflammation of the large intestine, which causes watery diarrhea normally with blood and mucus, stomach pain, and/or fever.

Acute inflammation of the pancreas (acute pancreatitis)

If you have severe and persistent stomach pain, this could be a sign of acute pancreatitis.

Drug-induced enterocolitis syndrome (DIES):

DIES has been reported mainly in children receiving amoxicillin/clavulanic acid. It is a certain type of allergic reaction with the main symptom of repeated vomiting (1-4 hours after taking the medicine). Other symptoms may include abdominal pain, lethargy, diarrhea, and low blood pressure.

• Contact your doctor as soon as possiblefor advice if you have these symptoms.

Common side effects

May affect up to 1 in 10 people

• thrush (candida - fungal infection of the vagina, mouth, or mucous membranes)
• diarrhea

Uncommon side effects

May affect up to 1 in 100 people

• skin rash, itching
• increased itchy rash (urticarial rash)
• nausea, especially when high doses are administered

• vomiting
• indigestion
• dizziness
• headache.

Uncommon side effects that may appear in your blood tests:

• increase in some substances (enzymes) produced by the liver

Rare side effects

May affect up to 1 in 1,000 people

• skin rash, which can form blisters that look like small targets (central dark spot surrounded by a paler area, with a dark ring around the edge - erythema multiforme)

• Contact a doctor urgentlyif you have any of these symptoms.

• swelling and redness along the vein, which is extremely sensitive to touch

Rare side effects that may appear in your blood or urine tests:

• significant decrease in the number of white blood cells
• low red blood cell count (hemolytic anemia)

Frequency not known

Frequency cannot be estimated from the available data.

• Allergic reactions (see above)
• Inflammation of the large intestine (see above)
• Severe skin reactions:
• • widespread rash with blisters and peeling of the skin, particularly around the mouth, nose, eyes, and genitals (Stevens-Johnson syndrome), and in its most severe form, causing widespread peeling of the skin (more than 30% of the body surface - toxic epidermal necrolysis)
  • widespread rash with small blisters containing pus (bullous exfoliative dermatitis)
  • red rash with bumps under the skin and blisters (pustular exanthematous rash)
  • flu-like symptoms with skin rash, fever, swollen glands, and abnormal blood test results (such as increased white blood cells (eosinophilia) and elevated liver enzymes) (drug reaction with eosinophilia and systemic symptoms (DRESS)).

• Contact a doctor immediatelyif you have any of these symptoms.

• Inflammation of the liver (hepatitis)
• Jaundice, caused by an increase in bilirubin in the blood (a substance produced by the liver) that can make the skin and the whites of the eyes turn yellow
• Inflammation of the kidney ducts
• Delayed blood clotting
• Convulsions (in patients taking high doses of Amoxicillin/Clavulanic Acid or with kidney problems)
• Rash with blisters arranged in a circle with a central crust or like a string of pearls (linear IgA disease)
• Inflammation of the membranes surrounding the brain and spinal cord (aseptic meningitis).

Side effects that may appear in your blood or urine tests:

• significant decrease in the number of white blood cells
• low red blood cell count (hemolytic anemia)
• crystals in the urine that cause acute kidney injury.

Reporting of side effects

If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly through the Spanish Pharmacovigilance System for Human Use Medicines: http://www.notificaRAM.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Amoxicillin/Clavulanic Acid Normon

The expiry date and storage instructions on the label are for the information of the doctor, nurse, or pharmacist. The doctor, pharmacist, or nurse will reconstitute your medicine, which must be used within 20 minutes of reconstitution.

Do not store above 25°C. Keep in the original packaging to protect from light.

Keep out of the sight and reach of children.

Do not use Amoxicillin/Clavulanic Acid NORMON after the expiry date stated on the packaging. The expiry date is the last day of the month indicated.

Medicines should not be disposed of via wastewater or household waste. Return the packaging and any unused medicine to the pharmacy. If you are unsure, ask your pharmacist how to dispose of the packaging and any unused medicine. This will help protect the environment.

6. Container Content and Additional Information

Composition of Amoxicillin/Clavulanic Acid NORMON

Each vial contains as active ingredients 1,000 mg of amoxicillin (as amoxicillin sodium) and 200 mg of clavulanic acid (as potassium clavulanate).

It does not contain excipients. However, see section 2 for important information about the sodium and potassium content of Amoxicillin/Clavulanic Acid NORMON.

The doctor, nurse, or pharmacist will prepare the injection before administration, using a suitable liquid (such as water for injectables or a liquid for injectables and perfusion).

Appearance of the Product and Container Content

Vials containing a sterile powder of white to off-white color.

Packages of 1 and 100 vials.

Marketing Authorization Holder and Manufacturer

LABORATORIOS NORMON, S.A.

Ronda de Valdecarrizo, 6 – 28760

Tres Cantos – Madrid (SPAIN)

Date of the Last Revision of this Prospectus: October 2023

Detailed and updated information about this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

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This information is intended only for doctors or healthcare professionals:

Please see the Technical Sheet for additional information

Administration

Amoxicillin/Clavulanic Acid NORMON can be administered by slow intravenous injection over a period of 3 to 4 minutes directly into a vein or by a drip for perfusion over 30-40 minutes. Amoxicillin/Clavulanic Acid NORMON is not suitable for intramuscular administration.

Reconstitution

The reconstitution of the solution for intravenous injection or the reconstitution and dilution of the solution for perfusion should be performed at the time of administration.

Preparation of solutions for intravenous injection

The usual solvent is water for injectable preparations. Amoxicillin/Clavulanic Acid NORMON 1,000 mg/200 mg should be dissolved in 20 ml of solvent. This results in approximately 20.9 ml of solution for single-dose use. A pale pink coloration may be observed during reconstitution. The reconstituted solutions are normally colorless or with a pale straw color.

Amoxicillin/Clavulanic Acid NORMON should be administered within 20 minutes after reconstitution.

Preparation of solutions for intravenous perfusion

Amoxicillin/Clavulanic Acid NORMON should be reconstituted as described above for injection. Immediately, the reconstituted solution should be added to 100 ml of perfusion fluid using a minibag or in-line burette.

Glucose (dextrose) injectable solutions, sodium bicarbonate solutions, or dextran solutions should not be used as solvents.

In general, it is recommended not to mix it with any other product in the same syringe or perfusion bottle. The combination of amoxicillin and clavulanic acid is incompatible with: blood and plasma, hydrocortisone succinate, amino acid solutions, protein hydrolysates, lipid emulsions, phenylephrine HCl, mannitol solutions.

Amoxicillin/Clavulanic Acid NORMON should not be mixed in the same syringe with aminoglycoside antibiotics, as this may result in a loss of aminoglycoside activity.

The vials of Amoxicillin/Clavulanic Acid NORMON are not suitable for multiple-dose use.

Stability of Prepared Solutions

Reconstituted vials (for intravenous injection or before dilution for perfusion)

The solution obtained after reconstituting the vial with 20 ml of water for injectables Ph. Eur. has been shown to be stable from a chemical and physical point of view for 20 minutes at 25 °C ± 2°C/ 60% ±5% HR.

Reconstituted and diluted vials for perfusion

The solution obtained by immediately diluting the reconstituted vial with 100 ml of water for injectables Ph. Eur. or NaCl 0.9% or sodium lactate 1/6M or Ringer's solution or Hartmann's solution has been shown to be stable from a chemical and physical point of view for 60 minutes at 25°C ± 2°C/ 60% ±5% HR.