APIRETAL 325 mg ORALLY DISINTEGRATING TABLETS

2. What you need to know before taking apiretal

Do not take apiretal:

• If you are allergic to the active substance or to any of the other components of this medicine (included in section 6).
  • If you have phenylketonuria (a hereditary disease diagnosed at birth).

Warnings and precautions:

• Do not take more medicine than recommended in section 3 of this leaflet "How to take apiretal";
• You should avoid the simultaneous use of this medicine with other medicines that contain paracetamol, such as flu and cold medicines, as high doses can lead to liver damage. Do not use more than one medicine that contains paracetamol without consulting your doctor.

Consult your doctor or pharmacist before starting to take apiretal:

• If you have glucose-6-phosphate dehydrogenase deficiency;
• If you have anorexia, bulimia, cachexia, or chronic malnutrition;
• If you have dehydration or hypovolemia;
• In patients with kidney, heart, or lung disease and in patients with anemia (decrease in hemoglobin levels in the blood, due to or not due to a decrease in red blood cells), consult your doctor before taking the medicine;

• Excessive consumption of alcoholic beverages (3 or more alcoholic beverages per day) can cause paracetamol to damage the liver;
  • If you have asthma and are sensitive to acetylsalicylic acid;

• If you are taking a medicine to treat epilepsy, you should consult your doctor before taking this medicine, as when used at the same time, it decreases the efficacy and increases the toxicity of paracetamol on the liver, especially in high-dose paracetamol treatments (see below in this section "Other medicines and apiretal");
• If you have Gilbert's disease (also known as Meulengracht's disease);

• If the pain persists for more than 3 days in children or 5 days in adults (2 days for throat pain) or the fever for more than 3 days, or worsens or other symptoms appear, you should discontinue treatment and consult your doctor.

During treatment with apiretal, inform your doctor immediately if:

• If you have severe diseases, such as severe kidney failure or sepsis (when bacteria and their toxins circulate in the blood, causing damage to organs), or if you have malnutrition, chronic alcoholism, or are also taking flucloxacillin (an antibiotic). A serious disease called metabolic acidosis (an anomaly in the blood and fluids) has been reported in patients in these situations when paracetamol is used at regular doses for a prolonged period or when paracetamol is taken together with flucloxacillin. The symptoms of metabolic acidosis may include: severe breathing difficulties with deep and rapid breathing, drowsiness, feeling of discomfort (nausea) and vomiting.

Children and adolescents

This medicine should not be used in children with a body weight of less than 21 kg (approximately 6 years). For children with lower weight, there are other suitable formats of apiretal; consult your doctor or pharmacist for more information.

Other medicines and apiretal

Inform your doctor or pharmacist if you are using, have recently used, or may need to use any other medicine.

In particular, if you are using medicines that contain in their composition any of the following active ingredients, it may be necessary to modify the dose or interrupt treatment of any of them:

• Antibiotics (chloramphenicol, flucloxacillin). In the case of flucloxacillin, due to a serious risk of blood and fluid anomaly (called metabolic acidosis) that requires urgent treatment (see section 2).
• Oral anticoagulants (acenocoumarol, warfarin).
• Oral contraceptives and estrogen treatments.

• Antiepileptics (lamotrigine, phenytoin, or other hydantoins, phenobarbital, methylphenobarbital, primidone, carbamazepine).

• Antituberculars (isoniazid, rifampicin).
• Barbiturates (used as sleep inducers, sedatives, and anticonvulsants).
• Activated charcoal, used for diarrhea or gas treatment.
• Colestyramine (used to decrease blood cholesterol levels).
• Medicines used to treat gout (probenecid and sulfinpyrazone).

• Medicines used for the relief of stomach, intestine, and bladder spasms or contractions (anticholinergics).

• Metoclopramide and domperidone (used to prevent nausea and vomiting).

• Propranolol used in the treatment of high blood pressure (hypertension) and heart rhythm disorders (cardiac arrhythmias).

• Zidovudine (used in the treatment of patients infected with the human immunodeficiency virus, the cause of AIDS).

Interference with analytical tests:

If you are going to have any analytical test (including blood tests, urine tests, skin tests that use allergens, etc.), inform your doctor that you are taking this medicine, as it may alter the results of these tests.

Taking apiretal with food, drinks, and alcohol

This medicine can be taken with food or drinks. The use of paracetamol in patients who habitually consume alcohol (three or more alcoholic beverages per day) can damage the liver.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

If necessary, paracetamol can be used during pregnancy. You should use the lowest possible dose that reduces pain or fever and use it for the shortest possible time.

Contact your doctor or midwife if the pain or fever does not decrease or if you need to take the medicine more frequently.

Paracetamol passes into breast milk, so breastfeeding women should consult their doctor before using this medicine.

Driving and using machines

No effects have been described that modify the ability to drive and use machines.

apiretal contains aspartame (E-951);each tablet contains 15.60 mg of aspartame. Aspartame contains a source of phenylalanine that may be harmful in case of phenylketonuria (PKU), a rare genetic disease in which phenylalanine accumulates because the body is unable to eliminate it correctly.

3. How to take apiretal

Follow exactly the administration instructions of this medicine contained in this leaflet or as indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist.

The use of high daily doses of paracetamol for prolonged periods of time should be avoided, as it increases the risk of suffering from side effects such as liver damage.

If the pain persists for more than 5 days (3 days in children), the fever for more than 3 days, or the pain or fever worsens or other symptoms appear, you should discontinue treatment and consult your doctor.

Use in children and adolescents

In children, the recommended daily dose of paracetamol depends on weight and is approximately 60 mg/kg/day, divided into 4 or 6 doses, i.e., 15 mg/kg every 6 hours or 10 mg/kg every 4 hours.

• In children with a weight between 21 and 32 kg (from6 to 10 years)the dose is 1 tablet per dose, repeating if necessary after 6 hours, up to a maximum of 4 tablets per day.
• In children with a weight between 33 and 40 kg (from10 to 12 years)the dose is 1 tablet per dose, repeating if necessary after 4 hours, up to a maximum of 6 tablets per day.
• In children with a weight between 41 and 49 kg (from12 to 15 years)the dose is 2 tablets per dose, repeating if necessary after 6 hours, up to a maximum of 8 tablets per day.
• In adolescents with a weight of 50 kg or more(over15 years)the dose is 2 tablets per dose, repeating if necessary after 4 hours, up to a maximum of 9 tablets per day.

These tablets contain 325 mg of paracetamol and allowmore precise dosing for children from 21-32 kg (approximately from 6 years to 10 years); for other children, there are other presentations of the medicine available that are more suitable.

Patient with kidney or liver disease and elderly people should consult their doctor before taking this medicine.

The administration of the medicine is subject to the appearance of painful or febrile symptoms. As these symptoms disappear, this medication should be suspended.

Remember to take your medicine.

Method of administration:

This medicine is administered orally.

Let the tablet dissolve in the mouth before swallowing. It can also be dispersed in water.

If you take more apiretal than you should

If you have taken more paracetamol than you should, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone 91 562 04 20, indicating the medicine and the amount used. It is recommended to take the package and the leaflet of the medicine to the healthcare professional.

If you have ingested an overdose, you should go quickly to a medical center, even if there are no symptoms, as they often do not appear until 3 days after ingestion, even in cases of severe poisoning. The symptoms of overdose may be: dizziness, vomiting, loss of appetite, yellowing of the skin and eyes (jaundice), and abdominal pain.

Paracetamol overdose is considered to be the ingestion of a single dose of more than 6 g in adults and more than 100 mg per kg of body weight in children. Treatment of overdose is more effective if started within 4 hours after ingestion of the medicine.

In case the patient is being treated with barbiturates or has chronic alcoholism, they may be more susceptible to a paracetamol overdose.

In general, symptomatic treatment will be performed.

If you forget to take apiretal

Do not take a double dose to make up for forgotten doses.

In case you have forgotten a dose, take another as soon as possible and continue with the usual schedule. However, if the time of the next dose is very close, skip the forgotten dose and take the next dose at the usual time.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Paracetamol side effects are, in general, rare (up to 1 in 1,000 people), very rare (up to 1 in 10,000 people), or of unknown frequency (cannot be estimated from the available data).

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

• low blood pressure (hypotension);
• increase in liver enzymes;
• discomfort.

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

• changes in blood, including changes in blood cell counts (such as abnormally low levels of certain blood elements that can cause, for example, bleeding through the nose or gums) and bleeding;
• allergic reactions (symptoms such as edema, shortness of breath, sweating, nausea, sudden drop in blood pressure);
• decrease in blood sugar;
• jaundice (yellowing of the skin), liver failure;
• skin reactions such as allergic dermatitis, urticaria, itching, rash, and other severe skin reactions;
• changes in urination (difficult or painful urination, decreased amount of urine, and blood in the urine);

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

• a serious disease that can make the blood more acidic (called metabolic acidosis) in patients with severe disease using paracetamol (see section 2).

Reporting of side effects

If you experience any side effect, consult your doctor, pharmacist, or nurse, even if it is a possible side effect not listed in this leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of apiretal

Keep this medicine out of the sight and reach of children.

No special storage conditions are required.

Do not use this medicine after the expiration date that appears on the carton after "EXP". The expiration date is the last day of the month indicated.

Medicines should not be disposed of via wastewater or household waste. Place the packages and medicines you no longer need in the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of packages and medicines you no longer need. This will help protect the environment.

6. Contents of the pack and further information

Composition ofapiretal

• The active substance is paracetamol. Each tablet contains 325 mg of paracetamol.
• The other components are: ethylcellulose, microcrystalline cellulose, guar gum, crospovidone, aspartame (E-951), colloidal silica, mannitol (E-421), talc, magnesium stearate, grape flavor.

Appearance ofapiretaland pack contents

The oral dispersible tablets are round and white and come in Alu/Alu blister packs, available in boxes of 12 or 24 tablets.

Not all pack sizes may be marketed.

Marketing authorization holder:

Laboratorios ERN, S.A.

C/Perú, 228 - 08020 Barcelona, Spain

Manufacturer:

Laboratorios ERN, S.A.

C/Gorchs Lladó, 188

Pol. Ind. Can Salvatella

08210 Barberá del Vallés (Barcelona), Spain

Date of last revision of this leaflet:February 2025.

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