APIXABAN PENSA 2.5 mg FILM-COATED TABLETS

2. What you need to know before you take Apixaban pensa

Do not take Apixaban pensa if:

• you are allergicto apixaban or any of the other ingredients of this medicine (listed in section 6),
• you have excessive bleeding,
• you have a disease in an organof the body that increases the risk of severe bleeding (such as an active or recent stomach or intestinal ulcer, or recent brain hemorrhage),
• you have a liver diseasethat increases the risk of bleeding (hepatic coagulopathy),
• you are taking medicines to prevent blood clotting(e.g., warfarin, rivaroxaban, dabigatran, or heparin), except when switching from one anticoagulant treatment to another, while having an arterial or venous line and being treated with heparin to keep the line open, or when a tube is inserted into a blood vessel (catheter ablation) to treat an irregular heartbeat (arrhythmia).

Warnings and precautions

Tell your doctor, pharmacist, or nurse before starting to take this medicine if you have any of these conditions:

• a higher risk of bleeding, such as:
• • bleeding disorders, including situations that result in a decrease in platelet activity,
  • very high blood pressure, not controlled by medical treatment,
  • you are over 75 years old,
  • you weigh 60 kg or less,
• severe kidney disease or if you are on dialysis,
• a liver problem or history of liver problems.
• • this medicine will be used with caution in patients with signs of liver function impairment

• you had a catheter or received an injection in the spine(for anesthesia or pain relief), your doctor will tell you to wait at least 5 hours after removing the catheter before taking this medicine,
• if you have a heart valve prosthesis,
• if your doctor determines that your blood pressure is unstable or you are scheduled to receive another treatment or undergo surgery to remove the blood clot from your lungs.

Be careful with Apixaban pensa

If you know you have a disease called antiphospholipid syndrome (an immune system disorder that increases the risk of blood clots), inform your doctor to decide if it may be necessary to modify the treatment.

If you need surgery or a procedure that may cause bleeding, your doctor will tell you to temporarily stop taking this medicine for a while. If you are not sure if a procedure may cause bleeding, ask your doctor.

Children and adolescents

Apixaban pensa is not recommended for use in children and adolescents under 18 years of age.

Other medicines and Apixaban pensa

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

Some medicines may increase the effects of apixaban and some medicines may decrease its effects. Your doctor will decide if you should be treated with apixaban if you are taking these medicines and if you should be kept under closer observation.

The following medicines may increase the effects of apixaban and increase the risk of unwanted bleeding:

• some medicines for fungal infections(e.g., ketoconazole, etc.),
• some antiviral medicines for HIV/AIDS(e.g., ritonavir),
• other medicines to reduce blood clotting(e.g., enoxaparin, etc.),
• anti-inflammatory or pain-relieving medicines(e.g., acetylsalicylic acid or naproxen). Especially if you are over 75 years old and taking acetylsalicylic acid, there is a higher likelihood of bleeding,
• medicines for high blood pressure or heart problems(e.g., diltiazem),
• antidepressantscalled selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.

The following medicines may reduce the ability of apixaban to prevent blood clot formation:

• medicines to prevent epilepsy or seizures(e.g., phenytoin, etc.),
• St. John's Wort(a herbal medicine for the treatment of depression),
• medicines to treat tuberculosis or other infections(e.g., rifampicin).

Pregnancy and breastfeeding

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

The effects of Apixaban pensa on pregnancy and the fetus are not known. You should not take this medicine if you are pregnant. Tell your doctor immediatelyif you become pregnant while taking this medicine.

It is not known if apixaban is excreted in human milk. Ask your doctor or pharmacist for advice before taking this medicine during breastfeeding. They will tell you whether to stop breastfeeding or whether to stop or not start taking this medicine.

Driving and using machines

Apixaban pensa has no known effects on the ability to drive and use machines.

Apixaban pensa contains lactose and sodium

If your doctor has told you that you have an intolerance to some sugars, consult them before taking this medicine.

This medicine contains less than 1 mmol of sodium (23 mg) per tablet; this is, essentially, “sodium-free”.

3. How to take Apixaban pensa

Follow exactly the administration instructions of this medicine given by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

Dosage

Take the tablet with water. Apixaban pensa can be taken with or without food. Try to take the tablets at the same time each day to achieve a better treatment effect.

If you have difficulty swallowing the tablet whole, talk to your doctor about other possible ways to take apixaban. The tablet can be crushed and mixed with water, 5% glucose in water, apple juice, or apple puree, immediately before taking it.

Instructions for crushing:

• Crush the tablets with a mortar.
• Transfer all the powder carefully into a suitable container, then mix the powder with a small amount, e.g., 30 ml (2 tablespoons), of water or any of the other liquids mentioned above to make the mixture.
• Take the mixture.
• Rinse the mortar and the mortar's hand that have been used to crush the tablet and the container with a small amount of water or one of the other liquids (e.g., 30 ml), and take that liquid.

If necessary, your doctor may also administer the crushed apixaban tablet mixed in 60 ml of water or 5% glucose in water through a nasogastric tube.

Take Apixaban pensa according to the following recommendations:

To prevent the formation of blood clots after hip or knee replacement surgery.

The recommended dose is one apixaban 2.5 mg tablet twice a day. For example, take one tablet in the morning and one in the evening.

You should take the first tablet between 12 and 24 hours after surgery.

If you have undergone hipreplacement surgery, you will generally take the tablets for a period of 32 to 38 days.

If you have undergone kneereplacement surgery, you will generally take the tablets for a period of 10 to 14 days.

To prevent the formation of a blood clot in the heart in patients with an irregular heartbeat and at least one additional risk factor

The recommended dose is one apixaban 5 mgtablet twice a day.

The recommended dose is one apixaban 2.5 mgtablet twice a day if:

• you have severely reduced kidney function,
• two or more of the following factors apply to you:
• • your blood test results suggest poor kidney function (the creatinine serum value is 1.5 mg/dl (133 micromoles/l) or higher),
  • you are 80 years old or older,
  • your weight is 60 kg or less.

The recommended dose is one tablet twice a day, for example, take one tablet in the morning and one in the evening.

Your doctor will tell you how long you should continue the treatment.

To treat blood clots in the veins of the legs and in the blood vessels of the lungs

The recommended dose is two tabletsof apixaban 5 mgtwice a day for the first 7 days, for example, two tablets in the morning and two tablets in the evening.

After 7 days, the recommended dose is one tabletof apixaban 5 mgtwice a day, for example, one tablet in the morning and one tablet in the evening.

To prevent blood clots from recurring after 6 months of treatment

The recommended dose is one apixaban 2.5 mgtablet twice a day, for example, one tablet in the morning and one tablet in the evening.

Your doctor will tell you how long you should continue the treatment.

Your doctor may change your anticoagulant treatment as follows:

• Changing from Apixaban pensa to anticoagulant medicines

Stop taking apixaban. Start treatment with anticoagulant medicines (e.g., heparin) at the time you would take the next apixaban tablet.

• Changing from anticoagulant medicines to Apixaban pensa

Stop taking anticoagulant medicines. Start treatment with apixaban at the time you would take the next dose of an anticoagulant medicine, and then continue as usual.

• Changing from a treatment with anticoagulants that contain Vitamin K antagonists (e.g., warfarin) to Apixaban pensa

Stop taking the medicine that contains a Vitamin K antagonist. Your doctor will need to perform blood tests and tell you when to start taking apixaban.

• Changing from Apixaban pensa to a treatment with anticoagulants that contain Vitamin K antagonists (e.g., warfarin).

If your doctor tells you to start taking a medicine that contains a Vitamin K antagonist, continue taking apixaban for at least 2 days after your first dose of the medicine that contains a Vitamin K antagonist. Your doctor will need to perform blood tests and tell you when to stop taking Apixaban pensa.

Patients undergoing cardioversion:

If your irregular heartbeat needs to be restored through a process called cardioversion, take apixaban at the times your doctor indicates to prevent blood clots in the blood vessels of the brain and other blood vessels in the body.

If you take more Apixaban pensa than you should

Tell your doctor immediatelyif you have taken a dose higher than the prescribed dose of apixaban. Take the medicine package to your doctor, even if there are no tablets left.

If you take more apixaban than the recommended dose, you may increase the risk of bleeding. If bleeding occurs, surgery, blood transfusions, or other treatments that can reverse the anti-factor Xa activity may be necessary.

In case of overdose or accidental ingestion, contact your doctor or call the Toxicology Information Service, phone 91 562 04 20, indicating the medicine and the amount taken.

If you forget to take Apixaban pensa

Take the dose as soon as you remember and:

• take the next dose of apixaban at the usual time,
• then continue taking the medicine as usual.

If you have doubts about what to do or if you forget to take more than one dose, ask your doctor, pharmacist, or nurse.

If you stop taking Apixaban pensa

Do not stop taking apixaban without talking to your doctor first, because the risk of developing a blood clot may be higher if you stop the treatment too soon.

If you have any doubts about the use of this medicine, ask your doctor, pharmacist, or nurse.

4. Possible Adverse Effects

Like all medicines, this medicine can cause adverse effects, although not all people suffer from them.

Apixaban can be administered in three different diseases. The known adverse effects and the frequency with which they occur may be different and are therefore indicated separately below. For these conditions, the most frequent adverse effect of apixaban is bleeding, which can endanger the patient's life and requires immediate medical attention.

The following adverse effects have been reported when taking apixaban to prevent the formation of blood clots after hip or knee replacement surgery.

Frequent Adverse Effects(may affect up to 1 in 10 people)

• Anemia, which can cause fatigue or paleness.
• Bleeding, including:
• • hematoma and swelling.
• Nausea (feeling of discomfort).

Uncommon Adverse Effects(may affect up to 1 in 100 people)

• Decrease in the number of platelets in the blood (which can affect coagulation).
• Bleeding:
• • after surgery, including hematoma and swelling, bleeding or fluid discharge from the wound/surgical incision (suppuration), or injection site,
  • from the stomach, intestine, or blood in the stool,
  • blood in the urine,
  • from the nose,
  • vaginal.
• Low blood pressure, which can cause fainting or a faster heart rate.
• Blood tests may show:
• • abnormal liver function,
  • increased liver enzymes,
  • increased bilirubin, a byproduct of red blood cells, which can cause yellowing of the skin and eyes.
• Itching.

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

• Allergic reactions (hypersensitivity) that can cause: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Inform your doctor immediatelyif you experience any of these symptoms.
• Bleeding:
• • in a muscle,
  • in the eyes,
  • from the gums and coughing up blood,
  • from the rectum,
• Hair loss.

Unknown Frequency(cannot be estimated from available data)

• Bleeding:
• • in the brain or spinal cord,
  • in the lungs or throat,
  • in the mouth,
  • in the abdomen or the space behind the abdominal cavity,
  • hemorrhoidal,
  • tests showing blood in the stool or urine.
• Skin rash that can form blisters and resemble small targets (dark spots in the center surrounded by a paler area, with a dark ring around) (erythema multiforme).
• Inflammation of the blood vessels (vasculitis) that can cause skin rash, appearance of red, round, and smooth spots under the skin surface, or bruising.

The following adverse effects have been reported when taking apixaban to prevent the formation of blood clots in the heart in patients with irregular heart rhythm and at least one additional risk factor.

Frequent Adverse Effects(may affect up to 1 in 10 people)

• Bleeding, including:
• • in the eyes,
  • in the stomach or intestine,
  • from the rectum,
  • blood in the urine,
  • from the nose,
  • from the gums,
  • hematoma and swelling.
• Anemia, which can cause fatigue or paleness.
• Low blood pressure, which can cause fainting or a faster heart rate.
• Nausea (general discomfort).
• Blood tests may show:
• • an increase in gamma-glutamyl transferase (GGT).

Uncommon Adverse Effects(may affect up to 1 in 100 people)

• Bleeding:
• • in the brain or spinal cord,
  • in the mouth or coughing up blood,
  • in the abdomen or vagina,
  • bright/red blood in the stool,
  • bleeding after surgery, including hematoma and swelling, bleeding or fluid discharge from the wound/surgical incision (suppuration), or injection site,
  • hemorrhoidal,
  • tests showing blood in the stool or urine.
• Decrease in the number of platelets in the blood (which can affect coagulation).
• Blood tests may show:
• • abnormal liver function,
  • increased liver enzymes,
  • increased bilirubin, a byproduct of red blood cells, which can cause yellowing of the skin and eyes.
• Skin rash.
• Itching.
• Hair loss.
• Allergic reactions (hypersensitivity) that can cause: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Inform your doctor immediatelyif you experience any of these symptoms.

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

• Bleeding:
• • in the lungs or throat,
  • in the space behind the abdominal cavity,
  • in a muscle.

Very Rare Adverse Effects(may affect up to 1 in 10,000 people)

• Skin rash that can form blisters and resemble small targets (dark spots in the center surrounded by a paler area, with a dark ring around) (erythema multiforme).

Unknown Frequency(cannot be estimated from available data)

• Inflammation of the blood vessels (vasculitis) that can cause skin rash, appearance of red, round, and smooth spots under the skin surface, or bruising.

The following adverse effects have been reported when taking apixaban to treat or prevent the recurrence of blood clots in the veins of the legs and in the blood vessels of the lungs.

Frequent Adverse Effects(may affect up to 1 in 10 people)

• Bleeding, including:
• • from the nose,
  • from the gums,
  • blood in the urine,
  • hematoma and swelling,
  • from the stomach, intestine, or rectum,
  • in the mouth,
  • vaginal.
• Anemia, which can cause fatigue or paleness.
• Decrease in the number of platelets in the blood (which can affect coagulation).
• Nausea (feeling of discomfort).
• Skin rash.
• Blood tests may show:
• • an increase in gamma-glutamyl transferase (GGT) or alanine aminotransferase (ALT).

Uncommon Adverse Effects(may affect up to 1 in 100 people)

• Low blood pressure, which can cause fainting or a faster heart rate.
• Bleeding:
• • in the eyes,
  • in the mouth or coughing up blood,
  • bright/red blood in the stool,
  • tests showing blood in the stool or urine,
  • bleeding after surgery, including hematoma and swelling, bleeding or fluid discharge from the wound/surgical incision (suppuration), or injection site,
  • hemorrhoidal,
  • in a muscle.
• Itching.
• Hair loss.
• Allergic reactions (hypersensitivity) that can cause: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Contact your doctor immediatelyif you experience any of these symptoms.
• Blood tests may show:
• • abnormal liver function,
  • increased liver enzymes,
  • increased bilirubin, a byproduct of red blood cells, which can cause yellowing of the skin and eyes.

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

• Bleeding:
• • in the brain or spinal cord,
  • in the lungs.

Unknown Frequency(cannot be estimated from available data)

• Bleeding:
• • in the abdomen or the space behind the abdominal cavity,
• Skin rash that can form blisters and resemble small targets (dark spots in the center surrounded by a paler area, with a dark ring around) (erythema multiforme).
• Inflammation of the blood vessels (vasculitis) that can cause skin rash, appearance of red, round, and smooth spots under the skin surface, or bruising.

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that is 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 adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Apixaban pensa

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

Do not use this medicine after the expiration date shown on the packaging and blister after CAD. The expiration date is the last day of the month indicated.

This medicine does not require special storage conditions.

Medicines should not be disposed of through wastewater or household waste. Deposit the packaging and medicines you no longer need at the SIGRE point in the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Apixaban pensa

• The active ingredient is apixaban. Each film-coated tablet contains 2.5 mg of apixaban.
• The other ingredients (excipients) are:
• • Core of the tablet:Lactose monohydrate, microcrystalline cellulose, sodium croscarmellose, sodium lauryl sulfate, magnesium stearate, and copovidone. See section 2 "Apixaban pensa contains lactose and sodium".
  • Coating:Lactose monohydrate, hypromellose, titanium dioxide (E171), triacetin, and yellow iron oxide (E172).

Appearance of the Product and Package Contents

Yellow, round (with a diameter of 6.1 mm), film-coated tablet, engraved with 'E23' on one side and nothing on the other.

Apixaban pensa 2.5 mg film-coated tablets EFG are available:

• in blisters in cardboard boxes of 10, 20, and 60 film-coated tablets.
• in bottles in cardboard boxes of 10, 20, and 60 film-coated tablets.

Not all pack sizes may be marketed.

Patient Information Card: Information Management

Attached to the outside of the Apixaban pensa cardboard box, you will find a Patient Information Card, or your doctor may give you a similar card.

This Patient Information Card includes useful information for you and will alert other doctors that you are taking Apixaban pensa. You must keep this card with you at all times.

1. Separate the card from the cardboard box.
2. Complete the following sections or ask your doctor to complete them:
   • Name:
   • Date of birth:
   • Indication:
   • Dose: mg twice a day
   • Doctor's name:
   • Doctor's phone number:
3. Fold the card and carry it with you at all times.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Towa Pharmaceutical, S.A.

C/ de Sant Martí, 75-97

08107 Martorelles (Barcelona)

Spain

Manufacturer:

Towa Pharmaceutical Europe, SL

c/ de Sant Martí 75-97

08107 Martorelles, Barcelona

Spain

This medicine is authorized in the Member States of the European Economic Area under the following names:

Italy: Apixaban Pensa

Portugal: Apixabano Pensa

Spain: Apixabán pensa 2.5 mg film-coated tablets EFG

Date of the Last Revision of this Leaflet:05/2024

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