APIXABAN SANDOZ 5 mg FILM-COATED TABLETS

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

Do not take Apixaban Sandoz if:

• if you are allergicto apixaban or any of the other ingredients of this medicine (listed in section 6),
• if you bleed excessively,
• if you have an organ diseasethat increases the risk of severe bleeding (such as an active or recent stomach or intestinal ulcer, or recent brain hemorrhage),
• if you have a liver diseasethat increases the risk of bleeding (hepatic coagulopathy),
• if 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 having a tube inserted into a blood vessel (catheter ablation) to treat an irregular heartbeat (arrhythmia).

Warnings and precautions

Tell your doctor, pharmacist, or nurse before you start taking this medicine if you have any of these conditions:

• an increased 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 alteration,

• 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,
• 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

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

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

Children and adolescents

This medicine is not recommended for children and adolescents under 18 years of age.

Other medicines and Apixaban Sandoz

Tell your doctor, pharmacist, or nurse if you are using, have recently used, or might use 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 possibility 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-inflammatoryor 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 probability of bleeding,
• medicines for high blood pressure or heart problems(e.g., diltiazem),
• antidepressantscalled selective serotonin reuptake inhibitorsor serotonin-noradrenaline reuptake inhibitors.

The following medicines may reduce the ability of apixaban to prevent blood clots.

• medicines for the treatment of epilepsy or convulsions(e.g., phenytoin, etc.),
• St. John's Wort(a herbal medicine for the treatment of depression),
• medicines for the treatment of tuberculosisor 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 this medicine 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 this medicine is excreted in human milk. Ask your doctor or pharmacist for advice before taking this medicine during breastfeeding. They will tell you whether to interrupt breastfeeding or whether to stop or not start taking this medicine.

Driving and using machines

Apixaban has no influence on the ability to drive or use machines.

Apixaban Sandoz contains lactose (a type of sugar) and sodium

If your doctor has told you that you have an intolerance to some sugars, consult with 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 Sandoz

Always take this medicine exactly as your doctor or pharmacist has told you. If you are not sure, check with your doctor, pharmacist, or nurse.

Dose

Take the tablet with water. Apixaban can be taken with or without food.

Try to take the tablets at the same time each day to achieve a better effect of the treatment.

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, mixing the powder with a small amount, e.g., 30 ml (2 tablespoons), of water or any of the other liquids mentioned to make the mixture.
• Take the mixture.
• Rinse the mortar and the pestle 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 Sandoz according to the following recommendations:

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 of apixaban is one 5 mg tablet twice a day.

The recommended dose of apixaban is one 2.5 mg tablet twice a day if:

• you have severely decreased kidney function
• you have two or more of the following factors:
• • your blood test results suggest poor kidney function(the serum creatinine 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, e.g., take one tablet in the morning and one in the evening.

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

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

The recommended dose of apixaban is two 5 mg tablets twice a day for the first 7 days, e.g., two tablets in the morning and two tablets in the evening.

After 7 days, the recommended dose of apixaban is one 5 mg tablet twice a day, e.g., one tablet in the morning and one in the evening.

To prevent blood clots from happening again after 6 months of treatment

The recommended dose of apixaban is one 2.5 mg tablet twice a day, e.g., one tablet in the morning and one in the evening.

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

Your doctor may change your anticoagulant treatment as follows:

Switching from Apixaban Sandoz to other anticoagulant medicines

Stop taking Apixaban Sandoz. Start treatment with other anticoagulant medicines (e.g., heparin) at the time you would have taken the next Apixaban Sandoz tablet.

Switching from other anticoagulant medicines to Apixaban Sandoz

Stop taking other anticoagulant medicines. Start treatment with Apixaban Sandoz at the time you would have taken the next dose of an anticoagulant medicine, and then continue as usual.

Switching from a treatment with anticoagulants that contain Vitamin K antagonists (e.g., warfarin) to Apixaban Sandoz

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 Sandoz.

Switching from Apixaban Sandoz 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 Sandoz 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 Sandoz.

Patients undergoing cardioversion

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

If you take more Apixaban Sandoz than you should

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

If you take more Apixaban Sandoz 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, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medicine and the amount taken.

If you forget to take Apixaban Sandoz

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 are not sure what to do or if you have forgotten to take more than one dose,ask your doctor, pharmacist, or nurse.

If you stop taking Apixaban Sandoz

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

If you have any further questions on 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. The most frequent adverse effect of this medicine is bleeding, which can put the patient's life at risk and requires immediate medical attention.

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 that 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, secretion of blood or fluid 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,
  • increase in some liver enzymes,
  • increase in 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 blood vessels (vasculitis) that can cause skin rash or pinpoint, flat, red, and round spots under the skin surface or bruising.

The following adverse effects have been reported when taking apixaban to treat or prevent blood clots from forming again 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,
  • in 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 (general 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 that 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, secretion of blood or fluid 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. Inform your doctor immediatelyif you experience any of these symptoms.
• Blood tests may show:
• • abnormal liver function,
  • increase in some liver enzymes,
  • increase in 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 spine,
  • 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 blood vessels (vasculitis) that can cause skin rash or pinpoint, flat, red, and round spots under the skin surface or bruising.

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor, pharmacist, or nurse, 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 Sandoz

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

Do not use this medicine after the expiration date stated on the carton and on each blister, after "EXP". 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 via wastewater or household waste. Deposit the packaging and any unused medicines in the pharmacy's SIGRE collection point. If in doubt, ask your pharmacist how to dispose of the packaging and any unused medicines. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Apixaban Sandoz

• The active ingredient is apixaban. Each film-coated tablet contains 5 mg of apixaban.
• The other ingredients are:
• • Core of the tablet: lactose monohydrate, microcrystalline cellulose, sodium croscarmellose, sodium lauryl sulfate, magnesium stearate.
  • Coating: hypromellose, hydroxypropylcellulose, macrogol 6000, titanium dioxide (E171), red iron oxide (E172), yellow iron oxide (E172).

See section 2 "Apixaban Sandoz contains lactose (a type of sugar) and sodium".

Appearance of the Product and Package Contents

Apixaban Sandoz 5 mg are film-coated tablets (tablets) pink, oval, biconvex, engraved with "AX" on one side and with "5" on the other side, with a width of 5.0 - 5.7 mm and a length of 9.6 - 10.3 mm.

The product is available in:

Alu-PVC/PVdC blisters in packs of 10, 12, 14, 20, 28, 30, 56, 60, 100, 168, 180, and 200 film-coated tablets.

Perforated unit-dose Alu-PVC/PVdC blisters in packs of 20x1, 30x1, 60x1, 100x1, and 168x1, and 180x1 film-coated tablets.

HDPE/PP bottle of 200 film-coated tablets.

Not all pack sizes may be marketed.

Patient Information Card: Information Management

Inside the Apixaban Sandoz package, along with the leaflet, you will find a Patient Information Card or your healthcare professional may give you a similar card.

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

1. Take the card
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:
• 1. Fold the card and carry it with you at all times

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Sandoz Farmacéutica, S.A.

Centro Empresarial Parque Norte

Edificio Roble

C/ Serrano Galvache, 56

28033 Madrid

Spain

Manufacturer

Lek Pharmaceuticals d.d.

Verovskova ulica 57

1526 Ljubljana

Slovenia

or

Lek S.A.

Ul. Podlipie 16

95 010 Strykow

Poland

This medicine is authorized in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland) under the following names:

Netherlands: Apixaban Sandoz 5 mg, filmomhulde tabletten

Austria: Apixaban Sandoz 5 mg - Filmtabletten

Belgium: Apixaban Sandoz 5 mg filmomhulde tabletten

Czech Republic: Apixaban Sandoz

Denmark: Apixaban Sandoz

Greece: Apixaban/Sandoz F.C. TAB 5 mg

Finland: Apixaban Sandoz

France: APIXABAN SANDOZ 5 mg, comprimé pelliculé

Hungary: Apixaban Sandoz 5 mg filmtabletta

Ireland: Apixaban Rowex 5 mg film-coated tablets

Iceland: Apixaban Sandoz

Italy: Apixaban Sandoz

Norway: Apixaban Sandoz

Portugal: Apixaban Sandoz

Sweden: Apixaban Sandoz

Slovakia: Apixaban Sandoz 5 mg

United Kingdom (Northern Ireland): Apixaban Sandoz 5 mg Film coated tablets

Date of the last revision of this leaflet:February 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/