ATAMAX 25 mg HARD CAPSULES

2. What you need to know before you take Atamax

Do not takeAtamax:

• if you are allergic to atomoxetine or any of the other ingredients of this medicine (listed in section 6).
• if you have taken a medicine called a monoamine oxidase inhibitor (MAOI), such as phenelzine, within the last two weeks. MAOIs are sometimes used for depression and other mental health conditions; taking Atamax with an MAOI could cause serious side effects or be life-threatening. You should also wait at least 14 days after stopping MAOI treatment before taking Atamax.
• if you have an eye problem called narrow-angle glaucoma (increased pressure in the eye).
• if you have serious heart problems that may get worse with an increase in heart rate and/or blood pressure, as this may be an effect of Atamax.
• if you have serious blood vessel problems in the brain, such as stroke, inflammation, and weakening of a blood vessel (aneurysm) or narrowed or blocked blood vessels.
• if you have a tumour of the adrenal gland (pheochromocytoma).

Do not take Atamax if any of the above apply to you. If you are not sure, consult your doctor or pharmacist before taking this medicine. The reason is that this medicine may make these problems worse.

Warnings and precautions

Both adults and children should be aware of the following warnings and precautions. Consult your doctor or pharmacist before starting to take Atamax if you:

• have serotonin syndrome

Serotonin syndrome is a potentially life-threatening condition that may occur when taking Atamax in combination with other medicines (see section 2 "Other medicines and Atamax"). The signs and symptoms of serotonin syndrome can include a combination of the following: confusion, agitation, lack of coordination, and stiffness, hallucinations, coma, rapid heartbeat, increased body temperature, rapid changes in blood pressure, sweating, flushing, tremors, hyperactive reflexes, nausea, vomiting, and diarrhea. Contact a doctor or go immediately to the emergency department of the nearest hospital if you think you are experiencing serotonin syndrome.

• the treatment with Atamax may make you feel aggressive, hostile, or violent; or worsen these symptoms if they were present before treatment. It may also cause unusual changes in behavior or mood (including physical aggression, threatening behavior, and thoughts of harming others). If you or your family and/or friends notice any of these reactions, talk to your doctor or pharmacist immediately.
• have suicidal thoughts or attempted suicide.
• have heart problems (including heart defects) or an increased heart rate. Atamax may increase your heart rate (pulse). There have been reports of sudden death in patients with heart defects.
• have high blood pressure. Atamax may increase your blood pressure.
• have low blood pressure. Atamax may cause dizziness or fainting in people with low blood pressure.
• have problems with sudden changes in blood pressure or heart rate.
• have cardiovascular disease or a history of stroke.
• have liver problems. You may need a lower dose.
• have psychotic symptoms, including hallucinations (hearing voices or seeing unreal things), believing things that are not true, or being suspicious.
• have mania (feeling elated or overexcited, which leads to unusual behavior) and agitation.
• have aggression.
• have feelings of hostility and anger.
• have a history of epilepsy or have had seizures for any other reason. Atamax may increase the frequency of seizures.
• have mood swings or feelings of unhappiness.
• have repeated spasms that are difficult to control of any part of the body or repetition of sounds and words.

Talk to your doctor or pharmacist if you have any of the symptoms mentioned above before starting treatment. The reason is that Atamax may make these problems worse. Your doctor will want to monitor how the medicine affects you.

Tests that your doctor will perform before you start taking Atamax

These tests are to decide if Atamax is the right medicine for you.

Your doctor will measure your:

• blood pressure and heart rate (pulse) before and while you are taking Atamax
• weight and height if you are a child or adolescent while you are taking Atamax

Your doctor will ask you about:

• other medicines you are taking
• if you have a family history of sudden death
• any other medical problems (such as heart problems) that you or your family may have

It is important that you provide all the information you can. This will help your doctor decide if Atamax is the right medicine for you. Your doctor may decide that other medical tests are needed before starting treatment with this medicine.

Important information about the contents of the capsules

Do not open Atamax capsules because the contents of the capsule can irritate the eye. If the contents of the capsules come into contact with the eye, you should immediately wash the affected eye with water and consult a doctor. The hands and any other part of the body that may have come into contact with the contents of the capsule should also be washed as soon as possible.

Other medicines andAtamax

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. This includes medicines bought without a prescription. Your doctor will decide if you can take Atamax with your other medicines and in some cases, your doctor may need to adjust your dose or increase your dose more slowly.

Do not take Atamax with medicines called MAOIs (monoamine oxidase inhibitors) used for depression. See section 2 "Do not take Atamax".

If you are taking other medicines, Atamax may affect how they work or cause side effects.

If you are taking any of the following medicines, check with your doctor or pharmacist before taking Atamax.

Atamax may be affected by or affect other medicines, including:

• certain antidepressants, opioids such as tramadol, and medicines used to treat migraine called triptans. These medicines may interact with Atamax and cause serotonin syndrome, a potentially life-threatening condition (see section 2, Warnings and precautions, Serotonin syndrome).
• medicines that increase blood pressure or are used to control blood pressure
• medicines such as antidepressants, for example, imipramine, venlafaxine, mirtazapine, fluoxetine, and paroxetine
• certain cough and cold remedies that contain medicines that can affect blood pressure. It is important to check with your pharmacist when you buy these products.
• certain medicines used to treat mental health conditions
• medicines known to increase the risk of seizures
• certain medicines that make Atamax stay in the body longer than usual

(such as quinidine and terbinafine)

• salbutamol (a medicine for asthma) when taken orally or injected may cause a feeling that your heart is racing, but this will not make your asthma worse.

The medicines described below may increase the risk of abnormal heart rhythm when taken with Atamax:

• medicines used to control heart rhythm
• medicines that alter the salt content of the blood
• medicines for the prevention and treatment of malaria
• certain antibiotics (such as erythromycin and moxifloxacin).

If you are not sure if the medicines you are taking are included in the list above, consult your doctor or pharmacist before taking Atamax.

Pregnancy and breastfeeding

There is no information on whether this medicine can affect the unborn child or pass into breast milk.

• This medicine should not be taken during pregnancy, unless your doctor recommends it.
• You should avoid taking this medicine if you are breastfeeding or stop 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.

Driving and using machines

Atamax may cause tiredness, drowsiness, or dizziness. Be careful when driving or using machinery until you know how Atamax affects you. If you feel tired, drowsy, or dizzy, do not drive or use machinery.

Atamax contains sodium

This medicine contains less than 23 mg of sodium (1 mmol) per capsule; this is essentially "sodium-free".

3. How to take Atamax

• Always take this medicine exactly as your doctor or pharmacist has told you. If you are not sure, check with your doctor or pharmacist. The recommended dose is once or twice daily (morning and late afternoon or early evening).
• Children should not take this medicine without the help of an adult.
• If you are taking Atamax once daily and feel drowsy or unwell, your doctor may change your treatment schedule to twice daily.
• Take orally.
• The capsules should be swallowed whole, with or without food.
• The capsules should not be opened and the contents of the capsules should not be removed or taken in any other way.
• Taking the medicine at the same time each day can help you remember to take it.

How much to take

If you are a child (from 6 years) or an adolescent:

Your doctor will tell you how much Atamax to take and will calculate it according to your weight. Normally, your doctor will start with a lower dose and then increase the amount of Atamax according to your body weight.

• Body weight up to 70 kg: starting with a total daily dose of 0.5 mg per kg of body weight for a minimum of 7 days. Your doctor will then decide if the dose should be increased to the usual maintenance dose of 1.2 mg per kg of body weight per day.
• Body weight over 70 kg: starting with a total daily dose of 40 mg for a minimum of 7 days. Your doctor will then decide if the dose should be increased to the usual maintenance dose of 80 mg per day. The maximum daily dose that your doctor will prescribe is 100 mg.

Adults

• Treatment with Atamax should be started with a total daily dose of 40 mg for a minimum of 7 days. Your doctor will then decide if the dose should be increased to the usual maintenance dose of 80-100 mg per day. The maximum daily dose that your doctor will prescribe is 100 mg.

If you have liver problems, your doctor may prescribe a lower dose.

What your doctor will do while you are taking Atamax

Your doctor will perform some tests

• before you start - to make sure Atamax is safe and will benefit you.
• after you have started - the tests will be done at least every 6 months, although they may be more frequent.

The tests will also be done when the dose is changed. These tests will include:

• measuring height and weight in children and adolescents.
• measuring blood pressure and heart rate.
• checking if you have any problems or if side effects have worsened while taking Atamax.

Long-term treatment

Atamax does not need to be taken indefinitely. If you take Atamax for more than a year, your doctor should review your treatment to check if the medicine is still needed.

If you take moreAtamaxthan you shouldcontact your doctor or the emergency department of the nearest hospital immediately and tell them how many capsules you have taken. The symptoms most commonly reported after an overdose are gastrointestinal symptoms, drowsiness, dizziness, tremors, and abnormal behavior. Very rarely, serotonin syndrome, a potentially life-threatening condition, has also been reported (see section 2, Warnings and precautions, Serotonin syndrome).

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 Atamax

If you miss a dose, take another as soon as possible, but do not take more than the total daily dose in a 24-hour period. Do not take a double dose to make up for missed doses.

If you stop taking Atamax

If you stop taking Atamax, you will not normally get any side effects, but the symptoms of ADHD may come back. You should talk to your doctor before stopping treatment.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. Possible Adverse Effects

Like all medicines, this medicine can cause adverse effects, although not all people suffer from them. Although some people suffer from adverse effects, most people consider that Atamax helps them. Your doctor will talk to you about these adverse effects.

Some adverse effects could be serious. If you experience any of the following effects, contact your doctor immediately.

Uncommon(may affect up to 1 in 100 people)

• feeling or having a very fast heart rate, abnormal heart rhythm
• suicidal thoughts or feelings
• feeling aggressive
• feeling of hostility or anger
• mood swings or changes in mood
• severe allergic reaction with symptoms of:
• swelling of the face and throat
• difficulty breathing
• hives (itchy, raised, red patches)
• seizures
• psychotic symptoms including hallucinations (hearing voices or seeing things that do not exist), believing things that are not true, or being suspicious.

Children and adolescents under 18 years of age have a higher risk of suffering from adverse effects such as:

• suicidal thoughts or feelings (may affect up to 1 in 100 people)
• mood swings or changes in mood (may affect up to 1 in 10 people)

Adults have a lower risk(may affect up to 1 in 1,000 people) of suffering from adverse effects such as:

• seizures
• psychotic symptoms including hallucinations (such as hearing voices or seeing things that do not exist), believing things that are not true, or being suspicious.

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

• liver problems

Stop treatment with Atamax and contact your doctor immediately if you experience any of the following adverse effects:

• dark urine
• yellowing of the skin and eyes
• abdominal pain when pressed (tenderness) in the upper right part of the abdomen, just below the ribs
• unexplained nausea
• fatigue
• itching
• feeling of having a cold

Other reported adverse effects are as follows. If any of them worsen, consult your doctor or pharmacist.

Effects on Growth

Some children experience decreased growth (weight and height) when they start taking Atamax. However, with long-term treatment, children recover the expected weight and height for their age group. Your doctor will monitor your child's height and weight over time. If your child is not growing or gaining weight as expected, your doctor may change the dose of Atamax or decide to temporarily suspend treatment with Atamax.

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 Atamax

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

Do not use this medicine after the expiration date stated on the packaging and on the blister pack after the abbreviation "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 via wastewater or household waste. Deposit the packaging and medicines that you no longer need in the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medicines that you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Atamax

• The active ingredient is atomoxetine.

Each hard capsule contains 25 mg of atomoxetine, equivalent to 28.57 mg of atomoxetine hydrochloride.

• The other ingredients are

Capsule content:pregelatinized corn starch, anhydrous colloidal silica, and dimethicone.

Capsule shell:gelatin, sodium lauryl sulfate (E487), titanium dioxide (E171), indigo carmine (E132), and purified water.

• Printing ink (black) composed of: Shellac Glaze-45% (20% esterified) in ethanol, black iron oxide (E172), and propylene glycol.

Appearance of the Product and Package Contents

Hard gelatin capsule containing white powder, size 3 (length of 15.7±0.4 mm), with a blue opaque cap with '25' printed in black ink and a white opaque body with 'mg' printed in black ink.

Atamax is available in blister packs in a cardboard box.

Available in packs of 7, 14, 28, and 56 hard capsules.

Not all pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

LABORATORIOS RUBIÓ, S.A.

Industria, 29

Pol. Ind. Comte de Sert

08755 Castellbisbal

Barcelona – Spain

Manufacturer:

Pharmathen International S.A.

Industrial Park Sapes, Rodopi Prefecture, Block No.5

69300 Rodopi

Greece

or

Pharmathen S.A.

6, Dervenakion Str

15351 Pallini Attikis

Greece

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

Austria Atomoxetin Pharmathen 25 mg hard capsules

Greece ATAMA καψ?κιο σκληρ? 25 mg

Germany ATAMA 25 mg hard capsules

Spain Atamax 25 mg hard capsules EFG

Date of the Last Revision of this Leaflet:November 2024

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