CLARITHROMYCIN CINFA 250 mg FILM-COATED TABLETS

2. What you need to know before you take Claritromicina Cinfa

Do not take Claritromicina Cinfa

• If you are allergic to clarithromycin or any of the other components of this medication (listed in section 6).
• If you are allergic to other antibiotics in the macrolide group (the group to which clarithromycin belongs).
• If you have a creatinine clearance of less than 30 ml/min.
• If you have an irregular heartbeat.
• If you have severe kidney and liver problems.
• If you are taking ergotamine or dihydroergotamine or using ergotamine inhalers (for migraines) while taking clarithromycin. Consult your doctor for alternative medications.
• If you are taking medications called terfenadine, astemizole (medication for hay fever or allergies), cisapride, or domperidone (used for stomach problems) or pimozide (medication used to treat certain psychiatric disorders), as taking these medications with clarithromycin can cause serious heart rhythm disturbances. Consult your doctor for alternative medications.
• If you are taking ticagrelor (to prevent blood clots in your veins and used in heart attacks and other heart problems), ivabradine, or ranolazine (for angina pectoris).
• If you are taking other medications known to cause serious heart rhythm disturbances.
• If you are undergoing treatment with midazolam oral (for anxiety or to help fall asleep).
• If you or a family member has a history of heart rhythm disorders (ventricular cardiac arrhythmia, including Torsade de Pointes) or abnormalities in the electrocardiogram (ECG, electrical record of the heart) called "QT prolongation syndrome".
• If you are taking medications called lovastatin or simvastatin (to lower cholesterol levels), as the combination of these medications can increase the appearance of side effects. Consult your doctor for alternative medications.
• If you have abnormally low levels of potassium or magnesium in the blood (hypokalemia or hypomagnesemia).
• If you have a severe liver dysfunction along with kidney failure.
• If you are taking colchicine.
• If you are taking a medication with lomitapide.

Warnings and Precautions

Consult your doctor or pharmacist before starting to take Claritromicina Cinfa.

• If you have heart, kidney, or liver problems.
• If you have or are prone to fungal infections (such as thrush).
• If you are pregnant or breastfeeding.
• If you are taking medications known as colchicine, triazolam, midazolam (for anxiety or insomnia), lovastatin, simvastatin.
• If you are diabetic and taking hypoglycemic agents (medications to lower blood sugar levels, such as nateglinide, pioglitazone, rosiglitazone, and repaglinide, sulfonylureas, or insulin), and clarithromycin may lower blood sugar levels too much. Careful glucose monitoring is recommended.
• If you are taking a medication called warfarin (blood anticoagulant).
• If you have myasthenia gravis, a condition where your muscles weaken and tire easily.
• If you develop severe or prolonged diarrhea during or after taking clarithromycin, consult your doctor immediately.

If any of these situations affect you, consult your doctor before taking clarithromycin.

Children and Adolescents

Do not administer this medication to children under 12 years of age.

Elderly Patients

Since clarithromycin is eliminated by the liver and kidneys, caution should be exercised in patients with liver insufficiency, moderate or severe renal insufficiency, and in elderly patients.

Other Medications and Claritromicina Cinfa

Inform your doctor or pharmacist if you are taking, have recently taken, or may need to take any other medication.

• The following medications should not be taken with clarithromycin: astemizole, terfenadine (for allergies), cisapride (for gastrointestinal problems), domperidone, pimozide (for psychiatric disorders), ticagrelor, ranolazine, colchicine, some medications for high cholesterol, and medications known to cause serious heart rhythm disturbances (see "Do not take Claritromicina Cinfa").
• Warfarin or other anticoagulants, such as dabigatran, rivaroxaban, apixaban, edoxaban (to thin the blood).

This is especially important if you are taking medications for:

• Heart problems (such as digoxin, verapamil, quinidine, or disopyramide).
• Blood thinning (such as warfarin).
• Migraines (such as ergotamine or dihydroergotamine).
• Epilepsy or bipolar disorder (carbamazepine, valproate, phenobarbital, or phenytoin).
• High cholesterol (such as simvastatin or lovastatin).

Or if you are taking any medication called:

• Theophylline (used in patients with breathing difficulties, such as asthma).
• Triazolam, alprazolam, or midazolam (sedatives).
• Cilostazol (for poor circulation).
• Methylprednisolone (a corticosteroid).
• Ibrutinib or vinblastine (for cancer treatment).
• Cyclosporine (immunosuppressant).
• Rifabutin (for the treatment of certain infections).
• Tacrolimus or sirolimus (for organ transplants and severe eczema).
• Sildenafil, tadalafil, or vardenafil (for treating impotence in adult men or for pulmonary arterial hypertension).
• Zidovudine (for treating viruses).
• St. John's Wort (herbal product for treating depression).
• Phenobarbital (medication for treating epilepsy).
• Nevirapine and efavirenz may decrease clarithromycin levels.
• Rifampicin or rifapentine (for treating tuberculosis).
• Omeprazole (for treating stomach acidity and stomach or intestinal ulcers).
• Ritonavir (antiviral medication used in the treatment of HIV infection) may increase clarithromycin levels. The concomitant use of atazanavir, etravirine, and saquinavir (also antiviral medications used in the treatment of HIV infection) with clarithromycin may increase both atazanavir (or saquinavir) and clarithromycin levels.
• Itraconazole (an antifungal) taken with clarithromycin may increase the levels of both medications.
• Fluconazole, another antifungal medication, may increase clarithromycin levels.
• Tolterodine (for treating symptoms of overactive bladder). In some patients, tolterodine levels may increase when taken with clarithromycin.
• Quetiapine (for schizophrenia or other psychiatric conditions).
• Beta-lactam antibiotics (certain penicillins and cephalosporins).
• Aminoglycosides (used as antibiotics to treat infections).
• Calcium channel blockers (medications for treating high blood pressure).
• Hydroxychloroquine or chloroquine (used to treat diseases such as rheumatoid arthritis or to treat or prevent malaria). Taking these medications at the same time as clarithromycin may increase the risk of abnormal heart rhythms and other serious adverse reactions affecting the heart.
• Corticosteroids, administered orally, by injection, or inhaled (used to suppress the immune system; this is useful in the treatment of a wide range of diseases).

Taking Claritromicina Cinfa with Food

Claritromicina tablets can be taken before, during, or after meals, as the presence of food in the digestive tract does not modify the activity of the medication.

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 medication.

The safety of clarithromycin during pregnancy has not been established, so your doctor will carefully weigh the benefits against the potential risk, especially during the first three months of pregnancy.

Claritromycin passes into breast milk, so breastfeeding should be interrupted during treatment with clarithromycin.

Driving and Using Machines

Since clarithromycin can cause dizziness, vertigo, confusion, and disorientation, during treatment with clarithromycin, you should exercise extreme caution when driving or using hazardous machinery.

Claritromicina Cinfa contains Hydrogenated Castor Oil

This medication may cause stomach upset and diarrhea because it contains hydrogenated castor oil.

Claritromicina Cinfa contains Sodium

This medication contains less than 23 mg of sodium (1 mmol) per tablet; it is essentially "sodium-free".

3. How to take Claritromicina Cinfa

Follow exactly the administration instructions of this medication as indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

Claritromicina Cinfa is administered orally.

Adults and Children over 12 years:

Patients with respiratory tract, skin, and soft tissue infections

The recommended dose is 250 mg twice a day for 7 days, although in more severe infections, the dose may be increased to 500 mg twice a day. The usual duration of treatment is 5 to 14 days, excluding community-acquired pneumonia and sinusitis, which require 6 to 14 days of therapy.

Eradiation of Helicobacter pyloriin patients with duodenal ulcers (adults):

The recommended treatments are:

Triple therapy: one tablet of clarithromycin 500 mg twice a day, with 30 mg of lansoprazole twice a day and 1000 mg of amoxicillin twice a day for 10 days. Or one tablet of clarithromycin 500 mg with 1000 mg of amoxicillin and 20 mg of omeprazole, all administered twice a day, for 7 to 10 days.

Elderly Patients

As for adults.

Patients with mycobacterial infections:

The recommended average dose for the prevention and treatment of mycobacterial infections is one tablet of clarithromycin 500 mg every 12 hours. The duration of treatment should be established by the doctor.

Patients with Renal Insufficiency:

In patients with renal insufficiency and a creatinine clearance of less than 30 ml/min, the dose of clarithromycin should be reduced to half, i.e., 250 mg once a day, or 250 mg twice a day in more severe infections. In these patients, treatment should be interrupted at 14 days. Since the tablet cannot be halved, the daily dose cannot be less than 500 mg/day, so Claritromicina Cinfa 500 mg tablets should not be administered in this group of patients.

Follow these instructions unless your doctor has given you different instructions.

Remember to take your medication. Take the tablets at the same time every day. Your doctor will indicate the duration of your treatment.

Use in Children and Adolescents

The suitable presentations for children from 6 months and adolescents under 12 years are: clarithromycin 25 mg/ml granules for oral suspension and clarithromycin 50 mg/ml granules for oral suspension.

If you think the effect of clarithromycin is too strong or too weak, consult your doctor or pharmacist.

If you take more Claritromicina Cinfa than you should

If you have taken more clarithromycin than you should, you can expect the appearance of digestive disorders, and consult your doctor or pharmacist immediately, as they will try to quickly eliminate the clarithromycin that your body has not yet absorbed. Hemodialysis or peritoneal dialysis is not effective.

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 medication and the amount ingested.

If you forget to take Claritromicina Cinfa

Do not take a double dose to make up for forgotten doses. Take the tablet as soon as possible and continue taking it every day at the same time.

If you stop treatment with Claritromicina Cinfa

Do not stop treatment before, as even if you are already feeling better, your illness could worsen or reappear.

If you have any other questions about the use of this medication, ask your doctor or pharmacist.

4. Possible Adverse Effects

Like all medications, this medication can cause adverse effects, although not all people suffer from them.

Adverse effects are classified as very frequent (may affect more than 1 in 10 patients), frequent (may affect up to 1 in 10 patients), infrequent (may affect up to 1 in 100 patients), and of unknown frequency (cannot be estimated from available data).

The frequent and very frequent adverse reactions related to treatment with clarithromycin, in both adults and children, are abdominal pain, diarrhea, nausea, vomiting, and alteration of taste. These adverse reactions are usually mild and coincide with the known safety profile of macrolide antibiotics (see below).

There were no significant differences in the incidence of these gastrointestinal adverse reactions during clinical trials between the patient population with or without pre-existing mycobacterial infections.

Summary of Adverse Effects

Adverse effects are described in order of decreasing severity within the same body system:

• Very frequently observed (with the intravenous injection formulation): phlebitis (inflammation of the vein) at the injection site.

• Frequently observed with all medications containing clarithromycin:

• Digestive system: diarrhea, vomiting, gastric disorder that makes digestion difficult (dyspepsia), nausea, abdominal pain.
• Nervous system: alteration of taste, headache, alteration of taste.
• Skin: mild skin eruptions, excessive sweating.
• Psychiatric disorders: insomnia.
• Vascular disorders: dilation of blood vessels in the body (vasodilation).
• Liver disorders: abnormal liver function tests.
• Disorders at the administration site: pain and inflammation at the injection site (only with the intravenous injection formulation).

• Less frequently observed:

• Infections: cellulitis (only with the intravenous injection formulation), candidiasis (infection caused by a type of fungus), gastroenteritis (only with prolonged-release tablets), infection (only with oral suspension granules), vaginal infection.
• Blood disorders: decrease in white blood cells, decrease in neutrophils (a type of white blood cell, only with immediate-release tablets), increase in platelets and, to a lesser extent, red and white blood cells in the blood (only with oral suspension granules), increase in eosinophils (a type of white blood cell, only with immediate-release tablets).
• Immune system: anaphylactoid reaction (generalized allergic reaction, only with the intravenous injection formulation), hypersensitivity (exaggerated allergic reaction to external agents).
• Eating disorders: anorexia, decreased appetite.
• Psychiatric disorders: anxiety and nervousness (the latter only with oral suspension granules).
• Nervous system: loss of consciousness and difficulty moving (both effects, only with the intravenous injection formulation), dizziness, somnolence, tremors.
• Ear and balance: vertigo, hearing problems, tinnitus.
• Heart disorders: cardiac arrest and alteration of heart rhythm (atrial fibrillation) (both effects, only with the intravenous injection formulation), prolongation of the QT interval (indicator of the electrocardiogram that arrhythmias may occur), extrasystoles (premature heartbeat, only with the intravenous injection formulation), palpitations (alterations in heartbeats).
• Respiratory disorders: asthma (difficulty breathing, chest oppression, and nocturnal cough, only with the intravenous injection formulation), nasal bleeding (only with prolonged-release tablets), pulmonary embolism (blockage of the pulmonary artery that causes chest pain on one side, cough, and difficulty breathing, only with the intravenous injection formulation).
• Gastrointestinal disorders: esophagus inflammation (only with the intravenous injection formulation), gastroesophageal reflux disease (damage to the esophagus that causes a burning sensation, chronic cough, shortness of breath, and difficulty swallowing, only with prolonged-release tablets), stomach mucosa inflammation (gastritis), pain in the anus and rectum (only with prolonged-release tablets), oral mucosa inflammation, tongue inflammation, abdominal distension (only with immediate-release tablets), constipation, dry mouth, belching, flatulence.
• Liver disorders: decrease or suppression of bile flow to the intestine and liver inflammation (hepatitis) (both effects, only with immediate-release tablets), increase in alanine aminotransferase (liver enzyme), aspartate aminotransferase (another liver enzyme), and gamma-glutamyltransferase (another liver enzyme, only with immediate-release tablets).
• Skin: bullous dermatitis (bullous eruptions, only with the intravenous injection formulation), itching, urticaria (edematous, red, and very itchy skin lesions), maculopapular eruption (skin lesion with a papule or wart on a patch, only with oral suspension granules).
• Muscle disorders: muscle spasms (only with oral suspension granules), musculoskeletal rigidity (only with the intravenous injection formulation), muscle pain (only with prolonged-release tablets).
• Kidney disorders: increase in serum creatinine and serum urea (both effects, which indicate poorer kidney function, only with the intravenous injection formulation).
• General disorders: discomfort (only with immediate-release tablets), chest pain, chills, and fatigue (the last three, only with immediate-release tablets).
• Laboratory analysis: abnormal albumin-globulin ratio (only with the intravenous injection formulation), increase in serum alkaline phosphatase and increase in blood lactate dehydrogenase (the last two, only with immediate-release tablets).

• With unknown frequency, the following have been observed:

• Infections: pseudomembranous colitis (diarrhea that can become severe), erysipelas (redness of the skin of variable extent that can cause pain, itching, and fever).
• Blood disorders: decrease in neutrophils (a type of white blood cell), decrease in platelets.
• Immune system: anaphylactic reaction (generalized allergic reaction), angioedema (swelling under the skin).
• Psychiatric disorders: psychotic disorder, confusion, depersonalization, depression, disorientation, hallucinations, daydreaming (attenuated perceptions of external stimuli).
• Nervous system: convulsions, decrease or loss of sense of taste, alteration of sense of smell, loss or decrease of sense of smell, sensation of tingling, numbness, or prickling in hands, feet, arms, or legs.
• Ear: deafness.
• Heart disorders: Torsades de pointes(a type of ventricular tachycardia), ventricular tachycardia (acceleration of heartbeats with more than 100 beats/minute with at least 3 consecutive irregular beats).
• Vascular disorders: hemorrhage.
• Digestive disorders: acute pancreatitis (inflammation of the pancreas), discoloration of the tongue, discoloration of the teeth.
• Liver disorders: liver failure, hepatocellular jaundice (yellowing of the skin and eyes).
• Skin: Stevens-Johnson syndrome (generalized eruption with blisters and peeling of the skin, mainly affecting genital, oral, and trunk areas), acute generalized exanthematous pustulosis (generalized scaly red eruption with bumps under the skin and blisters, accompanied by fever, mainly located in skin folds, trunk, and upper limbs) and toxic epidermal necrolysis (generalized eruption with blisters and peeling of the skin, particularly around the mouth, nose, eyes, and genitals, causing generalized skin peeling (more than 30% of the body surface) with flu-like symptoms, fever, lymph node inflammation, and abnormal blood test results (such as increased white blood cells (eosinophilia) and elevated liver enzymes) [drug reaction with eosinophilia and systemic symptoms (DRESS)] acne. If such reactions occur, treatment with clarithromycin should be discontinued immediately and a suitable treatment should be initiated by a doctor.
• Muscle disorders: rhabdomyolysis (muscle breakdown that can cause kidney damage), myopathy (muscle disease of multiple causes).
• Kidney disorder: kidney failure, interstitial nephritis (inflammation of the renal tubules).
• Laboratory analysis: increase in international normalized ratio (calculation to detect blood coagulation), prolongation of prothrombin time (indicates a deficit in blood coagulation) and abnormal urine color.

Specific Adverse Effects

Phlebitis at the injection site, pain at the injection site, pain at the venipuncture site, and inflammation at the injection site are specific to the intravenous formulation of clarithromycin.

After the marketing of the medication, reports of effects on the central nervous system (e.g., somnolence and confusion) have been received with the simultaneous use of clarithromycin and triazolam. It is suggested to monitor the patient.

In some reports of rhabdomyolysis, clarithromycin was administered concomitantly with statins, fibrates, colchicine, or allopurinol (see "Do not take clarithromycin cinfa" and "Warnings and precautions").

There have been rare reports that prolonged-release clarithromycin tablets appear in the feces; many of these cases have occurred in patients with gastrointestinal anatomical disorders [including ileostomy or colostomy (surgery to expel intestinal waste artificially from the ileum or colon)] or functional disorders (caused by a defect in the body) with shortened gastrointestinal transit time. In several reports, tablet residues have appeared in the context of diarrhea. It is recommended that patients who present with tablet residues in the feces and who do not experience any improvement change to another formulation of clarithromycin (e.g., suspension) or to another antibiotic.

Pediatric Population

It is expected that the frequency, type, and severity of adverse reactions in children will be the same as in adults.

Immunocompromised Patients

In patients with AIDS and other patients with a damaged immune system, treated with the highest doses of clarithromycin for long periods of time for mycobacterial infections, it is often difficult to distinguish adverse effects possibly associated with the administration of clarithromycin from effects caused by the disease or by other diseases that the patient may have along with AIDS.

In adult patients treated with total daily doses of 1,000 mg and 2,000 mg of clarithromycin, the most frequent adverse reactions that appeared were: nausea, vomiting, alteration of taste, abdominal pain, diarrhea, skin eruption, flatulence, headache, constipation, hearing disturbances, and elevations in transaminases (which may indicate liver, pancreas, heart, or muscle damage). Less frequently, difficulty breathing, insomnia, and dry mouth appeared. The incidences were similar in patients treated with 1,000 mg and 2,000 mg, but in general, they were 3 to 4 times more frequent in those who received a total daily dose of 4,000 mg of clarithromycin.

In these immunocompromised patients, around 2% to 3% who received 1,000 mg or 2,000 mg of clarithromycin daily presented severely abnormal elevated transaminase levels, as well as abnormally low white blood cell and platelet counts. A smaller percentage of patients in both dosage groups had increased blood levels of urea nitrogen (which may indicate decreased renal function). In patients who received 4,000 mg daily, slightly higher incidences of abnormal values were observed in all parameters, except for the white blood cell count.

Contact a doctor as soon as possible if you experience a severe skin reaction: a red and scaly eruption with bumps under the skin and blisters (pustular exanthematous eruption). The frequency of this adverse effect is considered unknown (cannot be estimated from available data).

Reporting of Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that does not appear in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medications: https://www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medication.

5. Conservation of Clarithromycin Cinfa

Keep this medication out of sight and reach of children.

Do not use this medication after the expiration date that appears on the packaging, after "CAD". The expiration date is the last day of the month indicated.

Do not store at a temperature above 30°C.

Medications should not be thrown down the drain or into the trash. Deposit the packaging and medications 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 medications you no longer need. This way, you will help protect the environment.

6. Package Contents and Additional Information

Composition of Clarithromycin Cinfa

• The active ingredient is clarithromycin. Each tablet contains 250 mg of clarithromycin.
• The other components are:

Core of the tablet:Hydrogenated castor oil, sodium croscarmellose, anhydrous colloidal silica, talc, microcrystalline cellulose, magnesium stearate.

Tablet coating:Titanium dioxide (E-171), quinoline yellow (E-104), yellow iron oxide (E-172), hypromellose, and hydroxypropylcellulose.

Appearance of the Product and Package Contents

Clarithromycin Cinfa is presented in the form of yellow, oblong, biconvex, film-coated tablets. Each package contains 14 or 500 (clinical package) tablets.

Only some package sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Date of the Last Revision of this Prospectus:March 2024

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

You can access detailed and updated information about this medication by scanning the QR code included in the prospectus and packaging with your smartphone. You can also access this information at the following internet address:

https://cima.aemps.es/cima/dochtml/p/67638/P_67638.html

QR code to: https://cima.aemps.es/cima/dochtml/p/67638/P_67638.html