ESOMEPRAZOL TEVA 20 mg HARD GASTRO-RESISTANT CAPSULES

2. What you need to know before you take Esomeprazol Teva

Do not take Esomeprazol Teva

• if you are allergic to esomeprazol or any of the other ingredients of this medicine (listed in section 6),
• if you are allergic to other proton pump inhibitors (e.g. pantoprazole, lansoprazole, rabeprazole, omeprazol),
• if you are taking a medicine containing nelfinavir (used to treat HIV).

Do not take Esomeprazol Teva if any of the above applies to you. If you are not sure, talk to your doctor or pharmacist before taking Esomeprazol Teva.

Warnings and precautions

Tell your doctor or pharmacist before taking Esomeprazol Teva if:

• You have severe liver problems.

• You have severe kidney problems.
• You have ever had a skin reaction after treatment with a medicine similar to Esomeprazol Teva to reduce stomach acid.
• You are due to have a specific blood test (Chromogranin A).

Esomeprazol Teva may hide the symptoms of other diseases. Therefore, if any of the following happen to you before you start taking Esomeprazol Teva or while you are taking it, talk to your doctor immediately:

• You lose a lot of weight for no reason and have problems swallowing.
• You have stomach pain or indigestion.
• You start vomiting food or blood.
• Your stools are black (blood-stained).

If your doctor has prescribed Esomeprazol Teva for you, and you get any of these symptoms, you should contact your doctor immediately.

Taking a proton pump inhibitor like Esomeprazol Teva, especially over a period of more than one year, may slightly increase your risk of fracture of the hip, wrist, or spine. Tell your doctor if you have osteoporosis or if you are taking corticosteroids (which can increase the risk of osteoporosis).

Skin and mucosal reactions

If you get a rash on your skin, especially in areas exposed to the sun, tell your doctor as soon as possible, as you may need to stop your treatment with Esomeprazol Teva. Also remember to mention any other symptoms that you may have, such as joint pain or difficulty breathing.

Severe skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis have been reported with esomeprazol (see also section 4). The rash may appear as a collection of small pus-filled bumps that can merge to form a larger area of red, swollen skin that blisters and peels, accompanied by fever, headache, and/or swollen lymph nodes. If you develop a rash or these skin symptoms, stop taking Esomeprazol Teva and contact your doctor immediately.

Children under 12 years

Esomeprazol Teva should not be used in children under 12 years since no data are available.

Other medicines and Esomeprazol Teva

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines that you can buy without a prescription. This is because Esomeprazol Teva can affect the way some medicines work and some medicines may have an effect on Esomeprazol Teva.

Do not take Esomeprazol Teva if you are taking a medicine containing nelfinavir(used to treat HIV).

Tell your doctor or pharmacist if you are taking any of the following medicines:

• Atazanavir (used to treat HIV infection).
• Clopidogrel (used to prevent blood clots).
• Ketoconazole, itraconazole or voriconazole (used to treat fungal infections).
• Erlotinib (used to treat cancer).
• Citalopram, imipramine or clomipramine (used to treat depression).
• Diazepam (used to treat anxiety, relax muscles or in epilepsy).
• Phenytoin (used in epilepsy). If you are taking phenytoin, your doctor will need to monitor you when you start or stop taking Esomeprazol Teva.
• Medicines used to thin the blood, such as warfarin. Your doctor will need to monitor you when you start or stop taking Esomeprazol Teva.
• Cilostazol (used to treat intermittent claudication – a pain in your legs when you walk which is caused by an insufficient blood supply).
• Cisapride (used for indigestion and heartburn),
• Digoxin (used for heart problems)
• Methotrexate (a chemotherapy medicine used at high doses to treat cancer) – if you are taking high doses of methotrexate, your doctor may need to temporarily stop your Esomeprazol Teva treatment.
• Tacrolimus (organ transplantation)
• Rifampicin (used to treat tuberculosis).
• St John’s Wort (Hypericum perforatum) (used to treat depression)

If your doctor has prescribed the antibiotics amoxicillin and clarithromycin with Esomeprazol Teva to treat ulcers caused by Helicobacter pyloriinfection, it is very important that you tell your doctor about any other medicines you are taking.

Taking Esomeprazol Teva with food and drink

You can take your capsules with food or on an empty stomach.

Pregnancy, breast-feeding and fertility

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

Your doctor will decide whether you can take Esomeprazol Teva during this time.

It is not known if Esomeprazol Teva passes into breast milk. Therefore, you should not take Esomeprazol Teva if you are breast-feeding.

Driving and using machines

Esomeprazol Teva is unlikely to affect your ability to drive or use any tools or machines.

However, sometimes side effects such as dizziness or blurred vision (see section 4) can occur. Do not drive or use any tools or machines if you are affected in this way.

Esomeprazol Teva contains sodium

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

Esomeprazol Teva contains sucrose

This medicine contains sucrose, a type of sugar. If your doctor has told you that you have an intolerance to some sugars, contact them before taking this medicine.

3. How to take Esomeprazol Teva

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

• If you are taking this medicine for a long time, your doctor will want to monitor you (particularly if you are taking it for more than one year).
• If your doctor has told you to take this medicine as and when you need it, tell your doctor if your symptoms change.

How much to take

• Your doctor will tell you how many capsules to take and for how long. This will depend on your condition, age, and how well your liver works.

• The recommended dose is as follows:

Use in adults aged 18 years and older

To treat heartburn caused by gastroesophageal reflux disease (GERD):

• If your doctor has found that your oesophagus (gullet) is slightly damaged, the recommended dose is one 40 mg gastro-resistant capsule of Esomeprazol Teva once a day for 4 weeks. Your doctor may tell you to take the same dose for another 4 weeks if your gullet has not healed.
• The recommended dose once the gullet has healed is one 20 mg gastro-resistant capsule of Esomeprazol Teva once a day.
• If your gullet has not been damaged, the recommended dose is one 20 mg gastro-resistant capsule of Esomeprazol Teva once a day. Once the condition has been controlled, your doctor may tell you to take your medicine as and when you need it, up to a maximum of one 20 mg gastro-resistant capsule of Esomeprazol Teva per day.
• If you have severe liver problems, your doctor will give you a lower dose.

To treat ulcers caused by Helicobacter pylori infection and to prevent them coming back:

• The recommended dose is one 20 mg gastro-resistant capsule of Esomeprazol Teva twice a day for one week.
• Your doctor will also tell you to take antibiotics called amoxicillin and clarithromycin.

To treat stomach ulcers caused by NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

• The recommended dose is one 20 mg gastro-resistant capsule of Esomeprazol Teva once a day for 4-8 weeks.

To prevent stomach ulcers if you are taking NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

• The recommended dose is one 20 mg gastro-resistant capsule of Esomeprazol Teva once a day.

To treat too much acid in the stomach caused by a tumour in the pancreas (Zollinger-Ellison syndrome):

• The recommended dose is one 40 mg gastro-resistant capsule of Esomeprazol Teva twice a day.
• Your doctor will adjust the dose according to your needs and will decide how long you will need to take the medicine. The maximum dose is 80 mg twice a day.

Prevention of rebleeding from gastric or duodenal ulcers following intravenous treatment with esomeprazol:

• The recommended dose is one 40 mg gastro-resistant capsule of Esomeprazol Teva once a day for 4 weeks.

Use in adolescents aged 12 years and older

To treat heartburn caused by gastroesophageal reflux disease (GERD):

• If your doctor has found that your oesophagus (gullet) is slightly damaged, the recommended dose is one 40 mg gastro-resistant capsule of Esomeprazol Teva once a day for 4 weeks. Your doctor may tell you to take the same dose for another 4 weeks if your gullet has not healed.
• The recommended dose once the gullet has healed is one 20 mg gastro-resistant capsule of Esomeprazol Teva once a day.
• If your gullet has not been damaged, the recommended dose is one 20 mg gastro-resistant capsule of Esomeprazol Teva once a day.
• If you have severe liver problems, your doctor will give you a lower dose.

To treat ulcers caused by Helicobacter pylori infection and to prevent them coming back

• The recommended dose is one 20 mg gastro-resistant capsule of Esomeprazol Teva twice a day for one week.
• Your doctor will also tell you to take antibiotics called amoxicillin and clarithromycin.

Taking this medicine

• You can take the capsules at any time of the day.
• You can take the capsules with or without food.
• Swallow the capsules whole with a glass of water. Do not chew or crush the capsules. This is because the capsules contain coated pellets which stop the medicine from being broken down by the acid in your stomach. It is important not to damage the pellets.

What to do if you have trouble swallowing the capsules

• If you have trouble swallowing the capsules:
• • Open the capsules and empty the pellets into a glass of water. Do not use other liquids.
  • Drink the mixture straight away or within 30 minutes. Always stir the mixture before drinking it.
  • To make sure that you get all of the medicine, rinse the glass very well with half a glass of water and drink it. The medicine should not be chewed or crushed.
• If you cannot swallow at all, the pellets can be mixed with some water and put into a syringe. This can then be given to you through a tube directly into your stomach (“gastric tube”).

Children under 12 years

Esomeprazol Teva should not be used in children under 12 years since no data are available.

Elderly patients

No dose adjustment is necessary in elderly patients.

If you take more Esomeprazol Teva than you should

If you take more Esomeprazol Teva than you should, talk to your doctor or pharmacist straight away.

In case of overdose or accidental ingestion, contact your doctor or pharmacist immediately or call the national poison centre, phone number: 91 562 04 20, indicating the medicine and the amount taken.

If you forget to take Esomeprazol Teva

• If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose.
• Do not take a double dose (two doses at the same time) to make up for a forgotten dose.

If you have any further questions on the use of this medicine, 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.

If you notice any of the following serious side effects, stop taking Esomeprazol Teva and consult your doctor immediately:

• Yellow skin, dark urine, and fatigue that can be symptoms of liver problems. These effects are rare, occurring in less than 1 in 1,000 patients.
• Sudden wheezing, inflammation of the lips, tongue, and throat, or body, rash, feeling of dizziness, or difficulty swallowing (severe allergic reaction). These effects are rare, occurring in less than 1 in 1,000 patients.
• Sudden appearance of a severe rash or skin redness with blisters or peeling, even after several weeks of treatment. Large blisters and bleeding of the lips, eyes, mouth, nose, and genitals may also occur. Skin rashes can become severe and widespread skin damage (peeling of the epidermis and superficial mucous membranes) with potentially fatal consequences. This could be a "multiform erythema", "Stevens-Johnson syndrome", "toxic epidermal necrolysis", or "drug reaction with eosinophilia and systemic symptoms".

Other adverse effects include:

Frequent (may affect up to 1 in 10 people)

• headache,

• effects on your stomach or intestine: diarrhea, stomach pain, constipation, flatulence, feeling of dizziness (nausea) or discomfort (vomiting),
• benign polyps in the stomach.

Infrequent (may affect up to 1 in 100 people)

• swelling of feet and ankles,
• sleep disturbances (insomnia),
• dizziness, tingling sensation, numbness,
• feeling of (vertigo),
• dry mouth,
• changes in blood tests that control how your liver works,
• rash, bumpy rash (urticaria), and itching of the skin,
• fracture of the wrist, hip, or spine (if Esomeprazol Teva is used at high doses and for a long period)

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

• blood problems such as a reduced number of white blood cells or platelets. This can cause weakness, bruising, or frequent infections,
• low sodium levels in the blood. This can cause weakness, discomfort (vomiting), and cramps,
• feeling of agitation, confusion, or depression,
• taste disturbances,
• vision problems such as blurred vision,
• sudden feeling of difficulty breathing or shortness of breath (bronchospasm),
• inflammation of the inside of the mouth,
• a fungal infection called "candidiasis" that can affect the intestine,
• liver problems, including jaundice that can cause yellowing of the skin, dark urine, and fatigue,
• hair loss (alopecia),
• skin rash after sun exposure,
• joint pain (arthralgia) or muscle pain (myalgia),
• feeling of general discomfort and lack of energy,
• increased sweating.

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

• changes in blood count, including agranulocytosis (lack of white blood cells),
• aggression,
• seeing, feeling, or hearing things that do not exist (hallucinations),

• severe liver problems leading to liver failure and brain inflammation,
• sudden appearance of a severe rash or blisters or peeling of the skin. This can be associated with high fever and joint pain (multiform erythema, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms),
• muscle weakness,
• severe kidney problems,
• increase in breast size in men.

Frequency Not Known (cannot be estimated from the available data)

• If you are taking Esomeprazol Teva for more than three months, it is possible that your blood magnesium levels may decrease. Low magnesium levels can manifest as fatigue, tetanus, delirium, convulsions, dizziness, and increased heart rate. If you experience any of these problems, consult your doctor immediately. Low magnesium levels in the blood can trigger low potassium or calcium levels in the blood. Your doctor may decide to perform blood tests to monitor magnesium levels.
• Inflammation of the intestine (which can cause diarrhea)
• Skin rash, possibly with joint pain

Esomeprazol Teva may, in very rare cases, affect the white blood cells, leading to immunodeficiency. If you have an infection with symptoms such as fever with a greatly reduced general condition or fever with symptoms of a local infection such as pain in the neck, throat, or mouth, or difficulty urinating, you should consult your doctor as soon as possible so that a lack of white blood cells (agranulocytosis) can be ruled out by a blood test. It is important that you provide information about your medication.

Reporting of 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 prospectus. 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 Esomeprazol Teva

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

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

Blister pack (OPA/Al/PE + film DES/Al foil)

This medicine does not require special storage conditions.

Store in the original packaging to protect it from moisture

or

Blister pack (OPA/Al/PVC + Al foil)

Do not store above 30°C

Store in the original packaging to protect it from moisture

HDPE bottle

This medicine does not require special storage conditions.

Keep the container tightly closed to protect it from moisture.

After the first opening, the medicine should be used within 6 months.

Medicines should not be disposed of via 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 Esomeprazol Teva

The active ingredient is esomeprazole.

Each hard gastro-resistant capsule contains 20 mg or 40 mg of esomeprazole (as esomeprazole magnesium dihydrate).

The other ingredients (excipients) are sugar spheres (sucrose and corn starch), povidone K30, sodium lauryl sulfate, polyvinyl alcohol, titanium dioxide (E-171), macrogol 3000, macrogol 6000, talc (E-553b), heavy magnesium carbonate, polysorbate 80 (E-433), and methacrylic acid-ethyl acrylate copolymer (1:1) dispersion 30% in the pellets in the capsule, and gelatin (E-441), titanium dioxide (E-171), red iron oxide (E-172) in the body of the capsule. See section 2 "Esomeprazol Teva contains sucrose".

Appearance of the Product and Package Contents

The body and cap of the Esomeprazol Teva 20 mg hard gastro-resistant capsules EFG are light pink in color. The capsules contain white or almost white pellets. Capsule size: No. 3.

The body and cap of the Esomeprazol Teva 40 mg hard gastro-resistant capsules EFG are pink in color. The capsules contain white or almost white pellets. Capsule size: No. 1.

The capsules are available in packs of 7, 10, 14, 15, 28, 30, 50, 56, 60, 90, 98, and 100 capsules in blister packs and packs of 98 capsules and a desiccant capsule in HDPE bottles. Do not ingest the desiccant capsule that comes in the bottle.

Not all pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Teva Pharma, S.L.U.

C/ Anabel Segura, 11, Edificio Albatros B, 1ª planta

Alcobendas, 28108 Madrid

Spain

Manufacturer

KRKA, D.D., NOVO MESTO

Smarjeska cesta 6

Novo mesto-8501- Slovenia

Or

Merckle GmbH

Ludwig-Merckle-Strassee 3

D-89143 Blaubeuren

Germany

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

Germany: Esomeprazol AbZ 20 mg magensaftresistente Hartkapseln

Esomeprazol AbZ 20 mg magensaftresistente Hartkapseln

Slovenia: Esora 20 mg trde gastrorezistentne kapsule

Esora 20 mg trde gastrorezistentne kapsule

Spain: Esomeprazol Teva 20 mg cápsulas duras gastrorresistentes EFG

Esomeprazol Teva 20 mg cápsulas duras gastrorresistentes EFG

Date of the Last Revision of this Prospectus: April 2023

The following information is intended exclusively for healthcare professionals:

Administration through the gastric tube

1. Open the capsule and pour the granules into a suitable syringe and fill the syringe with approximately 25 ml of water and approximately 5 ml of air. For some tubes, dispersion in 50 ml of water is needed to avoid clogging the tube.
2. Immediately shake the syringe to distribute the granules evenly in the suspension.
3. Keep the syringe with the tip up and check that the tip is not clogged.
4. Insert the syringe into the tube while maintaining the previous position.
5. Shake the syringe and place it with the tip down. Immediately inject 5-10 ml into the tube. Invert the syringe after injection and shake (the syringe must be kept with the tip up to avoid clogging the tip)
6. Turn the syringe with the tip down and immediately inject another 5-10 ml into the tube. Repeat this procedure until the syringe is empty.
7. Fill the syringe with 25 ml of water and 5 ml of air and repeat step 5 if necessary to wash any sediment remaining in the syringe. For some tubes, 50 ml of water is needed.

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/