PARNIDO 9 mg PROLONGED-RELEASE TABLETS

2. Before taking Parnido

Do not takepaliperidone

• if you are allergic to paliperidone, risperidone, or any of the other ingredients of this medicine (listed in section 6)

Warnings andprecautions

Talk to your doctor or pharmacist before starting to take paliperidone.

• Patient with schizoaffective disorder treated with this medicine should be closely monitored for a possible shift of manic symptoms to depressive symptoms.
• This medicine has not been studied in elderly patients with dementia. However, elderly patients with dementia who are treated with other similar medicines may have an increased risk of stroke or death (see section 4, Possible side effects).

• If you have Parkinson's disease or dementia.
• If you have ever been diagnosed with a disease whose symptoms are high temperature and muscle stiffness (also known as Neuroleptic Malignant Syndrome). If you have ever experienced abnormal movements of the tongue or face (Tardive Dyskinesia).
• You should know that these two disorders can be caused by this type of medicine. If you have had low white blood cell counts in the past (which may or may not have been caused by other medicines).
• If you are diabetic or have a tendency to diabetes.
• If you have heart disease or are being treated for heart diseases that may make you more prone to a decrease in blood pressure.
• If you have epilepsy.
• If you have any swallowing, stomach, or intestinal disorder that reduces your ability to swallow food or digest it with normal intestinal movements.
• If you have diseases associated with diarrhea.
• If you have kidney problems.
• If you have liver problems.
• If you have a prolonged and/or painful erection.
• If you have difficulty controlling your body temperature or are overheated.
• If you have an abnormally high level of the hormone prolactin in your blood or if you have a tumor that may be dependent on prolactin.
• If you or someone in your family has a history of blood clots, as antipsychotics are related to the formation of clots.

If you have any of these diseases, please consult your doctor, as it may be necessary to adjust your dose or keep you under observation for a while.

Because in very rare cases, a dangerously low number of a type of white blood cells necessary to fight infections in the blood has been observed in patients treated with paliperidone, your doctor may check your white blood cell count.

Paliperidone may cause you to gain weight. Significant weight gain can negatively affect your health. Your doctor will regularly monitor your weight.

In patients treated with paliperidone, diabetes mellitus or worsening of pre-existing diabetes mellitus has been observed, your doctor should check for signs of increased blood sugar. In patients with pre-existing diabetes mellitus, blood sugar should be regularly monitored.

During eye surgery for cataracts, the pupil (the black circle in the middle of the eye) may not increase in size as needed. Additionally, the iris (the colored part of the eye) may become flaccid during surgery, which can cause eye damage. If you are considering eye surgery, make sure to inform your ophthalmologist that you are using this medicine.

Children andadolescents

Paliperidone should not be given to children and adolescents under 15 years of age for the treatment of schizophrenia.

Paliperidone should not be given to children and adolescents under 18 years of age for the treatment of schizoaffective disorder.

This is because it is not known if paliperidone is safe or effective in this age group.

Other medicines and paliperidone

Tell your doctor or pharmacist if you are using, have recently used, or might use any other medicines.

Abnormalities in heart function may appear when taking this medicine with other medicines to control heart rhythm or other medicines such as antihistamines, antimalarials, or antipsychotics.

Since this medicine acts mainly on the brain, it may interfere with other medicines (or alcohol) that also act on it, due to the sum of effects on brain function.

This medicine may lower blood pressure, so you should be careful if you take this medicine with other medicines that also lower it.

This medicine may reduce the effect of medicines for Parkinson's disease and restless legs syndrome (e.g., levodopa).

The effects of this medicine may be affected if you take medicines that influence the speed of intestinal movement (e.g., metoclopramide).

A reduction in the dose of this medicine should be considered when it is administered at the same time as valproate.

The use of oral risperidone with this medicine is not recommended, as this combination may cause an increase in side effects.

Parnido should be used with caution with medicines that increase the activity of the central nervous system (psychostimulants such as methylphenidate).

Taking paliperidone withalcohol

You should avoid consuming alcohol during treatment with this medicine.

Pregnancy andlactation

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

You should not take this medicine during pregnancy unless you have discussed it with your doctor.

The following symptoms may occur in newborn babies of mothers who have been treated with paliperidone in the last trimester of pregnancy (the last three months of pregnancy): tremors, stiffness, and/or muscle weakness, drowsiness, agitation, breathing problems, and feeding difficulties. If your baby develops any of these symptoms, you should contact your doctor.

You should not breastfeed your child while taking this medicine.

Driving and usingmachines

Dizziness and vision problems (see section 4, possible side effects) may appear during treatment with this medicine. This should be taken into account when maximum attention is required, for example, when driving or operating machinery.

Parnido contains sodium

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

3. How to take Parnido

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

Use inadults

The recommended dose in adults is 6 mg once a day in the morning. Your doctor may increase or decrease it within the dosage range of 3 mg to 12 mg once a day in case of schizophrenia or 6 mg to 12 mg once a day in case of schizoaffective disorder. This depends on how well the medicine works for you.

Use inadolescents

The recommended starting dose for the treatment of schizophrenia in adolescents from 15 years of age is 3 mg once a day taken in the morning.

For adolescents who weigh 51 kg or more, the dose can be increased within the range of 6 mg to 12 mg once a day.

For adolescents who weigh less than 51 kg, the dose can be increased to 6 mg once a day.

Your doctor will decide how much you should take. The amount you take depends on how well the medicine works for you.

How and when to take paliperidone

This medicine should be taken orally, swallowed whole with water or other liquids. It should not be chewed, broken, or crushed.

This medicine should be taken in the mornings with breakfast or on an empty stomach, but in the same way every day. Do not alternate between taking the medicine one day with breakfast and the next day on an empty stomach.

The active substance, paliperidone, dissolves once swallowed, and the tablet coating is eliminated from the body through the feces.

Patients with kidney problems

Your doctor may adjust the dose of this medicine according to your renal function.

Elderly patients

Your doctor may reduce your dose of medicine if your renal function is reduced.

If you take more paliperidone than you should

In case of overdose or accidental ingestion, consult your doctor, pharmacist, or go to the nearest hospital immediately, or call the Toxicology Information Service. Phone: 91 562 04 20, indicating the medicine and the amount ingested. You may experience drowsiness, fatigue, abnormal body movements, problems standing and walking, dizziness due to low blood pressure, and changes in heartbeats.

If you forget to take paliperidone

Do not take a double dose to make up for forgotten doses. If you forget a dose, take the next dose the next day. If you forget two doses or more, contact your doctor.

If you stop taking paliperidone

Do not stop taking this medicine, as you will lose the effects of the medicine. You should not stop taking this medicine unless your doctor tells you to, as your symptoms may come back.

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

4. Possible Adverse Effects

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

Report immediately to your doctorif:

• Presents blood clots in the veins, especially in the legs (symptoms include swelling, pain, and redness of the leg), which can circulate through the blood vessels to the lungs causing chest pain and difficulty breathing. If you notice any of these symptoms, seek medical advice immediately.
• Has dementia and presents a sudden change in mental state or sudden weakness or numbness of the face, arms, or legs, especially on one side, or has difficulty speaking even for a short period. These may be signs of a stroke.
• Presents fever, muscle stiffness, sweating, or a decrease in the level of consciousness (a disorder known as "Neuroleptic Malignant Syndrome"). May require immediate medical treatment.
• Is a man and presents a prolonged or painful erection. It is known as priapism. May require immediate medical treatment.
• Presents rhythmic involuntary movements of the tongue, mouth, and face. It may be necessary to withdraw paliperidone.
• Presents a severe allergic reaction characterized by fever, swelling of the mouth, face, lips, or tongue, difficulty breathing, itching, rash, and sometimes a drop in blood pressure (i.e., an "anaphylactic reaction").

Very Common Adverse Effects: may affect more than 1 in 10 patients

• Difficulty staying or falling asleep
• Parkinsonism: This disease may include slow or altered movement, feeling of stiffness or muscle tension (making sudden movements) and sometimes a feeling of "freezing" of movement that then restarts. Other signs of parkinsonism include walking slowly, dragging feet, tremors while resting, increased saliva and/or drooling, and loss of facial expressiveness
• Restlessness
• Feeling drowsy or less alert/awake
• Headache

Common Adverse Effects: may affect up to 1 in 10 patients

• Chest infection (bronchitis), symptoms of a common cold, nose infection, urinary tract infection, feeling like having the flu
• Weight gain, increased appetite, weight loss, decreased appetite
• Euphoria (mania), irritability, depression, anxiety
• Dystonia: It is a condition that involves slow or continuous involuntary contraction of the muscles. Although any part of the body can be affected (and can cause abnormal postures), dystonia often affects the muscles of the face, including abnormal movements of the eyes, mouth, tongue, or jaw
• Dizziness
• Discinesia: This condition involves involuntary muscle movements and may include repetitive, spasmodic, or twisting movements, or spasms
• Tremors (agitation)
• Blurred vision
• Disruption of conduction between the upper and lower parts of the heart, anomalies in the electrical conduction of the heart, prolongation of the QT interval in the heart, slow heartbeat, rapid heartbeat
• Decrease in blood pressure when standing up (as a consequence, some people taking paliperidona may feel weakness, dizziness, or loss of consciousness when getting up or sitting down suddenly), increased blood pressure
• Sore throat, cough, nasal congestion
• Abdominal pain or discomfort, vomiting, nausea, constipation, diarrhea, indigestion, dry mouth, toothache
• Increased liver transaminases in the blood
• Itching, skin rash
• Pain in bones or muscles, back pain, joint pain
• Loss of menstrual periods
• Fever, weakness, fatigue (tiredness)

Uncommon Adverse Effects: may affect up to 1 in 100 patients

• Pneumonia, respiratory tract infection, bladder infection, ear infection, angina
• Decrease in the number of white blood cells in the blood, decrease in platelets (blood cells that help stop bleeding), anemia, decrease in the number of red blood cells in the blood
• Paliperidone may increase the levels of a hormone called "prolactin" that is detected in blood tests (which may or may not cause symptoms). When symptoms of increased prolactin appear, they may include: (in men) breast swelling, difficulty having or maintaining erections or other sexual dysfunctions, (in women) breast tenderness, milk secretion from the breasts, loss of menstrual periods or other problems with the cycle
• Diabetes or worsening of diabetes, increased blood sugar, increased waist circumference, loss of appetite that causes malnutrition and weight loss, increased triglycerides in the blood (a type of fat)
• Sleep disorder, confusion, decreased sexual desire, inability to achieve orgasm, nervousness, nightmares
• Late discinesia (involuntary spasmodic movements of the face, tongue, or other parts of the body that cannot be controlled). Report to your doctor immediately if you experience rhythmic involuntary movements of the tongue, mouth, or face. It may be necessary to withdraw paliperidone
• Seizures (epileptic fits), fainting, restlessness that causes movement of parts of the body, dizziness when standing up, attention disorder, speech problems, loss or alteration of taste, decreased sensitivity of the skin to pain or touch, sensation of tingling, pinching, or numbness of the skin
• Eye hypersensitivity to light, eye infection or "red eye", dry eyes
• Sensation that everything is spinning (vertigo), ringing in the ears, ear pain
• Irregular heartbeat, anomaly in the electrical activity of the heart (electrocardiogram or ECG), sensation of fluttering or pounding in the chest (palpitations)
• Decrease in blood pressure
• Difficulty breathing, wheezing (whistling in the chest), nasal bleeding
• Tongue swelling, stomach or intestinal infection, difficulty swallowing, excess gas or flatulence
• Increased GGT (a liver enzyme called gamma-glutamyltransferase) in blood, increased liver enzymes in blood
• Hives (or "urticaria"), hair loss, eczema, acne
• Increased CPK (creatine phosphokinase) in blood, an enzyme that is sometimes released with muscle breakdown, muscle spasms, joint stiffness, joint swelling, muscle weakness, neck pain
• Urinary incontinence (loss of control), frequent urination, inability to pass urine, pain when urinating
• Erectile dysfunction, ejaculation disorder
• Loss of menstrual periods or other problems with the cycle (women), milk secretion from the breasts, sexual dysfunction, breast pain, breast tenderness
• Swelling of the face, mouth, eyes, or lips, swelling of the body, arms, or legs
• Chills, increased body temperature
• Change in gait
• Feeling of thirst
• Chest pain, chest discomfort, feeling of discomfort
• Falls

Rare Adverse Effects: may affect up to 1 in 1,000 patients

• Eye infection, fungal infection of the nails, skin infection, skin inflammation caused by mites

• Dangerously low number of a type of white blood cells necessary to fight infections
• Decrease in a type of white blood cells that help fight infections, increase in eosinophils (a type of white blood cell) in the blood
• Severe allergic reaction characterized by fever, swelling of the mouth, face, lips, or tongue, difficulty breathing, itching, rash, and sometimes a drop in blood pressure, allergic reaction
• Sugar in the urine
• Inappropriate secretion of a hormone that controls urine volume
• Complications of uncontrolled diabetes with life-threatening risks
• Excessive water intake, decreased blood sugar, excessive water intake, increased cholesterol in the blood
• Sleepwalking
• Not moving or not responding while being awake (catatonia)
• Lack of emotions
• Neuroleptic malignant syndrome (confusion, decreased or lost consciousness, high fever, and severe muscle stiffness)
• Loss of consciousness, balance disorder, abnormal coordination
• Problems in the blood vessels of the brain, coma due to uncontrolled diabetes, unresponsive to stimuli, decreased level of consciousness, head tremors
• Glaucoma (increased eye pressure), increased tearing, eye redness, problems with eye movement, eye rotation
• Atrial fibrillation (abnormal heart rhythm), rapid heartbeat when standing up
• Blood clots in the veins, especially in the legs (symptoms include swelling, pain, and redness of the leg), which can circulate through the blood vessels to the lungs causing chest pain and difficulty breathing. If you suffer from any of these symptoms, seek medical help immediately
• Decrease in oxygen in parts of the body (due to decreased blood flow), flushing
• Breathing problems during sleep (sleep apnea), rapid, shallow breathing
• Pneumonia caused by aspiration of food, congestion of the airways, voice disorder
• Intestinal obstruction, fecal incontinence, very hard stools, absence of intestinal movement that causes obstruction
• Yellowing of the skin and eyes (jaundice)
• Pancreatitis
• Severe allergic reaction with swelling, which can affect the throat causing difficulty breathing
• Thickening of the skin, dryness of the skin, redness of the skin, discoloration of the skin, scaly and itchy skin or scalp, dandruff
• Muscle fiber breakdown and muscle pain (rhabdomyolysis), anomaly in posture
• Priapism (a prolonged erection that may require surgical treatment)
• Development of breasts in men, breast enlargement, milk secretion from the breasts, vaginal discharge
• Delayed menstrual periods, breast enlargement
• Very low body temperature, decreased body temperature
• Withdrawal symptoms from the medication

Unknown frequency: cannot be estimated from available data

• Congestion of the lungs
• Increased insulin (a hormone that controls blood sugar levels) in the blood

The following adverse effects have appeared with the use of another medicine called risperidone, which is very similar to paliperidone, so it is also expected to appear with paliperidone: sleep-related eating disorder, other types of cerebrovascular problems, crackling sounds in the lungs, and severe or fatal rash with blisters and peeling of the skin that can start inside and around the mouth, nose, eyes, or genitals and spread to other areas of the body (Stevens-Johnson syndrome/toxic epidermal necrolysis). Eye problems may also occur during cataract surgery. During cataract surgery, a condition called intraoperative floppy iris syndrome (IFIS) may occur if you are taking or have taken paliperidone. If you need to undergo cataract surgery, make sure to inform your ophthalmologist if you are taking or have taken this medication.

Additional Adverse Effects in Adolescents

Adolescents generally presented similar adverse effects to those found in adults, except for the following adverse effects that were detected more frequently:

• Feeling drowsy or less attentive
• Parkinsonism: This disease may include slow or altered movement, feeling of stiffness or muscle tension (making sudden movements) and sometimes a feeling of "freezing" of movement that then restarts. Other signs of parkinsonism include walking slowly, dragging feet, tremors while resting, increased saliva and/or drooling, and loss of facial expressiveness
• Tremors while resting, increased saliva and/or drooling, and loss of facial expressiveness
• Weight gain
• Cold symptoms
• Restlessness
• Tremors (agitation)
• Stomach pain
• Milk secretion from the breasts in girls
• Breast swelling in boys
• Acne
• Speech problems
• Stomach or intestinal infection
• Nasal bleeding
• Ear infection
• High triglycerides in the blood (a type of fat)
• Sensation of movement (vertigo)

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 does not appear 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. Conservation of Parnido

Keep this medicine out of 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.

Store in the original packaging to protect it from moisture.

Medicines should not be thrown down the drain or into the trash. Deposit the packaging and medicines that you no longer need in the SIGRE Point of the pharmacy. Ask your pharmacist how to dispose of the packaging and medicines that you no longer need. This way, you will help protect the environment.

6. Package Contents and Additional Information

Parnido Composition

• The active ingredient is paliperidone.

Each prolonged-release tablet contains 3 mg, 6 mg, or 9 mg of paliperidone.

• The other ingredients are:

Core: macrogol 200,000, macrogol 7,000,000, macrogol 4,000, hydroxybutyltoluene, povidone, sodium chloride, microcrystalline cellulose, magnesium stearate, red iron oxide (E172), hydroxypropylcellulose, and cellulose acetate.

Coating: hypromellose, titanium dioxide (E171), talc, propylene glycol, yellow iron oxide (E172) – only for 6 mg tablets, and red iron oxide (E172) – only for 9 mg tablets.

Printed Ink: shellac, black iron oxide (E172), and propylene glycol. See section 2 “Parnido contains sodium”.

Product Appearance and Package Contents

3 mg: Film-coated, biconvex, round tablets, white to light grey in color with a possible irregular surface and printed with the mark P3 on one side of the tablet. Diameter: approximately 9 mm.

6 mg: Film-coated, biconvex, round tablets, yellow-brown in color with a possible irregular surface and printed with the mark P6 on one side of the tablet. Diameter: approximately 9 mm.

9 mg: Film-coated, biconvex, round tablets, light pink in color with a possible irregular surface and printed with the mark P9 on one side of the tablet. Diameter: approximately 9 mm.

Parnido is available in packs of 28, 30, 56, 60, 84, 90, or 98 prolonged-release tablets in blisters.

Only some pack sizes may be marketed.

Marketing Authorization Holder

TAD Pharma GmbH, Heinz-Lohmann-Straße 5, 27472 Cuxhaven, Germany

Manufacturer

KRKA d.d. Novo mesto

Smarjeska cesta 6

8501 Novo mesto

Slovenia

You can request more information about this medication by contacting the local representative of the marketing authorization holder:

KRKA Farmacéutica, S.L., C/ Anabel Segura 10, 28108 Alcobendas, Madrid, Spain

This medication is authorized in the member states of the European Economic Area under the following names:

Date of the Last Revision of this Leaflet: April 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/