ALPRAGEN 0.25 mg Tablets

Contents of the leaflet

1. PATIENT INFORMATION LEAFLET
2. Leaflet attached to the packaging: patient information
3. Alpragen, 0.25 mg, tablets
4. Alpragen, 0.5 mg, tablets
5. Alpragen, 1.0 mg, tablets
   1. Read the leaflet carefully before taking the medicine, as it contains important information for the patient.
   2. Table of contents of the leaflet:
   3. What is Alpragen and what is it used for
6. Important information before taking Alpragen
   1. When not to take Alpragen:
   2. Warnings and precautions
   3. Children and adolescents
   4. Alpragen and other medicines
   5. Alpragen and alcohol
   6. Pregnancy and breastfeeding
   7. Driving and using machines
   8. Alpragen contains lactose monohydrate.
   9. Alpragen contains sodium
   10. Alpragen contains sodium benzoate
7. How to take Alpragen
   1. Adults (over 18 years)
   2. Elderly patients
   3. Patients with liver or kidney impairment
   4. Duration of treatment
   5. Taking a higher dose of Alpragen than recommended
   6. Missing a dose of Alpragen
   7. Stopping treatment with Alpragen
   8. Contact your doctor if you experience any of these symptoms or mood changes.
8. Possible side effects
   1. Reporting side effects
9. How to store Alpragen
   1. Do not use this medicine after the expiry date stated on the carton and blister after
10. Contents of the pack and other information
    1. What Alpragen contains
    2. What Alpragen looks like and contents of the pack
    3. Marketing authorization holder and manufacturer
    4. Viatris Healthcare Sp. z o.o.
    5. Date of last revision of the leaflet:

PATIENT INFORMATION LEAFLET

Leaflet attached to the packaging: patient information

Alpragen, 0.25 mg, tablets

Alpragen, 0.5 mg, tablets

Alpragen, 1.0 mg, tablets

Alprazolam

Read the leaflet carefully before taking the medicine, as it contains important information for the patient.

• Keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
• If you experience any side effects, including those not listed in this leaflet, please tell your doctor or pharmacist. See section 4.

Table of contents of the leaflet:

• 1. What is Alpragen and what is it used for
• 2. Important information before taking Alpragen
• 3. How to take Alpragen
• 4. Possible side effects
• 5. How to store Alpragen
• 6. Contents of the pack and other information

1.

What is Alpragen and what is it used for

Alpragen contains the active substance alprazolam, which belongs to a group of medicines called benzodiazepines.
Alpragen is indicated for the treatment of anxiety disorders in adults, only in situations where symptoms are severe, interfere with normal functioning, or are very troublesome for the patient. This medicine is intended for short-term use only.

2. Important information before taking Alpragen

When not to take Alpragen:

Warnings and precautions

Before starting treatment with Alpragen, discuss it with your doctor or pharmacist

• -if you have long-term lung problems, mild to moderate liver or kidney impairment
• -if you have depression or anxiety disorders associated with depression, as alprazolam may make suicidal thoughts (if they occur) more frequent
• -if you are taking other medicines for anxiety disorders or insomnia
• if you are taking medicines that affect the central nervous system (e.g., benzodiazepines, neuroleptics)
• -if you have a history of substance abuse or alcoholism, or if you have difficulty stopping the use of medicines, drinking alcohol, or taking substances. Your doctor may recommend special help when stopping this medicine
• -if you have personality disorders
• -if you are elderly, as this medicine may cause drowsiness or muscle weakness, which can lead to falls, often with serious consequences

During treatment with Alpragen, anterograde amnesia may occur in the patient. To reduce the risk, the patient should have uninterrupted sleep for 7-8 hours during treatment.
Alprazolam use has been associated with the occurrence of atypical reactions, such as: anxiety, especially motor, agitation, irritability, aggression, delusions, outbursts of anger, nightmares, hallucinations (seeing or hearing things that do not exist), psychosis (loss of contact with reality) and bizarre behavior. If such symptoms occur , you should consult a doctor, as it will be necessary to
stop taking the medicine.

Children and adolescents

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

Alpragen and other medicines

Tell your doctor or pharmacist about all medicines you are taking now or have taken recently, as well as any medicines you plan to take, including those available without a prescription. It is especially important to inform your doctor about taking medicines such as:

• antipsychotic medicines (medicines used to treat mental disorders) such as haloperidol and chlorpromazine, sleeping medicines (medicines used to induce sleep) such as phenobarbital and zolpidem, sedatives (medicines used to treat anxiety) such as diazepam and lorazepam, opioid painkillers (a type of painkiller) such as propoxyphene, cough medicines (medicines used to treat cough) such as dextromethorphan and codeine, medicines such as methadone (which may be used to relieve pain or help people addicted to opiates), anesthetics (medicines used for anesthesia) such as halothane and bupivacaine or antidepressants, as they may enhance the effect of alprazolam
• clozapine (a medicine used to treat mental illnesses, such as schizophrenia). This medicine may increase the amount of alprazolam in the blood
• selective serotonin reuptake inhibitors (SSRIs) (used to treat depression, e.g., fluoxetine or sertraline)
• medicines used to treat epilepsy (e.g., phenytoin and carbamazepine)
• antihistamines (e.g., cetirizine, cyclizine)
• medicines used to treat fungal infections (e.g., ketoconazole, itraconazole, posaconazole, voriconazole, or other azole derivatives)
• cimetidine (used to treat stomach ulcers), nefazodone (used to treat depression), or fluvoxamine (used to treat obsessive-compulsive disorder, also known as obsessive neurosis). When taking these medicines, the dose of alprazolam should be adjusted accordingly
• imipramine or desipramine - tricyclic antidepressants (TCA), used to treat depression, as a dose change may be necessary
• oral contraceptives
• diltiazem (used to treat angina and high blood pressure)
• certain antibiotics, such as erythromycin, clarithromycin, telithromycin, troleandomycin, and rifampicin
• medicines used to treat HIV infections, known as protease inhibitors (e.g., ritonavir)
• digoxin (a medicine used to treat heart conditions). The patient may experience symptoms of digoxin toxicity (symptoms include irregular heartbeat, confusion, hallucinations, vision disturbances, headaches, abdominal pain, nausea, and vomiting), when taking digoxin with Alpragen

Taking Alpragen with opioids (strong painkillers, medicines used in substitution therapy for drug addiction, some cough medicines) increases the risk of drowsiness, breathing difficulties (respiratory depression), coma, and can be life-threatening.
Deaths have been reported. For this reason, concurrent use should only be considered when other treatment methods are not possible.
However, if the doctor prescribes Alpragen with opioids, the dosage and duration of such treatment should be limited by the attending physician.
You should inform your doctor about all opioid medicines you are taking and strictly follow the dosage prescribed by your doctor. It may be helpful to inform friends or family about the above symptoms. If such symptoms occur, you should contact your doctor.
In case of planned surgery under general anesthesia, you should inform your doctor about taking alprazolam.

Alpragen and alcohol

You must not drink alcohol while taking Alpragen; alcohol enhances the effect of Alpragen.
You should not drink too much grapefruit juice while taking this medicine, as it may increase the amount of alprazolam in the blood.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to have a child, ask your doctor or pharmacist for advice before taking this medicine. You should not
take Alpragen if you are pregnant without discussing the possible risks and benefits with your doctor.
If alprazolam is taken regularly in the last trimester of pregnancy, the baby may become dependent on alprazolam and experience withdrawal symptoms after birth.
If the doctor decides to use alprazolam in late pregnancy or during childbirth, the baby may experience symptoms such as low body temperature, weakness, breathing difficulties, and feeding problems, tremors, increased excitability, and agitation.
You should not take Alpragen while breastfeeding, as this medicine may pass into breast milk.

Driving and using machines

You should not drive or operate machinery after taking alprazolam, as it may cause symptoms such as: loss of concentration, loss of muscle control, memory loss, dizziness, drowsiness, or confusion.

Alpragen contains lactose monohydrate.

If you have been diagnosed with intolerance to some sugars, you should consult your doctor before taking Alpragen.

Alpragen contains sodium

The medicine contains less than 1 mmol (23 mg) of sodium per tablet, which means the medicine is considered "sodium-free".

Alpragen contains sodium benzoate

The medicine contains 0.1 mg of sodium benzoate per tablet.
Sodium benzoate may increase the risk of jaundice (yellowing of the skin and whites of the eyes) in newborns (up to 4 weeks of age), but this medicine is not recommended for use in patients under 18 years of age.

3. How to take Alpragen

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

Adults (over 18 years)

The recommended dose is 0.25 mg to 0.5 mg three times a day.
If necessary, your doctor may decide to increase the dose to a maximum of 4 mg per day. If in doubt, consult your doctor or pharmacist again. You should be cautious when increasing the dose. You should first increase the evening dose, and then the daily dose.
In patients who have not taken this type of medicine before and in patients with a history of alcoholism, a lower dose should be used.

Elderly patients

The recommended dose for elderly patients is 0.25 mg two to three times a day. In elderly patients in good physical condition, the doctor may increase the dose by 0.5 mg every third day, up to a maximum dose of 1.5 mg per day. In frail elderly patients, the dose should not exceed 0.75 mg per day.
Alpragen should be taken orally. The score line on the tablet is only to facilitate breaking the tablet to make it easier to swallow.

Patients with liver or kidney impairment

In case of liver or kidney impairment, the doctor may recommend a lower dose than usual. The maximum recommended dose for patients with liver or kidney impairment is 0.75 mg to 1.5 mg per day.

Duration of treatment

Alpragen should not be taken for longer than prescribed by your doctor. The total treatment duration should not exceed 2-4 weeks. Taking alprazolam for too long and in too high a dose may lead to the development of psychological and physical dependence. Do not stop treatment prematurely.

Taking a higher dose of Alpragen than recommended

If you have taken more than the recommended dose contact your doctor or go to the emergency department of your nearest hospital immediately. Take the medicine packaging and any remaining tablets with you. Symptoms of overdose include: drowsiness, confusion, lack of coordination or unsteady movements, breathing difficulties, low blood pressure, fatigue, loss of consciousness, and in rare cases, death.

Missing a dose of Alpragen

Do not take a double dose to make up for a missed dose, just take the next dose at the right time.

Stopping treatment with Alpragen

Do not stop treatment on your own. Before stopping treatment, the doses of the medicine should be gradually reduced. Your doctor will tell you how to do this. If you stop taking Alpragen or stop treatment too early, you may experience symptoms such as: anxiety, restlessness, especially motor, seizures, headaches, muscle pain, tension, confusion, irritability, involuntary movements, and difficulty sleeping.
In severe cases, symptoms may also include loss of consciousness, loss of contact with reality, increased sensitivity to light, sound, and touch, feeling of numbness or tingling in the limbs, seeing or hearing things that do not exist, seizures, abdominal cramps, and muscle spasms, vomiting, sweating, and shivering.

Contact your doctor if you experience any of these symptoms or mood changes.

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

4. Possible side effects

Like all medicines, Alpragen can cause side effects, although not everybody gets them.
In people with a history of violence, borderline personality disorders, alcohol abuse, and people taking medicines that affect the central nervous system, hostile or aggressive behavior has been observed. If the patient has post-traumatic stress disorder, stopping treatment with Alpragen may cause irritability, hostility, and unpleasant thoughts and reflections.
Common side effects are usually observed at the beginning of treatment with Alpragen. These symptoms usually disappear during continued treatment.
You should tell your doctor immediatelyif you experience any of the following side effects, as they can be serious:
Uncommon(may affect up to 1 in 100 people)

• seizures
• epileptic seizures in the brain, which can affect muscle activity, senses, vital functions, or changes in the way the patient thinks, feels, and experiences things
• memory loss (amnesia)
• atypical reaction to the medicine, which may include one or more of the following symptoms: restlessness, especially motor, agitation, irritability, aggression, delusions, outbursts of anger, nightmares, hallucinations (seeing or hearing things that do not exist), loss of contact with reality (psychosis), and bizarre behavior
• withdrawal syndrome.

Side effects with unknown frequency(frequency cannot be estimated from available data)

• increased risk of infections, which may be manifested by fever, severe chills, mouth ulcers, or throat pain. These may be symptoms of a low white blood cell count
• respiratory failure causing breathing difficulties
• liver inflammation, which may cause nausea, vomiting, loss of appetite, general malaise, fever, itching, yellowing of the skin or whites of the eyes, pale stools, dark urine
• symptoms of a severe allergic reaction, which may include symptoms such as itching rash, swelling of the eyelids, face, lips, mouth, tongue, or throat, which may cause difficulty swallowing or breathing
• passing small amounts of urine or inability to pass urine
• medicine abuse

Stop taking the medicine. Your doctor will tell you how to do this.
Other side effects
Very common(may affect more than 1 in 10 people)

• drowsiness or drowsiness, sleep problems
• dizziness, difficulty controlling movements (ataxia)
• headaches
• speech difficulties
• severe constipation, dry mouth
• fatigue
• weight gain or loss
• depression
• memory problems.

Common(may affect up to 1 in 10 people)

• increased or decreased appetite
• blurred vision
• feeling of detachment from the body (depersonalization)
• perceiving others and the surrounding world in an unrealistic way, as if in a dream (derealization)
• fear, nervousness, or anxiety, confusion, disorientation
• tingling, uncontrolled muscle contractions, coordination disorders, shivering, or trembling, balance problems
• difficulty concentrating, lack of energy
• rapid heartbeat, which may be felt as palpitations in the chest
• hot flashes
• stuffy nose, sore throat, or choking cough. These may be symptoms of an infection
• rapid breathing
• increased or decreased sexual desire
• insomnia
• excessive drowsiness
• sexual function disorders
• increased salivation
• vomiting, feeling of discomfort in the stomach, diarrhea, nausea (nausea), abdominal pain
• excessive sweating
• skin rash, itching
• muscle spasms or convulsions, back pain, muscle pain, joint pain
• chest pain
• unusual weakness
• swelling caused by excess fluid in the body (peripheral edema)
• ringing in the ears
• risk of road accidents

Uncommon(may affect up to 1 in 100 people)

• greater tendency to bruise
• restless sleep
• talkativeness, impulsiveness, slowed thinking
• muscle weakness
• restricted movements
• double vision, other vision problems
• euphoria or excitement, inability to feel pleasure from enjoyable activities
• permanent inability to achieve orgasm
• mood changes
• panic attacks
• fainting
• clumsiness
• taste disorders
• state of near-unconsciousness (stupor)
• stiffness of the joints, limb pain
• involuntary urination (incontinence) or frequent urination during the day
• problems with ejaculation, inability to achieve or maintain an erection
• irregular menstrual periods in women
• general malaise
• change in gait, feeling of intoxication, feeling of nervousness or tension, feeling of relaxation, feeling of drunkenness
• flu-like symptoms, drowsiness
• thirst
• increased bilirubin levels, which may be visible in blood tests
• falls, limb injuries
• overdose
• medicine dependence

Side effects with unknown frequency(frequency cannot be estimated from available data)

• high prolactin levels in the blood, which may be visible in blood tests (hyperprolactinemia)
• hostile behavior
• inability to sit or stand still, hyperactivity
• thinking disorders
• learning and problem-solving difficulties
• vessel problems
• swelling of the hands and feet (peripheral edema)
• increased alertness
• increased sensitivity to light
• rapid heartbeat (tachycardia)
• low blood pressure
• decreased salivation
• liver function disorders, which may be visible in blood tests
• muscle tone disorders
• feeling of heat
• increased eye pressure

Reporting side effects

If you experience any side effects, including those not listed in this leaflet, please tell your doctor or pharmacist. Side effects can be reported directly to the Department of Drug Safety Monitoring of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products,
Jerozolimskie Avenue 181C, phone: 22 49 21 301, fax: 22 49 21 309,
website: https://smz.ezdrowie.gov.pl
Side effects can also be reported to the marketing authorization holder.
By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Alpragen

Keep this medicine out of the sight and reach of children.
Store in a temperature below 25°C. Store in the original packaging to protect from light and moisture.

Do not use this medicine after the expiry date stated on the carton and blister after

“EXP”.The expiry date refers to the last day of the month.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.

6. Contents of the pack and other information

What Alpragen contains

• The active substance of Alpragen is alprazolam. Each tablet contains 0.25 mg, 0.5 mg, or 1 mg of alprazolam
• The other ingredients are: lactose monohydrate (see section 2 "Alpragen contains lactose monohydrate"), microcrystalline cellulose, cornstarch, sodium benzoate, diethyl phthalate sodium salt, povidone, colloidal silica, sodium glycolate starch, magnesium stearate
• The coating of the 0.5 mg tablets contains indigo carmine (E 132) and erythrosine lake (E 127)
• The coating of the 1.0 mg tablets contains indigo carmine (E 132)

What Alpragen looks like and contents of the pack

0.25 mg tablets: white, oval tablets with the inscription "AL" score line "0.25" on one side and "G" on the other side.
0.5 mg tablets: pink, oval tablets with the inscription "AL" score line "0.5" on one side and "G" on the other side.
1 mg tablets: light blue, oval tablets with the inscription "AL" score line "1.0" on one side and "G" on the other side.
Alpragen is available in packs containing 30 or 60 tablets in blisters.
Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder
Viatris Limited
Damastown Industrial Park
Mulhuddart, Dublin 15
DUBLIN
Ireland
Manufacturer
McDermott Laboratories Ltd., trading as Gerard Laboratories Ltd.
35/36 Baldoyle Industrial Estate
Grange Road, Dublin 13
Ireland
Mylan Hungary Kft.
Mylan utca 1.
Komárom, 2900
Hungary
To obtain more detailed information, please contact the representative of the marketing authorization holder:

Viatris Healthcare Sp. z o.o.

phone: +48 22 54 66 400

Date of last revision of the leaflet: