Atenza

Leaflet accompanying the packaging: information for the user

Atenza, 18 mg, prolonged-release tablets

Atenza, 27 mg, prolonged-release tablets

Atenza, 36 mg, prolonged-release tablets

Atenza, 45 mg, prolonged-release tablets

Atenza, 54 mg, prolonged-release tablets

Methylphenidate hydrochloride

Read the leaflet carefully before the patient or child takes the medicine, as it contains important information for the patient.

• Keep this leaflet, you may need to read it again.
• In case of any doubts, consult a doctor or pharmacist.
• This medicine has been prescribed specifically for this person. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same.
• If the patient experiences any side effects, including any not listed in this leaflet, they should tell their doctor or pharmacist. See section 4.

Table of contents of the leaflet

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

1. What is Atenza and what is it used for

What is Atenza used for

Atenza is used to treat attention deficit hyperactivity disorder (ADHD).

• It is used in children and adolescents from 6 years of age and older, as well as in adults.
• It is used only after previous attempts at treatment without medication, such as psychological counseling and behavioral training (behavioral therapy).

Atenza is not intended for use in the treatment of ADHD in children under 6 years of age.

How Atenza works

Atenza improves the function of certain parts of the brain that are underactive. The medicine may help improve attention, concentration, and reduce impulsive behavior.
The medicine is used as part of a treatment program that usually includes therapy:

• psychological
• educational
• environmental. The medicine is prescribed exclusively by a doctor with experience in the field of behavioral disorders in children and adolescents or adults. In adults who have not been treated before, a specialist will conduct studies to confirm that the patient has had ADHD since childhood. Although there is no cure for ADHD, it can be controlled with therapeutic programs.

Information about ADHD

Children and adolescents with ADHD have difficulty:

• sitting still for a long time
• concentrating.

This behavior is not their fault, as they have no control over it.
Many children and adolescents experience such disorders. However, ADHD can cause problems in daily life. Children and adolescents with ADHD may have difficulty learning and doing homework. They have trouble behaving properly at home, school, and other places.
ADHD does not limit intelligence.
Adults with ADHD often have difficulty concentrating. They often feel restless, impatient, and inattentive. They may have trouble organizing their private and professional life.
Not all patients with ADHD require pharmacological treatment.

2. Important information before taking Atenza

When not to take Atenza

• psychopathic or emotionally unstable personality (borderline type)
• abnormal thoughts or visions or a disease called schizophrenia
• severe mood disorders with symptoms such as: thoughts or suicidal tendencies, severe depression, when the patient is very sad, feels worthless, and has no hope for the future, mania, when the patient is extremely excited, overly active, and uncontrolled in their actions. Methylphenidate should not be taken if any of the above situations apply to the patient. In case of doubts, before taking methylphenidate, consult a doctor or pharmacist, as methylphenidate may exacerbate these conditions.

Warnings and precautions

Before starting treatment with Atenza, the patient should discuss with their doctor if they:

• have liver or kidney function disorders
• have difficulty swallowing or swallowing whole tablets
• have narrowing or obstruction of the intestines or esophagus
• have had seizures (seizures, epilepsy) or abnormal brain electroencephalogram (EEG)
• have ever abused or been dependent on alcohol, prescription drugs, or narcotics
• are a woman or girl who has started menstruating (see below "Pregnancy, breastfeeding, and contraception")
• have uncontrollable, repetitive movements or sounds (tics)
• have high blood pressure
• have heart diseases other than those listed above in "When not to take Atenza"
• have other mental disorders than those listed above in "When not to take Atenza"

Other mental disorders include:

• mood swings (from mania to depression, known as "bipolar affective disorder")
• feeling aggressive or hostile
• seeing, hearing, or feeling things that are not there (hallucinations)
• believing in things that are not true (delusions)
• excessive suspicion (paranoia)
• feeling excited, anxious, and tense
• feeling depressed or guilty.

Before starting treatment, the patient should inform their doctor or pharmacist if any of the above symptoms or diseases apply to them, as methylphenidate may exacerbate these conditions.
The doctor will want to monitor how the medicine affects the patient.
During treatment in boys and young men, unexpected, prolonged erections may occur. This can be painful and occur at any time. If an erection lasts longer than 2 hours, the patient should immediately contact their doctor, especially if it is painful.

Medical history before starting Atenza

The medical history is intended to decide whether methylphenidate is a suitable medicine for the patient. The doctor will discuss with the patient:

• all other medicines taken by the patient
• any cases of sudden, unexplained death in the family
• any other diseases (such as heart disease) that the patient or their family members have
• the patient's well-being, e.g., whether they have mood swings, unusual thoughts, or if such feelings have occurred in the past
• the occurrence of tics (uncontrollable, repetitive movements or sounds) in the patient's family
• any mental health or behavioral disorders that have occurred in the patient or their family members. The doctor will assess the risk of mood swings (from mania to depression - known as "bipolar affective disorder"). This will involve conducting a mental state interview, including questions about suicidal attempts in the family, the occurrence of bipolar affective disorder or depression. It is essential to provide as much information as possible. This will help the doctor decide whether methylphenidate is a suitable medicine for the patient. Before taking the medicine, the doctor may decide to perform other tests. In the case of adult patients who are starting to take Atenza for the first time, the doctor may refer the patient to a heart specialist.

Atenza and other medicines

The patient should tell their doctor about all medicines they are currently taking or have recently taken, as well as any medicines they plan to take.
Do not take methylphenidate if the patient:

• takes a medicine called a "monoamine oxidase inhibitor" (MAOI), used to treat depression, or if this medicine has been taken in the last 14 days. Taking this medicine with methylphenidate can cause a sudden increase in blood pressure (see "When not to take Atenza").

The patient should tell their doctor or pharmacist if they are taking any of the following antidepressant or anti-anxiety medicines:

• tricyclic antidepressants
• selective serotonin reuptake inhibitors (SSRIs)
• serotonin and norepinephrine reuptake inhibitors (SNRIs). Taking methylphenidate with these medicines can lead to a life-threatening increase in serotonin levels in the brain (serotonin syndrome), which can cause confusion, anxiety, sweating, shivering, muscle contractions, or rapid heartbeat. If the patient experiences these side effects, they should immediately contact their doctor.

If the patient is taking other medicines, methylphenidate may affect their action or cause side effects. Before taking methylphenidate, the patient should inform their doctor or pharmacist if they are taking any of the following medicines:

• medicines used in severe mental disorders
• medicines used in Parkinson's disease (such as levodopa)
• antiepileptic medicines
• medicines used to lower or increase blood pressure
• certain cough and cold medicines that contain ingredients that can affect blood pressure. It is essential to consult a pharmacist when purchasing such medicines.
• blood-thinning medicines that prevent blood clots.

In case of doubts about whether any of the medicines taken by the patient are on the above list, the patient should consult their doctor or pharmacist before taking methylphenidate.
The patient should tell their doctor or pharmacist about all medicines they are currently taking or have recently taken, including those that are available without a prescription.

Before surgery

The patient should tell their doctor about planned surgery. Do not take methylphenidate on the day of the operation if a certain type of anesthetic is used, due to the risk of a sudden increase in blood pressure during the operation.

Drug tests

The medicine may cause a positive result in drug tests. This also applies to tests performed on athletes.

Atenza and alcohol

Do not drink alcohol while taking this medicine. Alcohol may exacerbate the side effects of this medicine. Remember that some foods and medicines contain alcohol.

Pregnancy, breastfeeding, and contraception

If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor before taking this medicine.
Available data do not indicate an increased risk of developmental disorders in general, although a slight increase in the risk of heart defects during treatment with the medicine in the first three months of pregnancy cannot be ruled out. The doctor will provide the patient with additional information about this risk. Before taking methylphenidate, the patient should consult their doctor or pharmacist if they:

• are sexually active. The doctor will discuss contraception methods with the patient
• are pregnant or think they may be pregnant. The doctor will decide whether methylphenidate should be taken
• are breastfeeding or plan to breastfeed. Methylphenidate passes into human milk. Therefore, the doctor will decide whether to continue breastfeeding during treatment with methylphenidate.

Driving and using machines

While taking methylphenidate, the patient may experience dizziness, concentration disorders, and blurred vision. If this happens, it may be dangerous to perform activities such as: driving a vehicle, operating machines, cycling, horse riding, or climbing trees.
This medicine may affect the ability to drive a vehicle. Do not drive a vehicle while taking this medicine until it is known how the medicine affects the patient. Driving a vehicle may be an offense if the patient has impaired ability to drive safely.

Atenza contains lactose

If the patient has been diagnosed with intolerance to some sugars, they should consult their doctor before taking this medicine.

Atenza contains sodium

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

3. How to take Atenza

What dose to take

This medicine should always be taken according to the doctor's instructions. In case of doubts, consult a doctor or pharmacist.

• The doctor usually starts treatment with a small dose and, if necessary, gradually increases the daily dose by 18 mg, no more than once a week. The goal should be the smallest dose that is effective for the patient. The doctor will decide on the maximum daily dose for the patient.
• Atenza should be taken once a day, in the morning, with a glass of water. The tablet should be swallowed whole. The tablets should not be chewed, divided, or crushed. The tablet can be taken with or without food. The tablet may not dissolve completely after the release of the active substance, and therefore, its coating may sometimes be visible in the patient's stool. This is a normal phenomenon.

Use in children aged 6 years and older

• The recommended initial dose of Atenza is 18 mg once daily for children who are not currently taking methylphenidate or for children who are switching from another stimulant to methylphenidate,
• The maximum daily dose is 54 mg.

Use in adults

Adults who have previously taken Atenza:

• adult patients may require a higher daily dose, but the doctor will aim to use the smallest dose that is effective.

Adults who have not previously taken Atenza:

• The recommended initial dose is 18 mg per day.
• The maximum daily dose in adults is 72 mg.

If the patient does not feel better after a month of treatment

If the patient does not feel better after a month of treatment, they should tell their doctor, who may decide to use a different treatment.

Incorrect use of Atenza

Incorrect use of Atenza can lead to abnormal behavior. This can also be a sign of dependence on the medicine. The patient should tell their doctor if they have ever abused or been dependent on alcohol, prescription drugs, or narcotics.
The medicine is intended only for the patient for whom it was prescribed. Do not pass it on to another person, even if they have similar symptoms.

Taking a higher dose of Atenza than recommended

In case of taking too much of the medicine, the patient should immediately contact their doctor or call emergency services. They should inform about the amount of medicine taken. Treatment may be necessary.
Overdose symptoms may include: vomiting, feeling excited, shivering, increased involuntary movements, muscle twitching, seizures (which may be followed by coma), feeling euphoric, disoriented, seeing, feeling, or hearing things that are not real (hallucinations), increased sweating, hot flashes, headache, high fever, changes in heart rhythm (slow, fast, or irregular), high blood pressure, dilated pupils, and dryness of the nasal and oral mucosa.

Missing a dose of Atenza

Do not take a double dose to make up for a missed tablet. If the patient forgets to take a tablet, they should wait until it is time for the next scheduled dose.

Stopping treatment with Atenza

If the patient suddenly stops taking the medicine, ADHD symptoms may return or side effects may occur, such as depression. The doctor may recommend gradually reducing the amount of medicine taken daily before it is completely discontinued. The patient should discuss with their doctor before stopping treatment with Atenza.

Tests performed by the doctor during treatment

The doctor will perform several tests

• before starting treatment - to ensure that Atenza is safe and beneficial for the patient;
• after starting treatment, at least once every 6 months, but possibly more often, as well as with each dose change;
• the tests will include:
• appetite check
• measurement of growth and body weight
• measurement of blood pressure and heart rate
• assessment of mood disorders, mental state, or any other abnormalities in the patient and whether they have worsened while taking Atenza.

Long-term treatment
Atenza does not have to be taken indefinitely. If Atenza is taken for more than 1 year, the doctor should temporarily stop it, e.g., during school vacations. This will allow assessment of whether the medicine is still needed.
In case of any further doubts about taking this medicine, the patient should consult their doctor or pharmacist.

4. Possible side effects

Like all medicines, Atenza can cause side effects, although not everybody gets them.
Although some people experience side effects, most patients find that methylphenidate helps them. The doctor will discuss these side effects with the patient.

Some side effects can be serious. If the patient experiences any of the following side effects, they should immediately inform their doctor.

Common side effects (may occur in up to 1 in 10 people)

• irregular heartbeat (palpitations)
• mood changes or personality changes.

Uncommon side effects (may occur in up to 1 in 100 people)

• suicidal thoughts or tendencies
• seeing, feeling, or hearing things that are not real - these are symptoms of psychosis
• uncontrolled sounds or movements (Tourette's syndrome)
• allergic reactions, such as rash, itching, or hives on the skin, swelling of the face, lips, tongue, or other parts of the body, difficulty breathing, wheezing, or shortness of breath.

Rare side effects (may occur in up to 1 in 1,000 people)

• feeling overly excited, overly active, and lacking restraint (mania).

Very rare side effects (may occur in up to 1 in 10,000 people)

• heart attack
• sudden death
• suicide attempts
• seizures (epileptic fits, epilepsy)
• skin peeling or purple-red spots on the skin
• inflammation or blockage of brain blood vessels
• transient paralysis or movement disorders, vision, or speech disorders (these may be symptoms of cerebrovascular disorders)
• involuntary muscle contractions of the eye, head, neck, body, and neurological symptoms
• reduced blood cell count (red, white, and platelets), which can increase the risk of infections, bleeding, and bruising
• sudden increase in body temperature, very high blood pressure, and severe seizures (malignant neuroleptic syndrome). It is not certain whether this side effect is caused by methylphenidate or other medicines that may be taken at the same time.

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

• recurring unwanted thoughts
• unexplained fainting, chest pain, shortness of breath (these may be symptoms of heart disease)
• prolonged erections, sometimes painful, or increased number of erections.

If the patient experiences any of these side effects, they should immediately contact their doctor.

Tell the doctor or pharmacist if any of the following side effects worsen:

Very common side effects (may occur in more than 1 in 10 people)

• headache
• nervousness
• insomnia.

Common side effects (may occur in up to 1 in 10 people)

• joint pain
• blurred vision
• pressing headache
• dry mouth, thirst
• difficulty falling asleep
• high temperature (fever)
• decreased libido
• unusual hair loss or thinning
• muscle tension, muscle spasms
• loss of appetite or decreased appetite
• difficulty achieving or maintaining an erection
• itching, rash, or raised, red, itchy rash (hives)
• unusual drowsiness, feeling tired
• excessive grinding of teeth (bruxism)
• feeling panicked
• feeling of pinching, tingling, or numbness of the skin
• increased alanine aminotransferase (liver enzyme) in the blood
• cough, sore throat, or irritation of the nose and throat; upper respiratory tract infections, sinusitis
• high blood pressure, rapid heartbeat (tachycardia)
• dizziness, feeling weak, involuntary movements, excessive psychomotor activity
• aggression, excitement, anxiety, depression, irritability, tension, and behavioral disorders
• nausea, abdominal pain, diarrhea, nausea, discomfort in the abdominal cavity, and vomiting
• excessive sweating
• weight loss.

Uncommon side effects (may occur in up to 1 in 100 people)

• dry eyes
• constipation
• discomfort in the chest
• blood in the urine
• indifference
• tremors
• need to urinate frequently
• muscle pain, muscle spasms
• shortness of breath or chest pain
• feeling hot
• elevated liver function test results (in blood tests)
• anger, feeling impatient or tearful, logorrhea, excessive alertness, sleep disorders.

Rare side effects (may occur in up to 1 in 1,000 people)

• sexual function disorders
• state of disorientation or confusion
• vision or double vision disorders
• breast enlargement in men
• redness, raised, red, itchy rash.

Very rare side effects (may occur in up to 1 in 10,000 people)

• muscle spasms
• small red spots on the skin
• liver function disorders, including acute liver failure and coma
• changes in test results - including liver function tests and blood tests
• thinking disorders, apathy, repetition of actions, excessive focus on one thing
• feeling numbness in the fingers and toes, tingling, and color change of the skin (from white to blue, and then red) after cooling (Raynaud's phenomenon).

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

• migraine
• pupil dilation
• very high fever
• slow or fast heart rate or extra heartbeats
• grand mal seizures
• delusions
• severe abdominal pain, often with nausea and vomiting
• disorders related to blood vessels in the brain (stroke, cerebral vasculitis, or cerebral vessel obstruction)
• inability to control urination (urinary incontinence)
• muscle spasm of the jaw that makes it difficult to open the mouth (jaw lock)
• stuttering
• nosebleeds.

Effect on physical development

Methylphenidate taken for more than a year may cause slowing of physical development in some children. This occurs in less than 1 in 10 children.

• There may be a lack of weight gain or growth.
• The doctor will carefully monitor the patient's growth and weight, as well as their diet.
• If the child's development is slower than expected, treatment with methylphenidate may be temporarily stopped.

Reporting side effects

If side effects occur, including any not listed in this leaflet, the patient should tell their doctor, pharmacist, or nurse. 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, Al. Jerozolimskie 181C, 02-222 Warsaw; phone: +48 22 49 21 301; fax: +48 22 49 21 309; website: https://smz.ezdrowie.gov.pl .
Side effects can also be reported to the marketing authorization holder.
Reporting side effects will help gather more information on the safety of this medicine.

5. How to store Atenza

Keep the medicine out of sight and reach of children.
Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the month.
Store the bottle tightly closed to protect from moisture.
There are no special storage temperature instructions for this medicine.
Medicines should not be disposed of via wastewater or household waste. The patient should ask their 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 Atenza contains

The active substance of the medicine is methylphenidate hydrochloride.

• Each tablet contains 18 mg, 27 mg, 36 mg, 45 mg, or 54 mg of methylphenidate hydrochloride. The other ingredients are:
• Tablet core:hypromellose, macrogol, succinic acid, magnesium stearate, sodium chloride, colloidal silica, anhydrous, black iron oxide (E 172).
• Coating:cellulose acetate, macrogol.
• Colorless coating:hypromellose, macrogol, phosphoric acid (to adjust pH).
• Colored coating:lactose, hypromellose, triacetin, titanium dioxide (E 171), yellow iron oxide (E 172) (18 mg tablet), red iron oxide (E 172) (18 mg, 27 mg, and 54 mg tablets), black iron oxide (E 172) (27 mg tablet), indigo carmine (E 132) (45 mg tablet).

What Atenza looks like and contents of the pack

• 18 mg: round, biconvex, yellow film-coated tablets, approximately 9 mm in diameter, with a small hole on one side of the tablet.
• 27 mg: round, biconvex, gray film-coated tablets, approximately 9 mm in diameter, with a small hole on one side of the tablet.
• 36 mg: round, biconvex, white film-coated tablets, approximately 10 mm in diameter, with a small hole on one side of the tablet.
• 45 mg: round, biconvex, blue film-coated tablets, approximately 10 mm in diameter, with a small hole on one side of the tablet.
• 54 mg: round, biconvex, pink film-coated tablets, approximately 10 mm in diameter, with a small hole on one side of the tablet.

The medicine is available in a plastic bottle with a plastic child-resistant cap, containing 2 desiccant containers. The desiccant containers, which should not be swallowed, ensure that the tablets remain dry.
The bottle is packaged in a cardboard box.
Pack sizes: 30 tablets, 60 tablets (2 x 30), or 90 tablets (3 x 30).
Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

Exeltis Poland Sp. z o.o.
ul. Szamocka 8
01-748 Warsaw
e-mail: biuro@exeltis.com

Manufacturer

LABORATORIOS LICONSA S.A.
Avda. Miralcampo, Nº 7
Polígono Industrial Miralcampo
19200 Azuqueca de Henares (Guadalajara)
Spain

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

Sweden: Phenichem 18 mg, 27 mg, 36 mg, 45 mg, 54 mg depottablett
United Kingdom: Phenichem XL 18 mg, 27 mg, 36 mg, 54 mg prolonged release tablets
Spain: Atenza 18 mg, 27 mg, 36 mg, 45 mg, 54 mg comprimidos de liberación prolongada
Poland: Atenza
Date of last revision of the leaflet:24.05.2024