Palexia retard

Leaflet accompanying the packaging: patient information

Palexia retard, 25 mg, prolonged-release tablets

Tapentadol

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

• Keep this leaflet, so you can read it again if you need to.
• If you have any doubts, consult your doctor, pharmacist, or nurse.
• This medicine has been prescribed specifically for you. 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 those not listed in this leaflet, they should inform their doctor, pharmacist, or nurse. See section 4.

Table of contents of the leaflet

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

1. What is Palexia retard and what is it used for

Tapentadol, the active substance of Palexia retard, is a strong pain-relieving opioid. Palexia retard is indicated for the treatment of:

• severe chronic pain in adults that can only be adequately managed with opioid pain relievers;
• severe chronic pain in children over 6 years of age and adolescents who can only be adequately managed with opioid pain relievers.

2. Important information before taking Palexia retard

When not to take Palexia retard:

• if the patient is allergic to tapentadol or any of the other ingredients of this medicine (listed in section 6),
• in patients with asthma or life-threatening slow and shallow breathing (respiratory depression, increased carbon dioxide levels in the blood),
• in patients with intestinal obstruction,
• in case of acute alcohol poisoning, sleeping pills, pain relievers, or other psychotropic medicines (mood- and emotion-affecting medicines) (see "Palexia retard and other medicines").

Warnings and precautions

Before starting treatment with Palexia retard, the patient should discuss it with their doctor, pharmacist, or nurse:

• in case of slow or shallow breathing,
• in case of increased intracranial pressure or impaired consciousness up to coma,
• in patients after head injury or with brain tumors,
• in patients with liver or kidney disease (see "How to take Palexia retard"),
• in patients with pancreatic or biliary disorders, including pancreatitis,
• in patients taking mixed agonist-antagonist opioid receptor "mi" medicines (e.g., pentazocine, nalbuphine) or partial agonists of the opioid receptor "mi" (e.g., buprenorphine).
• in patients with a history of seizure disorders or convulsions, or when taking other medicines that increase the risk of seizures and may increase the risk of attacks,
• if the patient or a family member has ever abused or been dependent on alcohol, prescription drugs, or illegal substances ("addiction"),
• if the patient is a smoker,
• if the patient has ever had mood disorders (depression, anxiety, or personality disorder) or has been treated by a psychiatrist for other mental disorders.

This medicine contains tapentadol, which is an opioid. Repeated use of opioid pain relievers can lead to reduced efficacy of the medicine (the body getting used to it). It can also lead to dependence and abuse, which can cause life-threatening overdose. If the patient is concerned about becoming dependent on Palexia retard, they should consult their doctor. Taking the medicine (even at therapeutic doses) can lead to physical dependence, which can cause withdrawal symptoms and recurrence of problems if treatment is suddenly stopped.
Palexia retard can cause physical and psychological dependence. In cases of a tendency to abuse medicines or addiction, treatment should be short-term and under close medical supervision.
Children and adolescents
Children and adolescents with obesity should be closely monitored and not exceed the recommended maximum dose.
The medicine should not be given to children under 6 years of age.
Sleep apnea syndrome
Palexia retard may cause sleep apnea syndrome, such as sleep apnea (pauses in breathing during sleep) and hypoxemia (low oxygen levels in the blood). Symptoms may include pauses in breathing during sleep, nighttime awakenings due to shortness of breath, difficulty staying asleep, or excessive daytime sleepiness. If the patient or another person notices such symptoms, they should contact their doctor. The doctor may consider reducing the dose.

Palexia retard and other medicines

The patient should tell their doctor or pharmacist about all medicines they are taking or have recently taken, as well as any medicines they plan to take.
The risk of side effects increases if the patient takes medicines that can cause seizures (epileptic fits), such as antidepressants or antipsychotics. The risk of an attack may increase if the patient takes Palexia retard at the same time. The doctor will inform the patient whether taking Palexia retard is suitable for them.
Concomitant use of Palexia retard and sedative medicines, such as benzodiazepine derivatives or benzodiazepine-like medicines (e.g., certain sleeping pills or sedatives (e.g., barbiturates) or pain relievers, such as opioids, morphine, and codeine (also used as a cough suppressant), antipsychotics, antihistamines H1, alcohol), increases the risk of drowsiness, breathing difficulties (respiratory depression), and coma, and can be life-threatening. Therefore, concomitant use of such medicines should only be considered when there are no other treatment options available.
If the doctor prescribes Palexia retard with sedative medicines, they should limit the dose and duration of concomitant treatment.
Concomitant use of opioids and medicines used to treat epilepsy, neuralgia, or anxiety (gabapentin and pregabalin) increases the risk of opioid overdose, respiratory depression, and can be life-threatening.
The patient should inform their doctor if they are taking gabapentin or pregabalin or any sedative medicine and strictly follow the doctor's dosage instructions. It may be helpful to inform friends or relatives to be aware of the above symptoms and contact a doctor if they occur.
If the patient is taking medicines that affect serotonin levels (e.g., certain medicines used to treat depression), they should consult their doctor before taking Palexia retard, due to the risk of "serotonin syndrome". Serotonin syndrome is rare but can be life-threatening. Its symptoms include: uncontrolled, rhythmic muscle contractions, including those that control eye movements, agitation, excessive sweating, shivering, increased muscle tone, and body temperature above 38°C. If this happens, the patient should consult their doctor.
Concomitant use of Palexia retard with opioid medicines from the mixed agonist/antagonist receptor "mi" group (e.g., pentazocine, nalbuphine) or partial agonists of the receptor "mi" (e.g., buprenorphine) has not been studied. It is possible that Palexia retard will not work properly if taken concomitantly with medicines from the above groups.
The patient should immediately inform their doctor about any concomitant use of the above medicines.
Concomitant use of Palexia retard with strong inhibitors or inducers (e.g., rifampicin, phenobarbital, St. John's Wort) of the enzymes necessary for the elimination of tapentadol from the body may affect the action of tapentadol or cause side effects, especially when starting or stopping their administration. The patient should tell their doctor about all medicines they are currently taking.
Palexia retard should not be used concomitantly with MAO inhibitors (medicines used to treat depression). The patient should tell their doctor if they are taking or have taken these medicines in the last 14 days.

Palexia retard with food, drink, and alcohol

The patient should not drink alcohol while taking Palexia retard, as some side effects, such as drowsiness, may be exacerbated. The medicine can be taken with or without food.

Pregnancy, breastfeeding, and fertility

If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor or pharmacist before taking this medicine.
Palexia retard should not be used:

• during pregnancy, unless the doctor decides to use it. Long-term use of tapentadol during pregnancy may cause withdrawal symptoms in newborns, which can be life-threatening if not recognized and treated by a doctor.
• during childbirth, as it may cause dangerous respiratory depression or shallow breathing in the newborn (respiratory depression),
• while breastfeeding, as the medicine may be excreted in breast milk.

Driving and using machines

Palexia retard may cause drowsiness, dizziness, blurred vision, and affect reaction time. These symptoms may occur especially at the beginning of treatment with Palexia retard, after a dose change prescribed by the doctor, or when concomitantly using alcohol or sedative medicines. The patient should ask their doctor if they can drive or operate machinery after taking the medicine.

Palexia retard contains lactose

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

3. How to take Palexia retard

This medicine should always be taken as directed by the doctor. If the patient has any doubts, they should consult their doctor or pharmacist.
Dosage should be adjusted according to the severity of the pain and the patient's individual sensitivity. The smallest effective dose should be used to relieve pain.

Adults

The usual initial dose is 50 mg every 12 hours.
The doctor may prescribe a different, more suitable dose or interval between doses if necessary.
If the patient feels that the effect of the medicine is too strong or too weak, they should contact their doctor or pharmacist.
Total daily doses greater than 500 mg of tapentadol are not recommended.

Elderly patients

Dose adjustment is not usually necessary in elderly patients (over 65 years).
Elimination of the medicine may be prolonged in this age group, and the doctor may prescribe a different dosing schedule.

Patients with impaired liver or kidney function

Patients with severe liver impairment should not take this medicine.
In case of moderate liver impairment, the doctor will prescribe a different dosing schedule.
Patients with mild liver impairment do not require dose adjustment.
Patients with severe kidney impairment should not take this medicine.
In case of mild or moderate kidney impairment, dose adjustment is not necessary.

Use in children and adolescents

The dose of Palexia retard in children and adolescents from 6 to less than 18 years of age depends on age and body weight.
The appropriate dose will be determined by the doctor. The total daily dose should not exceed 500 mg, i.e., 250 mg every 12 hours.
The medicine should not be used in children and adolescents with impaired kidney or liver function.
Palexia retard is not recommended for use in children under 6 years of age.

Method of administration

Palexia retard should be taken orally.
The tablet should be swallowed whole, with a sufficient amount of liquid.
The tablet should not be chewed, broken, or crushed, as this may lead to overdose due to rapid release of the medicine in the body.
The medicine can be taken with or without food.
The empty tablet shell may not be completely digested and may be present in the stool. The patient should not be concerned, as the active substance has already been absorbed by the body, and only the tablet shell is present in the stool.

Duration of treatment

The patient should not take the tablets for longer than prescribed by the doctor.

Taking a higher dose of Palexia retard than recommended

After taking very high doses, the following symptoms may occur:

• pupil constriction to the size of a pinhead, vomiting, blood pressure drop, rapid heartbeat, collapse, impaired consciousness or coma (deep state of loss of consciousness), seizures, life-threatening slow or shallow breathing or respiratory arrest. In such cases, the patient should immediately contact their doctor!

Missing a dose of Palexia retard

If the patient forgets to take a dose, their pain symptoms will likely return.
The patient should not take a double dose to make up for the missed dose.
The patient should return to their previous dosing schedule.

Stopping treatment with Palexia retard

If the patient stops taking Palexia retard or discontinues treatment before the end of the treatment period, their pain symptoms will likely return. The patient should contact their doctor before stopping the medicine.
Generally, no side effects are observed after stopping the medicine, although in rare cases, patients who have taken the medicine for some time and stop it abruptly may experience general malaise.
The following symptoms may occur:

• restlessness, tearfulness, runny nose, yawning, sweating, chills, muscle pain, and pupil dilation,
• irritability, anxiety, back pain, joint pain, weakness, abdominal cramps, difficulty sleeping, nausea, loss of appetite, vomiting, diarrhea, increased blood pressure, respiratory rate, and heart rate. If these symptoms occur, the patient should immediately consult their doctor.

The patient should not suddenly stop taking the medicine unless their doctor advises them to do so.
The doctor will inform the patient about how to stop taking the medicine. Stopping the medicine may involve gradually reducing the dose.
If the patient has any further doubts about taking this medicine, they should consult their doctor or pharmacist.

4. Possible side effects

Like all medicines, Palexia retard can cause side effects, although not everybody gets them. In children and adolescents, no additional side effects have been observed compared to those in adults.

Important side effects or symptoms to watch out for and what to do if they occur:

This medicine can cause allergic reactions. Symptoms may include wheezing, difficulty breathing, swelling of the eyelids, face, or lips, rash, or itching, especially affecting the whole body.
Another serious side effect is excessive respiratory depression. It occurs most often in elderly and frail patients.
If any of these important side effects affect the patient, they should immediately contact their doctor.

Other side effects that may occur:

Very common(may affect more than 1 in 10 people): nausea, constipation, dizziness, drowsiness, headache.
Common(may affect up to 1 in 10 people): loss of appetite, anxiety, depressive mood, sleep disorders, nervousness, restlessness, concentration disorders, tremors, muscle spasms, flushing, shortness of breath, vomiting, diarrhea, indigestion, itching, excessive sweating, rash, feeling weak, fatigue, feeling of temperature change, dryness of mucous membranes, water retention (edema).
Uncommon(may affect up to 1 in 100 people): allergic reactions to the medicine (including skin swelling, urticaria, and in severe cases, difficulty breathing, low blood pressure, collapse, or shock), weight loss, disorientation, confusion, agitation (excitement), perception disorders, unusual dreams, euphoric mood, decreased level of consciousness, memory impairment, mental disorders, fainting, excessive sedation, balance disorders, speech disorders, tingling, abnormal skin sensations (e.g., burning, prickling), vision disorders, rapid heartbeat, slow heartbeat, palpitations, decreased blood pressure, abdominal discomfort, hives, difficulty urinating, frequent urination, sexual dysfunction, withdrawal syndrome (see "Stopping treatment with Palexia retard"), feeling abnormal, irritability.
Rare(may affect up to 1 in 1,000 people): dependence on the medicine, thinking disorders, seizures, feeling of impending fainting, coordination disorders, life-threatening slow or shallow breathing (respiratory depression), impaired gastric emptying, feeling of alcohol intoxication, feeling of relaxation.
Frequency not known(frequency cannot be estimated from the available data): delirium.
Generally, the risk of suicidal thoughts and behaviors is higher in patients with chronic pain. Additionally, medicines used to treat depression (which affect the neurotransmitter system in the brain) may increase this risk, especially at the beginning of treatment. Although tapentadol also affects neurotransmitters, data from human use of the medicine have not provided evidence of an increased risk.

Reporting side effects

If the patient experiences any side effects, including those not listed in the leaflet, they should inform their doctor, pharmacist, or nurse. Side effects can be reported directly to the Department of Monitoring of Adverse Reactions to Medicinal Products, Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, Tel.: +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 to gather more information on the safety of the medicine.

5. How to store Palexia retard

The medicine should be stored out of sight and reach of children.
The medicine should not be used after the expiry date stated on the carton and blister pack. The expiry date refers to the last day of the month.
There are no special precautions for storing 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 Palexia retard contains

• The active substance of Palexia retard is tapentadol. Each tablet contains 25 mg of tapentadol (29.12 mg of tapentadol hydrochloride).
• The other ingredients are: Tablet core: hypromellose, microcrystalline cellulose silanized (microcrystalline cellulose, colloidal silicon dioxide), magnesium stearate. Tablet coating Opadry II Orange 30C230000: hypromellose, lactose monohydrate, talc, macrogol, titanium dioxide (E 171), yellow iron oxide (E 172), red iron oxide (E 172).

What Palexia retard looks like and contents of the pack

Palexia retard are light orange-brown, prolonged-release tablets, oval in shape (5.5 mm x 10 mm), with the Grünenthal logo on one side and "H9" on the other side.
Pack sizes available on the Polish market: 20, 24, 30, 54, and 60 prolonged-release tablets.
Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Grünenthal GmbH
Zieglerstrasse 6
52078 Aachen
Germany

This medicinal product is authorized in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland) under the following names:

Belgium, Croatia, Cyprus, Czech Republic, Germany, Greece, Luxembourg, Netherlands, Poland, Portugal, Slovakia, Spain: PALEXIA retard.
Denmark, Norway, Sweden: PALEXIA Depot.
Ireland, Slovenia, United Kingdom (Northern Ireland): PALEXIA SR.
Italy: PALEXIA.
To obtain more detailed information on this medicine, the patient should contact the representative of the marketing authorization holder:
Stada Pharm Sp. z o.o.
ul. Krakowiaków 44
02-255 Warsaw
Tel. +48 22 737 79 20
Date of last revision of the leaflet:03.2024