Ritmonorm 150

Leaflet attached to the packaging: patient information

Warning! The leaflet should be kept. Information on the immediate packaging in a foreign language.

Rytmonorm 150 (Rytmonorm 150 mg)

150 mg, coated tablets

Propafenone hydrochloride
Rytmonorm 150 and Rytmonorm 150 mg are different trade names for the same drug.

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 a doctor or pharmacist.
• 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 any side effects not listed in this leaflet, they should tell their doctor, pharmacist, or nurse. See section 4.

Table of contents of the leaflet

• 1. What is Rytmonorm 150 and what is it used for
• 2. Important information before taking Rytmonorm 150
• 3. How to take Rytmonorm 150
• 4. Possible side effects
• 5. How to store Rytmonorm 150
• 6. Package contents and other information

1. What is Rytmonorm 150 and what is it used for

Propafenone hydrochloride, the active substance of Rytmonorm 150, has antiarrhythmic properties, meaning it restores or maintains a normal heart rhythm. The mechanism of action of the drug is complex and involves stabilizing the cell membrane and blocking sodium channels. Propafenone hydrochloride also has a weak beta-adrenergic blocking effect. Rytmonorm 150 is indicated:

• for symptomatic supraventricular tachyarrhythmias requiring treatment, such as nodal tachycardia, supraventricular tachycardia in patients with Wolff-Parkinson-White syndrome (WPW) or paroxysmal atrial fibrillation
• for severe symptomatic ventricular tachyarrhythmia, if the doctor considers it life-threatening.

2. Important information before taking Rytmonorm 150

When not to take Rytmonorm 150

• If the patient is allergic to the active substance or any of the other ingredients of this medicine (listed in section 6).
• If the patient has:
• Brugada syndrome
• clinically significant structural heart disease, such as:
• myocardial infarction within the last 3 months
• uncompensated congestive heart failure, with a left ventricular ejection fraction below 35%
• cardiogenic shock, except for shock caused by arrhythmia
• symptomatic severe bradycardia (bradycardia)

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• disorders of sinus node function, atrioventricular conduction disorders, second- or third-degree atrioventricular block, bundle branch block, or distal block in patients without a pacemaker
• severe hypotension
• If the patient has symptoms of water and electrolyte balance disorders (e.g., potassium metabolism disorders).
• In case of severe obstructive pulmonary disease.
• In patients with myasthenia gravis (a disease characterized by muscle weakness).
• If the patient is taking ritonavir (a drug used to treat HIV infections) at the same time.

Warnings and precautions

Before starting to take Rytmonorm 150, discuss it with your doctor. Propafenone, like other antiarrhythmic drugs, may cause proarrhythmic effects, i.e., it may cause new or exacerbate existing heart rhythm disorders (see section 4). Before starting treatment with Rytmonorm 150 and during treatment, the doctor will order an ECG and assess the patient's clinical condition to determine whether the response to the drug justifies its use and to rule out Brugada syndrome (a genetically determined heart disease). Particular caution should be exercised:

• in patients with an implanted pacemaker, the doctor will check the pacemaker's function and, if necessary, reprogram it, as the drug may affect the stimulation threshold and sensitivity of the implanted pacemaker
• in patients with clinically significant structural heart disease, the drug is contraindicated
• in patients with asthma

Some patients may experience a transition from paroxysmal atrial fibrillation to atrial flutter with a 2:1 or 1:1 conduction block.

Rytmonorm 150 and other medicines

Tell your doctor about all the medicines you are taking now or have taken recently, as well as any medicines you plan to take. Taking Rytmonorm 150 with the following medicines may increase the risk of side effects:

• local anesthetics (e.g., during pacemaker implantation, surgery, or dental procedures)
• other medicines that slow the heart rate and (or) contractility of the heart muscle (beta-adrenergic blockers, tricyclic antidepressants) There have been reports of increased risk of lidocaine side effects on the central nervous system when used with propafenone hydrochloride.

Rytmonorm 150 may increase the effect of the following medicines:

• drugs metabolized by the CYP2D6 isoenzyme, such as venlafaxine
• beta-adrenergic blockers, such as propranolol, metoprolol
• antidepressants, such as desipramine
• immunosuppressants, such as cyclosporine
• asthma medications, such as theophylline
• cardiac glycosides, such as digoxin
• oral anticoagulants, such as phenprocoumon, acenocoumarol, warfarin

The following medicines may increase the effect of Rytmonorm 150:

• antifungal agents (e.g., ketoconazole)
• medicines used to treat stomach and duodenal ulcers (e.g., cimetidine)
• antiarrhythmic agents (e.g., quinidine)

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• antibacterial agents - antibiotics (e.g., erythromycin)
• antidepressants from the group of selective serotonin reuptake inhibitors, such as paroxetine, fluoxetine

If these medicines are taken at the same time as Rytmonorm 150, the doctor will monitor the cardiovascular system and, if necessary, adjust the dose of propafenone hydrochloride. The following medicines, when taken with Rytmonorm 150, may reduce its effectiveness:

• phenobarbital
• rifampicin

In the case of combined treatment with amiodarone and Rytmonorm 150, it may be necessary to adjust the doses of both medicines, taking into account the response to treatment.

Children and adolescents

Studies on the effect of one drug on the results of another drug have been conducted only in adults. It is not known whether the range of these interactions in children and adolescents is similar to that in adults.

Rytmonorm 150 with grapefruit juice

Grapefruit juice may increase the concentration of propafenone hydrochloride in the blood.

Pregnancy and breastfeeding

If the patient is pregnant or breastfeeding, thinks she may be pregnant, or plans to have a child, she should consult a doctor or pharmacist before taking this medicine. Rytmonorm 150 can be used during pregnancy only if the benefits to the mother outweigh the potential risk to the fetus. Propafenone has not been studied in breast milk. Limited data indicate that propafenone may pass into breast milk. Caution should be exercised when taking Rytmonorm 150 in breastfeeding women.

Driving and operating machinery

Some side effects, such as blurred vision, dizziness, fatigue, and orthostatic hypotension (a sudden drop in blood pressure caused by changing position from lying to standing), may affect reaction speed and impair the ability to drive vehicles and operate machinery. If they occur, do not drive vehicles or operate machinery.

Rytmonorm 150 contains sodium

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

3. How to take Rytmonorm 150

This medicine should always be taken as directed by the doctor. In case of doubts, consult a doctor or pharmacist. The doctor will determine the dose individually. Due to the bitter taste of propafenone and its surface anesthetic effect, the coated tablets should be swallowed whole (without chewing), with a liquid.

Adults

During the dose titration period and in maintenance therapy in patients with a body weight of approximately 70 kg, the recommended daily dose of propafenone hydrochloride is 450 to 600 mg, given in two or three divided doses. Sometimes it may be necessary to increase the daily dose of propafenone hydrochloride to 900 mg. In patients with a lower body weight, the doctor will reduce the daily dose accordingly. The dose can be increased only after 3 to 4 days of treatment. If there is a significant widening of the QRS complex or second- or third-degree atrioventricular block, the doctor will consider reducing the dose. The individual maintenance dose should be determined under cardiac monitoring, including ECG recording and repeated measurement of blood pressure (dose titration phase).

Use in children

Rytmonorm 150, due to its strength, cannot be used in children.

Elderly patients

In elderly patients or patients with significant left ventricular dysfunction (left ventricular ejection fraction below 35%) or structural heart disease, treatment should be initiated gradually, with particular caution, using small, gradually increasing doses. The same applies to maintenance therapy. If a dose increase is necessary, it can be done only after 5 to 8 days of treatment.

Patients with liver and/or kidney function disorders

In patients with liver and/or kidney failure, after administration of the usual therapeutic doses, the drug may accumulate. In these patients, the doctor will individually select the dosage, monitoring the ECG and serum drug concentration.

Using a higher dose of Rytmonorm 150 than recommended

In case of overdose, cardiac arrhythmias, cardiac arrest, and hypotension may occur, as well as metabolic acidosis (a condition of acid-base imbalance in the body), headaches, dizziness, blurred vision, sensory disturbances (tingling, prickling, numbness) of the hands or feet, tremors, nausea, constipation, dry mouth, and seizures (convulsions). Death has also been reported. In severe cases of poisoning, additional symptoms may include tonic-clonic seizures (seizures with loss of consciousness and muscle contractions throughout the body), paresthesia (tingling), drowsiness, coma, and respiratory arrest. In case of overdose, seek immediate medical attention.

Missing a dose of Rytmonorm 150

Do not take a double dose to make up for a missed dose of the medicine. If you have any further doubts about taking this medicine, consult a doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. The most common side effects associated with propafenone hydrochloride treatment are dizziness, conduction disturbances, and palpitations. The following side effects have been reported in clinical trials and after the marketing of propafenone hydrochloride.

• dizziness (except for peripheral dizziness)

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• conduction disturbances in the heart
• palpitations

Very common(in at least 1 in 10 patients)

• anxiety, sleep disturbances
• headache, taste disturbance
• blurred vision
• bradycardia (slow heart rate) sinus, bradycardia, tachycardia (fast heart rate), atrial flutter
• shortness of breath
• abdominal pain, vomiting, nausea, diarrhea, constipation, dry mouth
• abnormal liver function (abnormal liver test results, such as increased aspartate aminotransferase activity, increased alanine aminotransferase activity, increased gamma-glutamyltransferase activity, and increased alkaline phosphatase activity in the blood)
• chest pain, asthenia (weakness), fatigue, fever

Common(in 1 to 10 patients out of 100 patients)

• thrombocytopenia (low platelet count)
• decreased appetite, nightmares
• fainting, ataxia (coordination disorders), paresthesia (tingling)
• dizziness
• ventricular tachycardia
• arrhythmias
• hypotension
• increased abdominal circumference, bloating with gas
• urticaria, itching, rash, flushing
• erectile dysfunction

Uncommon(in 1 to 10 patients out of 1,000 patients)

• agranulocytosis (complete or almost complete lack of granulocytes in the blood), leukopenia (decreased white blood cell count), granulocytopenia (decreased granulocyte count)
• hypersensitivity (may manifest as cholestasis, abnormal blood count, and rash)
• confusional state
• seizures, extrapyramidal symptoms, restlessness
• ventricular fibrillation, heart failure (may worsen existing heart failure), decreased heart rate
• orthostatic hypotension (sudden drop in blood pressure, associated with changing position from lying to standing)
• vomiting, gastrointestinal disorders
• liver cell damage, cholestasis, hepatitis, jaundice
• lupus-like syndrome
• pustular skin eruptions
• decreased sperm count (reversible after discontinuation of propafenone)

Reporting side effects

If you experience any side effects, including any side effects not listed in this leaflet, tell your doctor, pharmacist, or nurse. Side effects can be reported directly to the Department of Monitoring of Adverse Reactions to Medicinal Products, Urząd Rejestracji Produktów Leczniczych, Wyrobów Medycznych i Produktów Biobójczych (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. By reporting side effects, you can help gather more information on the safety of this medicine.

5. How to store Rytmonorm 150

Keep the medicine out of sight and reach of children. There are no special precautions for storage. Do not use this medicine after the expiration date stated on the packaging. The expiration date refers to the last day of the specified 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. Package contents and other information

What Rytmonorm 150 contains

• The active substance of the medicine is propafenone hydrochloride. One coated tablet contains 150 mg of the active substance.
• The other ingredients are: microcrystalline cellulose, sodium croscarmellose, pregelatinized starch, hypromellose, magnesium stearate, purified water. The coating contains: macrogol 400, macrogol 6000, hypromellose, titanium dioxide (E 171).

What Rytmonorm 150 looks like and what the package contains

Rytmonorm 150 is available in the form of coated tablets. The coated tablet is white, biconvex, with the inscription "150" on one side. The packages contain 20, 50, or 90 coated tablets. Blister packs of PVC/Aluminum in a cardboard box. For more detailed information, please contact the marketing authorization holder or the parallel importer.

Marketing authorization holder in Bulgaria, the country of export:

Mylan EOOD, Office building "Serdika Offices", Sitnyakovo Blvd., No.48, fl. 7, 1505 Sofia, Bulgaria

Manufacturer:

Mylan Hungary Kft., Mylan utca 1, Komárom 2900, Hungary

Parallel importer:

Delfarma Sp. z o.o., ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź

Repackaged by:

Delfarma Sp. z o.o., ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź
Marketing authorization number in Bulgaria, the country of export: 20020603

Parallel import authorization number: 14/23 Date of approval of the leaflet: 01.02.2023

[Information about the trademark]
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