Trelema

Leaflet included in the packaging: patient information

Trelema, 50 mg, film-coated tablets
Trelema, 100 mg, film-coated tablets
Trelema, 150 mg, film-coated tablets
Trelema, 200 mg, film-coated tablets
Lacosamide

You should carefully read the content of the leaflet before taking the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if necessary.
• In case of any doubts, you should consult a doctor or pharmacist.
• This medicine has been prescribed to you by a doctor for a specific person. Do not pass it on to others. The medicine may harm another person, even if the symptoms of their illness are the same.
• If the patient experiences any undesirable effects, including any undesirable effects not mentioned in this leaflet, they should inform their doctor or pharmacist. See section 4.

Table of contents of the leaflet

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

1. What is Trelema and what is it used for

What is Trelema

Trelema contains the active substance lacosamide. It belongs to a group of medicines called antiepileptics, which are used to treat epilepsy.
This medicine has been prescribed by your doctor to reduce the number of seizures.

What is Trelema used for

• Trelema is used:
• as monotherapy and in combination with other antiepileptic medicines in adults, adolescents, and children from 2 years of age for the treatment of a type of epilepsy characterized by partial seizures and secondary generalized partial seizures. In this type of epilepsy, seizures initially affect only one side of the brain but may subsequently spread to other areas on both sides of the brain.
• in combination with other antiepileptic medicines in adults, adolescents, and children from 4 years of age for the treatment of primary generalized tonic-clonic seizures (grand mal seizures involving loss of consciousness) in patients with generalized idiopathic epilepsy (a type of epilepsy considered to be genetically determined).

2. Important information before taking Trelema

When not to take Trelema

Do not take Trelema if any of the following situations apply to you. In case of doubt, consult a doctor or pharmacist.

Warnings and precautions

Before starting to take Trelema, you should discuss it with your doctor if:

• the patient has thoughts of self-harm or suicide. In a small number of patients taking antiepileptic medicines, such as lacosamide, thoughts of self-harm or suicide have occurred. If such thoughts occur, the patient should immediately contact their doctor.
• the patient has heart rhythm disorders, such as a very slow, fast, or irregular heartbeat (e.g., atrioventricular block, atrial flutter, or atrial fibrillation).
• the patient has severe heart disease, such as heart failure or has had a heart attack.
• the patient often experiences dizziness or falls. Trelema may cause dizziness, which may increase the risk of accidental injuries or falls. This means that the patient should be particularly cautious until they get used to the effect of this medicine.

If any of the above situations apply to you (or if you have any doubts), before taking Trelema, consult a doctor or pharmacist.
If you are taking Trelema, you should inform your doctor about any new type of seizure or worsening of existing seizures.
If you are taking Trelema and experience symptoms of abnormal heart rhythm (such as slow, fast, or irregular heartbeat, palpitations, shortness of breath, dizziness, or fainting), you should immediately consult a doctor (see section 4).

Children

Trelema is not recommended for children under 2 years of age with epilepsy characterized by partial seizures or for children under 4 years of age with primary generalized tonic-clonic seizures. The efficacy and safety of the medicine in children of this age group are not yet known.

Trelema and other medicines

You should tell your doctor or pharmacist about all medicines you are currently taking or have recently taken, as well as any medicines you plan to take.
You should inform your doctor or pharmacist, in particular, about taking the following medicines that affect heart function:

• medicines for heart disease
• medicines that prolong the PR interval, which is visible in the ECG recording, such as antiepileptic medicines or painkillers, e.g., carbamazepine, lamotrigine, or pregabalin
• medicines for certain heart rhythm disorders or heart failure If any of the above situations apply to you (or if you have any doubts), before taking Trelema, consult a doctor or pharmacist.

You should also inform your doctor or pharmacist if you are taking any of the following medicines, as they may weaken or enhance the effect of Trelema:

• antifungal medicines, such as fluconazole, itraconazole, or ketoconazole
• HIV protease inhibitors, such as ritonavir
• antibiotics, such as clarithromycin or rifampicin
• a herbal medicine used to treat mild depression, containing St. John's Wort (Hypericum perforatum)

If any of the above situations apply to you (or if you have any doubts), before taking Trelema, consult a doctor or pharmacist.

Trelema and alcohol

For safety reasons, you should not drink alcohol while taking Trelema.

Pregnancy and breastfeeding

Women of childbearing age should discuss the use of contraception with their doctor.
If you are pregnant or breastfeeding, or think you may be pregnant or plan to have a baby, consult a doctor or pharmacist before taking this medicine.
Trelema should not be taken during pregnancy, as its effect on pregnancy and the unborn child is not known.
Breastfeeding is not recommended while taking Trelema, as the medicine passes into breast milk. You should immediately consult a doctor if you become pregnant or plan to become pregnant. The doctor will help you decide whether to continue taking Trelema.
Do not stop taking Trelema without consulting a doctor, as this may cause the symptoms of epilepsy to return or worsen. The worsening of the mother's disease may also harm the child.

Driving and using machines

You should not drive a car or bicycle or use any tools or machines until you are sure what effect the medicine has on you, as Trelema may cause dizziness or blurred vision.

3. How to take Trelema

This medicine should always be taken exactly as prescribed by your doctor. In case of doubt, consult a doctor or pharmacist. For children, other forms of this medicine may be more suitable; consult a doctor or pharmacist.

How to take Trelema

• the medicine should be taken twice a day, approximately every 12 hours
• you should try to take the medicine at the same times every day
• the tablets should be swallowed with a glass of water
• Trelema can be taken with or without food
• the tablet can be divided into equal doses

Treatment usually starts with a low dose taken daily, which the doctor will gradually increase over several weeks. After reaching the dose that is effective for you, the so-called maintenance dose, you will take the same dose every day. Trelema is intended for long-term use. You should take the medicine for as long as your doctor recommends.

Recommended dose

The following are the usual recommended doses of Trelema for patients in different age groups and with different body weights. Your doctor may prescribe a different dose if you have kidney or liver function disorders.

Adolescents and children with a body weight of at least 50 kg and adults

Monotherapy with Trelema
The usual starting dose of Trelema is 50 mg twice a day.
Your doctor may also prescribe a starting dose of 100 mg of Trelema twice a day.
Your doctor may increase the dose taken twice a day by 50 mg every week, up to a maintenance dose of between 100 mg and 300 mg twice a day.
Combination therapy with other antiepileptic medicines
The usual starting dose of Trelema is 50 mg twice a day.
Your doctor may increase the dose taken twice a day by 50 mg every week, up to a maintenance dose of between 100 mg and 200 mg twice a day.
In patients with a body weight of 50 kg or more, the doctor may decide to start treatment with a single loading dose of 200 mg. Then, after 12 hours, the patient will start taking the maintenance dose.

Children and adolescents with a body weight below 50 kg

• Treatment of partial seizures:note that Trelema is not recommended for children under 2 years of age.
• Treatment of primary generalized tonic-clonic seizures: note that Trelema is not recommended for children under 4 years of age.

The dose depends on body weight. In children and adolescents with a body weight below 50 kg, treatment usually starts with the syrup form. Switching to tablets is only possible if the child can swallow the tablet and the correct dose can be achieved using different tablet strengths. The doctor will prescribe the most suitable form of the medicine for the child.

Taking a higher dose of Trelema than recommended

In case of taking a higher dose of Trelema than prescribed, you should immediately contact a doctor. Do not try to drive a car.
The patient may experience:

• dizziness
• nausea or vomiting
• seizures (convulsions), heart rhythm disorders, such as slow, fast, or irregular heartbeat, drowsiness, or a drop in blood pressure with rapid heartbeat and sweating.

Missing a dose of Trelema

• If you forget to take the medicine at the usual time and there are more than 6 hours left until the next dose, you should take the dose immediately.
• If you forget to take the medicine at the usual time and there are less than 6 hours left until the next dose, do not take the missed dose. Take the next dose at the usual time.
• Do not take a double dose to make up for the missed dose.

Stopping Trelema treatment

• Do not stop taking Trelema without consulting a doctor, as the symptoms of epilepsy may return or worsen.
• If the doctor decides to stop Trelema treatment, they will provide detailed instructions on how to gradually reduce the dose.

In case of any further doubts related to the use of this medicine, consult a doctor or pharmacist.

4. Possible undesirable effects

Like all medicines, Trelema can cause undesirable effects, although not everybody gets them.
Neurological symptoms, such as dizziness, may be stronger after taking a single loading dose.

Inform your doctor or pharmacist if you experience any of the following symptoms:

Very common(may affect more than 1 in 10 people)

• headache
• dizziness or nausea (nausea)
• double vision

Common(may affect up to 1 in 10 people)

• brief muscle twitches or muscle group twitches (myoclonic seizures).
• difficulty with coordination or walking.
• balance disorders, dizziness, tingling (paresthesia), muscle cramps, tendency to fall or bruise.
• memory disorders, thinking disorders, difficulty finding words, confusion.
• rapid involuntary eye movements (nystagmus), blurred vision.
• feeling of spinning (dizziness), feeling of being drunk.
• vomiting, dry mouth, constipation, indigestion, excessive gas in the stomach or intestines, diarrhea.
• weakened sensation and sensitivity to stimuli, difficulty speaking, attention disorders.
• ringing in the ears, such as buzzing, ringing, or whistling.
• irritability, sleep disorders, depression.
• drowsiness, fatigue, or weakness (asthenia).
• itching, rash.

Uncommon(may affect up to 1 in 100 people)

• slow heart rate, palpitations, irregular heartbeat, or other changes in heart electrical activity (conduction disorders).
• excessive well-being, seeing and/or hearing things that do not exist.
• allergic reactions to the medicine, hives.
• liver function disorders in test results, liver damage.
• thoughts of self-harm or suicide or attempted suicide - you should immediately contact a doctor.
• feeling of anger or agitation.
• thinking disorders or loss of contact with reality.
• severe allergic reactions causing facial, throat, hand, foot, ankle, or lower leg swelling.
• fainting.
• involuntary movements (dyskinesia).

Frequency not known(cannot be estimated from the available data)

• abnormal rapid heartbeat (ventricular tachycardia).
• sore throat, high fever, and more frequent than usual infections. Blood tests may show a significant decrease in the number of a certain type of white blood cell (agranulocytosis).
• severe skin allergic reactions with high fever and other flu-like symptoms, rash on the face, spreading rash, swollen lymph nodes (enlarged lymph nodes). Blood tests may show increased liver enzyme levels and an increased number of one type of white blood cell (eosinophilia).
• widespread rash with blisters and peeling skin, especially around the mouth, nose, eyes, and genitals (Stevens-Johnson syndrome) and a more severe form causing skin peeling on more than 30% of the body surface (toxic epidermal necrolysis).
• seizures.

Additional undesirable effects in children

Additional undesirable effects in children included: fever, runny nose (nasopharyngitis), sore throat (pharyngitis), decreased appetite, behavioral changes, the child does not behave as usual (abnormal behavior), and lack of energy (lethargy). Drowsiness is a very common undesirable effect in children and may occur in more than 1 in 10 children.

Reporting undesirable effects

If you experience any undesirable effects, including any undesirable effects not mentioned in the leaflet, you should inform your doctor or pharmacist. Undesirable effects can be reported directly to:
Department for Monitoring of Undesirable Effects of Medicinal Products, Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products
Al. Jerozolimskie 181 C
02-222 Warsaw
Phone: +48 22 49 21 301
Fax: +48 22 49 21 309
e-mail: ndl@urpl.gov.pl
Undesirable effects can also be reported to the marketing authorization holder:

5. How to store Trelema

The medicine should be stored out of sight and reach of children.
Do not use this medicine after the expiry date stated on the carton after EXP.
The expiry date refers to the last day of the month stated.
There are no special precautions for storing the medicine.
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 packaging and other information

What Trelema contains

• The active substance is lacosamide. Each film-coated tablet of Trelema 50 mg contains 50 mg of lacosamide. Each film-coated tablet of Trelema 100 mg contains 100 mg of lacosamide. Each film-coated tablet of Trelema 150 mg contains 150 mg of lacosamide. Each film-coated tablet of Trelema 200 mg contains 200 mg of lacosamide.
• The other ingredients are: microcrystalline cellulose, hypromellose, hypromellose, microcrystalline cellulose, silicon dioxide, crospovidone, colloidal anhydrous silica, magnesium stearate

Tablet coating
Polyvinyl alcohol
Macrogol 3350
Titanium dioxide (E 171)
Talc
Colorants:
50 mg, film-coated tablets:
indigo carmine (E 132), iron oxide red (E 172), iron oxide black (E 172)
100 mg, film-coated tablets:
iron oxide yellow (E 172)
150 mg, film-coated tablets:
iron oxide yellow (E 172), iron oxide red (E 172), iron oxide black (E 172)
200 mg, film-coated tablets:
indigo carmine (E 132)

What Trelema looks like and contents of the pack

Trelema, 50 mg, film-coated tablets
Pink, oval, biconvex film-coated tablets with a dividing line on both sides.
The tablet can be divided into equal doses.
Trelema, 100 mg, film-coated tablets
Yellow, oval, biconvex film-coated tablets with a dividing line on both sides.
The tablet can be divided into equal doses.
Trelema, 150 mg, film-coated tablets
Brown, oval, biconvex film-coated tablets with a dividing line on both sides.
The tablet can be divided into equal doses.
Trelema, 200 mg, film-coated tablets
Blue, oval, biconvex film-coated tablets with a dividing line on both sides.
The tablet can be divided into equal doses.
Trelema is available in the following pack sizes:
10, 14, 20, 28, 30, 40, 56, 60, 84, 90, 100, 112, 120, and 168 film-coated tablets in PVC/Aluminum or PVC/PVdC/Aluminum blisters.
Not all pack sizes may be marketed.

Marketing authorization holder

G.L. Pharma GmbH
Schlossplatz 1
8502 Lannach
Austria

Manufacturer

G.L. Pharma GmbH
Schlossplatz 1
8502 Lannach
Austria
Delorbis Pharmaceuticals Ltd.
2643 Ergates, Lefkosia
Cyprus

To obtain more detailed information and information on the names of the medicinal product in other EEA member states, please contact the representative of the marketing authorization holder:

G.L. PHARMA POLAND Sp. z o.o.
Al. Jana Pawła II 61/313
01-031 Warsaw, Poland
Phone: 022/ 636 52 23; 636 53 02
e-mail: biuro@gl-pharma.pl

Date of last revision of the leaflet: