RIVASTIGMINE SANDOZ 4.5 mg HARD CAPSULES

2. What you need to know before taking Rivastigmine Sandoz

Do not take Rivastigmine Sandoz

• if you are allergic to rivastigmine (the active substance of Rivastigmine Sandoz) or to any of the other components of this medication (listed in section 6).
• if you have experienced a previous skin reaction suggestive of allergic contact dermatitis with rivastigmine.

If you are in one of these situations, inform your doctor and do not take Rivastigmine Sandoz.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Rivastigmine Sandoz

• if you have or have ever had a heart problem, such as an irregular or slow heart rate, prolonged QTc interval, family history of prolonged QTc interval, torsades de pointes, or low levels of potassium or magnesium in the blood.
• if you have or have ever had an active stomach ulcer
• if you have or have ever had difficulty urinating
• if you have or have ever had seizures
• if you have or have ever had asthma or a severe respiratory disease
• if you have or have ever had kidney function impairment
• if you have or have ever had liver function impairment
• if you suffer from tremors
• if you have a low body weight
• if you have gastrointestinal reactions such as a feeling of dizziness (nausea), vomiting, and diarrhea. You may become dehydrated (lose a large amount of fluid) if vomiting or diarrhea is prolonged
• if you experience skin reactions all over your body.

If you are in one of these situations, your doctor may consider it necessary to monitor you more closely while you are being treated.

If you have not taken Rivastigmine Sandoz for more than three days, do not take the next dose until you have spoken to your doctor.

Rivastigmine Sandoz is not recommended for use in children or adolescents (under 18 years of age).

Children and adolescents

There is no specific recommendation for the use of Rivastigmine Sandoz in the pediatric population for the treatment of Alzheimer's dementia.

Use of other medications and Rivastigmine Sandoz

Inform your doctor or pharmacist if you are using, have recently used, or may need to use any other medication.

Rivastigmine Sandoz should not be administered at the same time as other medications with similar effects to those of Rivastigmine Sandoz. Rivastigmine Sandoz may interfere with anticholinergic medications (medications used to relieve stomach cramps or spasms, for the treatment of Parkinson's disease, or to prevent travel sickness).

Rivastigmine Sandoz should not be administered with metoclopramide (a medication used to relieve or prevent nausea and vomiting). Taking the two medications at the same time could cause problems such as stiffness of the limbs and hand tremors.

In case you need to undergo surgery while taking Rivastigmine Sandoz, inform your doctor before you are given any anesthetic, as Rivastigmine Sandoz may exaggerate the effects of some muscle relaxants during anesthesia.

Be cautious when taking Rivastigmine Sandoz with beta-blockers (medications, such as atenolol, used to treat hypertension, angina pectoris, and other heart conditions). Taking the two medications at the same time could cause problems such as a decrease in heart rate (bradycardia), leading to fainting or loss of consciousness.

Be cautious when taking Rivastigmine Sandoz with other medications that may affect heart rate or the heart's electrical system (prolongation of the QT interval).

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medication.

If you are pregnant, the benefits of using Rivastigmine Sandoz should be evaluated against the potential effects on the fetus. Rivastigmine Sandoz should not be used during pregnancy, unless it is clearly necessary.

You should not breastfeed your child during treatment with Rivastigmine Sandoz.

Driving and using machines

Your doctor will indicate whether your condition allows you to drive or use machinery safely. Rivastigmine Sandoz may cause dizziness and drowsiness, mainly at the start of treatment or when increasing the dose. If you feel dizzy or drowsy, do not drive or use machinery, or perform other tasks that require your attention.

3. How to take Rivastigmine Sandoz

Follow the instructions for administration of this medication indicated by your doctor exactly. In case of doubt, consult your doctor or pharmacist again.

How to start treatment:

Your doctor will indicate what dose of Rivastigmine Sandoz you should take.

• Normally, treatment starts with a low dose.

• Your doctor will gradually increase the dose depending on how you respond to treatment.
• The highest dose you should take is 6 mg twice a day.

Your doctor will regularly check if the medication is working for you. Your doctor will also check your weight while you are taking this medication.

If you have not taken Rivastigmine Sandoz for more than three days, do not take the next dose until you have consulted your doctor.

Taking this medication:

• Inform your caregiver that you are taking Rivastigmine Sandoz.
• To benefit from your medication, take it every day.
• Take Rivastigmine Sandoz twice a day (in the morning and at night), with meals.
• Swallow the capsule whole with the help of a liquid.
• Do not open or crush the capsule.

If you take more Rivastigmine Sandoz than you should

If you accidentally take more Rivastigmine Sandoz than you should, inform your doctor. You may need medical attention. Some people who have taken accidentally higher doses have experienced nausea, vomiting, diarrhea, high blood pressure, and hallucinations. There may also be a slowing of the heart rate and fainting.

If you forget to take Rivastigmine Sandoz

If you forget your dose of Rivastigmine Sandoz, wait and take the next dose at the usual time. Do not take a double dose to make up for the forgotten doses.

If you have any doubts about the use of this medication, consult your doctor or pharmacist.

4. Possible side effects

Like all medications, this medication can cause side effects, although not all people experience them.

You may have side effects more frequently when starting to take your medication or when your dose is increased. Generally, side effects will slowly disappear as your body gets used to the medication.

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

• Nausea
• Lack of appetite
• Stomach problems such as nausea, vomiting, diarrhea

Common(may affect up to 1 in 10 patients)

• Anxiety
• Sweating
• Headache
• Heartburn
• Weight loss
• Stomach pain
• Restlessness
• Feeling of fatigue or weakness
• General feeling of discomfort
• Tremors or feeling of confusion
• Decreased appetite
• Nightmares

Uncommon(may affect up to 1 in 100 patients)

• Depression
• Difficulty sleeping
• Fainting or accidental falls
• Changes in liver function

Rare(may affect up to 1 in 1,000 patients)

• Chest pain
• Skin rash, itching
• Seizures (convulsions)
• Ulcers in your stomach or intestine

Very rare(may affect up to 1 in 10,000 patients)

• High blood pressure
• Urinary tract infection
• Seeing things that do not exist (hallucinations)
• Heart rate problems such as slow or fast heart rate
• Gastrointestinal bleeding - manifested as blood in the stool or when vomiting
• Pancreatitis - signs include severe pain in the upper abdomen, often with nausea or vomiting
• Worsening of Parkinson's disease symptoms or development of similar symptoms - such as muscle stiffness, difficulty moving

Not known(frequency cannot be estimated from the available data)

• Severe vomiting that can cause a tear in the tube that connects your mouth to your stomach (esophagus)
• Dehydration (loss of a large amount of fluid)
• Liver disorders (yellowing of the skin, yellowing of the whites of the eyes, abnormal darkening of urine or unexplained nausea, vomiting, fatigue, and loss of appetite)
• Aggression, feeling of restlessness
• Irregular heart rate

Patients with dementia or Parkinson's disease

These patients experience some side effects more frequently and also have some additional side effects:

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

• Tremors
• Fainting
• Accidental falls

Common(may affect up to 1 in 10 patients)

• Anxiety
• Restlessness
• Slow and fast heart rate
• Difficulty sleeping
• Excessive saliva and dehydration
• Abnormally slow movements or movements that cannot be controlled
• Worsening of Parkinson's disease symptoms or development of similar symptoms - such as muscle stiffness, difficulty moving, and muscle weakness

Uncommon(may affect up to 1 in 100 patients)

• Irregular heartbeat and loss of movement control

Other side effects observed in transdermal patches and that may occur with hard capsules:

Common(may affect up to 1 in 10 patients)

• Fever
• Severe confusion
• Urinary incontinence (inability to retain urine)

Uncommon(may affect up to 1 in 100 patients)

• Hyperactivity (high level of activity, agitation)

Not known(frequency cannot be estimated from the available data)

• Allergic reaction at the patch application site, such as blisters or skin inflammation

If you experience any of these side effects, contact your doctor, as you may need medical attention.

Reporting of side effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect not listed in this package leaflet. You can also report them directly through the Spanish Medication Monitoring System for Human Use: https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of this medication.

5. Storage of Rivastigmine Sandoz

Keep this medication out of the sight and reach of children.

Do not use Rivastigmine Sandoz after the expiration date stated on the blister, bottle, and carton after "EXP" or "CAD". The expiration date is the last day of the month indicated.

Medications should not be disposed of through wastewater or household waste. Ask your pharmacist how to dispose of the packaging and any unused medication. This will help protect the environment.

Do not store above 30°C.

6. Package Contents and Additional Information

Rivastigmine Sandoz Composition

• The active ingredient is rivastigmine.
• The other components are hypromellose, magnesium stearate, microcrystalline cellulose, colloidal silica, gelatin, yellow iron oxide, red iron oxide, titanium dioxide, and shellac.

Each Rivastigmine Sandoz 1.5 mg capsule contains 1.5 mg of rivastigmine.

Each Rivastigmine Sandoz 3 mg capsule contains 3 mg of rivastigmine.

Each Rivastigmine Sandoz 4.5 mg capsule contains 4.5 mg of rivastigmine.

Each Rivastigmine Sandoz 6 mg capsule contains 6 mg of rivastigmine.

Product Appearance and Package Contents

• Rivastigmine Sandoz 1.5 mg hard capsules contain a white to slightly yellowish powder, with a yellow cap and body, and a red printed mark "RIV 1.5 mg" on the body.

• Rivastigmine Sandoz 3 mg hard capsules contain a white to slightly yellowish powder, with an orange cap and body, and a red printed mark "RIV 3 mg" on the body.

• Rivastigmine Sandoz 4.5 mg hard capsules contain a white to slightly yellowish powder, with a red cap and body, and a white printed mark "RIV 4.5 mg" on the body.

• Rivastigmine Sandoz 6 mg hard capsules contain a white to slightly yellowish powder, with a red cap and an orange body, and a red printed mark "RIV 6 mg" on the body.

It is packaged in blisters and is available in three different presentations (28, 56, or 112 capsules).

Marketing Authorization Holder

Sandoz GmbH

Biochemiestraße 10

A-6250 Kundl

Austria

Manufacturer

Novartis Farmacéutica, S.A.

Gran Via de les Corts Catalanes, 764

08013 Barcelona

Spain

Novartis Pharma GmbH

Roonstrasse 25

90429 Nuremberg

Germany

Salutas Pharma GmbH

Otto-Von-Guericke-Allee 1, Barleben,

Saxony-Anhalt, 39179,

Germany

You can request more information about this medication by contacting the local representative of the marketing authorization holder:

This leaflet was last revised inNovember 2024

Detailed information on this medication is available on the European Medicines Agency website http://www.ema.europa.eu