AREMIS 100 mg FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the User

Aremis 100mg film-coated tablets

Sertraline

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack

1. What Aremis is and what it is used for
2. What you need to know before you take Aremis
3. How to take Aremis
4. Possible side effects
5. Storing Aremis
6. Contents of the pack and other information

1. What Aremis is and what it is used for

Aremis contains sertraline as the active ingredient. Sertraline belongs to a group of medicines called selective serotonin reuptake inhibitors (SSRIs); these medicines are used to treat depression and/or anxiety disorders.

Aremis can be used to treat:

• Depression and prevention of depression relapse (in adults).
• Social anxiety disorder (in adults).
• Post-traumatic stress disorder (PTSD) (in adults).
• Panic disorder (in adults).
• Obsessive-compulsive disorder (OCD) (in adults and in children and adolescents aged 6-17 years).

Depression is a clinical illness with symptoms such as feelings of sadness, inability to sleep well or to enjoy life as you used to.

OCD and anxiety disorders are illnesses related to anxiety, with symptoms such as being constantly worried about recurring ideas (obsessions) that lead to performing repetitive rituals (compulsions).

PTSD is a disorder that can occur after a very traumatic emotional experience, and has some symptoms similar to depression and anxiety. Social anxiety disorder (social phobia) is an anxiety-related illness. It is characterized by feeling intense anxiety or distress in social situations (e.g., talking to strangers, speaking in public, eating or drinking in front of others, or worrying about behaving in a shameful way).

Your doctor has considered that this medicine is suitable for treating your illness.

If you are not sure why you have been prescribed Aremis, you should ask your doctor.

2. What you need to know before you take Aremis

Do not take Aremis:

• If you are allergic to sertraline or any of the other ingredients of this medicine (listed in section 6).
• If you are taking or have taken in the last 14 days medicines called monoamine oxidase inhibitors (MAOIs, such as selegiline, moclobemide) or other medicines that are similar to MAOIs (such as linezolid). If you stop treatment with sertraline, you must wait at least one week before starting treatment with an MAOI. After stopping treatment with an MAOI, you must wait at least two weeks before starting treatment with sertraline.
• If you are taking another medicine called pimozide (a medicine used to treat mental disorders such as psychosis).

Warnings and precautions

Consult your doctor or pharmacist before starting treatment with Aremis.

Medicines are not always suitable for everyone. Before starting treatment with Aremis, tell your doctor if you have or have had any of the following:

• If you have epilepsy (seizures) or a history of seizures. If you have a seizure, contact your doctor immediately.
• If you have manic-depressive illness (bipolar disorder) or schizophrenia. If you have a manic episode, contact your doctor immediately.
• If you have or have had thoughts of harming yourself or suicide (see below Thoughts of suicide and worsening of your depression or anxiety).
• If you have serotonin syndrome. This syndrome can occur when taking certain medicines at the same time as sertraline. (To see the symptoms, read section 4. Possible side effects). Your doctor will tell you if you have had this syndrome before.
• If you have low sodium levels in your blood, as this condition may occur as a result of treatment with Aremis. You should also inform your doctor if you are taking any medication for hypertension, as these medications can also alter sodium levels in your blood.
• If you are elderly, as you may be at greater risk of having low sodium levels in your blood (see above).
• If you have liver disease; your doctor may consider that you should take a lower dose of Aremis.
• If you have diabetes; Aremis may alter your blood sugar levels, so it may be necessary to adjust the dose of your diabetes medications.
• If you have a history of bleeding disorders (tendency to develop bruises), or if you are pregnant (see section Pregnancy, breastfeeding, and fertility) or have been taking medications that reduce blood clotting [such as acetylsalicylic acid (aspirin) or warfarin] or that may increase the risk of bleeding.
• If you are a child or adolescent under 18 years of age. Aremis should only be used to treat children and adolescents aged 6 to 17 years with obsessive-compulsive disorder (OCD). If you are going to be treated for this disorder, your doctor will want to monitor you closely (see below "Children and adolescents").
• If you are receiving electroconvulsive therapy (ECT).
• If you have any eye disorder, such as certain types of glaucoma (increased intraocular pressure).
• If you have been told that you have an abnormality in the graph of your heart that is obtained after an electrocardiogram (ECG), known as QT interval prolongation.
• If you have heart disease, have low potassium or magnesium levels, family history of QTc prolongation, low heart rate, or are taking concomitantly medications that prolong the QTc interval.

Restlessness/Akathisia:

The use of sertraline has been associated with unpleasant restlessness and a need to move, often accompanied by an inability to sit or stand still (akathisia). This occurs more often during the first few weeks of treatment. An increase in dose may be harmful, so if you develop these symptoms, you should contact your doctor.

Withdrawal symptoms:

Side effects related to discontinuation of treatment (withdrawal symptoms) are common, particularly if treatment is discontinued abruptly (see section 3. If you stop taking Aremis and section 4. Possible side effects). The risk of experiencing withdrawal symptoms depends on the duration of treatment, dose, and rate at which the dose is reduced. Generally, these symptoms are mild or moderate. However, in some patients, they can be severe. These symptoms usually occur during the first few days after discontinuation of treatment. In general, these symptoms usually resolve on their own and normally disappear within two weeks. In some patients, they can last longer (2-3 months or more). It is recommended that when discontinuing treatment with sertraline, the dose should be gradually reduced over a period of several weeks or even months, and you should always agree with your doctor on the best way to discontinue treatment.

Thoughts of suicide and worsening of your depression or anxiety:

If you are depressed and/or have anxiety disorders, you may sometimes have thoughts of harming yourself or suicide. This may increase at the beginning of treatment with antidepressants, due to the fact that these medications take time to work, which is usually a few weeks but can sometimes be longer.

This is more likely to happen:

• If you have previously had thoughts of suicide or self-harm.
• If you are a young adult. There is information from clinical trials that shows an increased risk of suicidal behavior in adults under 25 years of age with psychiatric disorders who are being treated with an antidepressant.

If you have thoughts of harming yourself or suicide at any time, contact your doctor or go to the hospital immediately.

It may be helpful for you to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You can also ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behavior.

Some medicines in the same group as Aremis (called SSRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms persist after discontinuation of treatment.

Children and adolescents

Aremis should not normally be used in the treatment of children and adolescents under 18 years of age, except in patients with obsessive-compulsive disorder (OCD). Patients under 18 years of age have a higher risk of side effects such as suicidal attempts, thoughts of self-harm or suicide (suicidal ideas), and hostility (mainly aggression, confrontational behavior, and anger) when they are treated with this class of medications. Nevertheless, your doctor may decide to prescribe Aremis to a patient under 18 years of age if they consider it is in the patient's best interest. If your doctor has prescribed Aremis for you and you are under 18 years of age and wish to discuss this decision, please go back to your doctor. You should inform your doctor if any of the symptoms mentioned above appear or worsen when you are taking Aremis. The long-term effects on safety and related to growth, maturity, and learning (cognitive development) and behavioral development of Aremis were evaluated in a long-term study in over 900 children aged 6 to 16 years who were monitored for a period of 3 years. In general, the results of the study showed that children treated with sertraline developed normally, except for a slight increase in weight in those treated with a higher dose.

Taking Aremis with other medicines

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

Some medicines may affect how Aremis works, or Aremis may reduce the effectiveness of other medicines that you are taking at the same time.

The use of Aremis with the following medicines may cause serious side effects:

• Medicines called monoamine oxidase inhibitors (MAOIs, such as moclobemide (for depression), selegiline (for Parkinson's disease), the antibiotic linezolid, and methylthioninium chloride (methylene blue) (for high levels of methemoglobin in the blood). Do not use Aremis with these medicines.
• Medicines for treating mental disorders such as psychosis (pimozide). Do not use Aremis with pimozide.

Tell your doctor if you are taking the following medicines:

• Medicines containing amphetamines (used to treat attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity).
• Herbal medicines containing St. John's Wort (Hypericum perforatum). The effects of St. John's Wort may last 1-2 weeks.
• Products containing the amino acid tryptophan.
• Medicines for treating severe or chronic pain (opioids, such as tramadol, fentanyl).
• Medicines used in anesthesia (such as fentanyl, mivacurium, and suxamethonium).
• Medicines for treating migraines (such as sumatriptan).
• Medicines that reduce blood clotting (warfarin).
• Medicines for treating pain/arthritis [non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, acetylsalicylic acid (aspirin)].
• Sedatives (diazepam).
• Diuretics.
• Medicines for treating epilepsy (phenytoin, phenobarbital, carbamazepine).
• Medicines for treating diabetes (tolbutamide).
• Medicines for treating acidity, ulcers, and heartburn (cimetidine, omeprazole, lansoprazole, pantoprazole, rabeprazole).
• Medicines for treating mania and depression (lithium).
• Other medicines for treating depression (such as amitriptyline, nortriptyline, nefazodone, fluoxetine, fluvoxamine).
• Medicines for treating schizophrenia and other mental disorders (such as perphenazine, levomepromazine, and olanzapine).
• Medicines for treating high blood pressure, chest pain, or for regulating heart rate and rhythm (such as verapamil, diltiazem, flecainide, propafenone).
• Medicines used to treat bacterial infections (such as rifampicin, clarithromycin, telithromycin, erythromycin).
• Medicines used to treat fungal infections (such as ketoconazole, itraconazole, posaconazole, voriconazole, fluconazole).
• Medicines used to treat HIV/AIDS and hepatitis C (protease inhibitors such as ritonavir, telaprevir).
• Medicines used to prevent nausea and vomiting after surgery or chemotherapy (aprepitant).
• Medicines known to increase the risk of changes in heart electrical activity (such as some antipsychotics and antibiotics).

Taking Aremis with food, drinks, and alcohol

Aremis tablets can be taken with or without food.

Alcohol intake should be avoided while being treated with Aremis.

Sertraline should not be taken in combination with grapefruit juice, as it can increase sertraline levels in your body.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

The safety of sertraline in pregnant women has not been fully established. If you are pregnant, sertraline will only be given to you if your doctor considers that the benefit to you outweighs any possible risk to the developing baby.

If you take Aremis during the late stage of pregnancy, there may be an increased risk of heavy vaginal bleeding shortly after delivery, especially if you have a history of bleeding disorders. Your doctor or midwife should know that you are taking Aremis so they can advise you.

If you take Aremis during pregnancy, especially during the last 3 months, medicines like Aremis may increase the risk of a serious disease in babies called persistent pulmonary hypertension of the newborn (PPHN), which makes the baby breathe faster and have a bluish appearance. These symptoms usually start within the first 24 hours after birth. If this happens to your baby, contact your midwife and/or doctor immediately.

Your newborn baby may have other conditions, which usually appear within the first 24 hours after birth. The symptoms include:

• difficulty breathing,
• bluish skin or being too hot or cold,
• bluish lips,
• vomiting or feeding problems,
• excessive tiredness, inability to sleep, or excessive crying,
• stiffness or decreased muscle tone,
• tremors, restlessness, or seizures,
• increased reflexes,
• irritability,
• low blood sugar levels.

If your baby has any of these symptoms at birth, or you are concerned about your baby's health, consult your doctor or midwife for advice.

There are indications that sertraline passes into breast milk. Therefore, sertraline can only be used in breastfeeding women if the doctor considers that the benefit outweighs any possible risk to the child.

In animal studies, it has been shown that some medicines like sertraline may reduce sperm quality. This could theoretically affect fertility; however, it has not yet been determined in humans.

Driving and using machines

Psychotropic medicines like sertraline may affect your ability to drive or use machines. Therefore, do not drive or operate heavy machinery until you know how this medicine affects your ability to perform these activities.

Sodium contentThis medicine contains less than 23 mg of sodium (1 mmol) per tablet, which is essentially "sodium-free".

3. How to take Aremis

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

The recommended dose is:

Adults:

Depression and Obsessive-Compulsive Disorder:

For depression and OCD, the usual effective dose is 50 mg per day. The daily dose can be increased in increments of 50 mg, at intervals of at least one week, and so on for several weeks. The maximum recommended dose is 200 mg per day.

Anxiety Disorder, Social Anxiety Disorder, and Post-Traumatic Stress Disorder:

For anxiety disorder, social anxiety disorder, and post-traumatic stress disorder, treatment should be started with a dose of 25 mg per day, and increased to 50 mg per day after one week.

The daily dose can be increased in increments of 50 mg over a period of several weeks. The maximum recommended dose is 200 mg per day.

Use in children and adolescents:

Aremis should only be used to treat children and adolescents aged 6 to 17 years who have OCD.

Obsessive-Compulsive Disorder:

Children from 6 to 12 years:The recommended starting dose is 25 mg per day.

After one week, your doctor may increase the dose to 50 mg per day. The maximum dose is 200 mg per day.

Adolescents from 13 to 17 years:The recommended starting dose is 50 mg per day. The maximum dose is 200 mg per day.

If you have liver or kidney problems, inform your doctor and follow the instructions they give you .

Method of administration:

Aremis tablets can be taken with or without food.

Take your medication once a day, either in the morning or at night.

Your doctor will indicate the duration of treatment with this medication. The duration will depend on the nature of your illness and your response to treatment. It will take several weeks for your symptoms to start improving. Treatment of depression usually needs to continue for 6 months after improvement.

If you take more Aremis than you should

If you accidentally take an excess of Aremis, contact your doctor or go to the emergency department of the nearest hospital. Always carry the medication packaging with you, whether there is medication left in it or not.

You can also call the Toxicology Information Service, phone 91 562 04 20, indicating the medication and the amount ingested.

The symptoms of overdose may include drowsiness, nausea, and vomiting, increased heart rate, tremors, agitation, dizziness, and rarely loss of consciousness.

If you forget to take Aremis:

Do not take a double dose to make up for missed doses. If you forget to take a dose, do not take it when you realize it. Take the next dose when it is due.

If you interrupt treatment with Aremis

Do not interrupt treatment with Aremis unless your doctor tells you to. Your doctor will want to gradually reduce the dose of Aremis over several weeks before you stop taking this medication definitively. If you interrupt treatment abruptly, you may experience side effects such as dizziness, numbness, sleep disturbances, agitation, or anxiety, headaches, nausea, vomiting, and tremors. If you experience any of these side effects, or any other during the interruption of your treatment with Aremis, please inform your doctor.

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

4. Possible side effects

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

The most common side effect is nausea. Side effects depend on the dose and often disappear or decrease as treatment continues.

Tell your doctor immediately:

If you experience any of the following symptoms after taking this medication, as these symptoms can be serious.

• If you develop a severe skin rash that causes blisters (erythema multiforme), (can affect the mouth and tongue). These can be signs of a disease known as Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis (TEN). In these cases, your doctor will interrupt treatment.
• Allergic reaction or allergy, which can present symptoms such as skin rash with itching, breathing problems, wheezing, swelling of the eyelids, face, or lips.
• If you experience agitation, confusion, diarrhea, increased temperature and blood pressure, excessive sweating, and increased heart rate. These are symptoms of serotonin syndrome. In rare cases, this syndrome can occur when taking certain medications at the same time as sertraline. Your doctor may decide to interrupt treatment.
• If you have a yellowish color of the skin and eyes, which can indicate liver damage.
• If you experience depressive symptoms with thoughts of self-harm or suicide (suicidal thoughts).
• If, after starting treatment with Aremis, you begin to feel restless and are unable to sit or stand. You should inform your doctor if you start to feel restless.
• If you have a seizure (convulsions).
• If you have a manic episode (see section 2. Warnings and precautions).

The following side effects were observed in clinical trials in adults and after marketing.

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

Insomnia, dizziness, drowsiness, headache, diarrhea, feeling unwell, dry mouth, ejaculation problems, and fatigue.

Common (may affect up to 1 in 10 patients):

• cold (chest), sore throat, runny nose,
• loss of appetite, increased appetite,
• anxiety, depression, agitation, decreased libido, nervousness, feeling strange, nightmares, teeth grinding,
• tremors, muscle movement problems (such as constant movements, muscle tension, difficulty walking, and stiffness, spasms, and involuntary muscle movements) *, numbness and tingling, increased muscle tone, lack of concentration, abnormal taste,
• visual disturbances,
• ringing in the ears,
• palpitations,
• hot flashes,
• yawns,
• stomach upset, constipation, abdominal pain, vomiting, gas,
• increased sweating, rash,
• back pain, joint pain, muscle pain,
• irregular menstrual cycle, erectile dysfunction,
• discomfort, chest pain, weakness, fever,
• weight gain,
• injury.

Uncommon (may affect up to 1 in 100 patients):

• diverticulitis, swollen lymph nodes, decreased platelets*, decreased white blood cell count*,
• severe allergic reaction,
• endocrine problems*,
• high cholesterol, problems controlling blood sugar levels (diabetes), low blood sugar, high blood sugar*, low sodium levels in the blood*,
• physical symptoms due to stress or emotions, abnormal nightmares*, drug dependence, sleepwalking, premature ejaculation,
• coma, abnormal movements, difficulty moving, increased sensitivity, severe headache (which can be a sign of a serious disease known as reversible cerebral vasoconstriction syndrome (RCVS))*, sensory disturbances,
• seeing spots in front of the eyes, glaucoma, double vision, photophobia (eye sensitivity to light), eye bleeding, irregular pupils*, abnormal vision*, tear problems,
• heart attack, dizziness, fainting or chest discomfort that could be signs of changes in heart activity (seen on an electrocardiogram) or abnormal heart rhythm*, decreased heart rate,
• circulation problems in the arms and legs,
• rapid breathing, progressive scarring of lung tissue (interstitial lung disease)*, throat spasm, difficulty speaking, slow breathing, hiccups,
• mouth ulcers, pancreatitis*, blood in stool, tongue ulcers, mouth sores,
• liver problems, serious liver problems*, yellowing of the skin and eyes (jaundice)*,
• sunburn*, skin swelling*, abnormal hair texture, unusual skin odor, capillary rash,
• muscle rupture*, bone disorder,
• urination problems, urinary disorders, urinary retention, incontinence, increased urine production, need to urinate at night,
• sexual dysfunction, excessive vaginal bleeding, vaginal hemorrhage, female sexual dysfunction,
• swollen legs, chills, difficulty walking, thirst,
• increased liver enzyme levels, weight loss,
• There have been reports of suicidal thoughts and behavior during treatment with sertraline or shortly after its interruption (see section 2).

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

• diverticulitis, swollen lymph nodes, decreased platelets*, decreased white blood cell count*,
• severe allergic reaction,
• endocrine problems*,
• high cholesterol, problems controlling blood sugar levels (diabetes), low blood sugar, high blood sugar*, low sodium levels in the blood*,
• physical symptoms due to stress or emotions, abnormal nightmares*, drug dependence, sleepwalking, premature ejaculation,
• coma, abnormal movements, difficulty moving, increased sensitivity, severe headache (which can be a sign of a serious disease known as reversible cerebral vasoconstriction syndrome (RCVS))*, sensory disturbances,
• seeing spots in front of the eyes, glaucoma, double vision, photophobia (eye sensitivity to light), eye bleeding, irregular pupils*, abnormal vision*, tear problems,
• heart attack, dizziness, fainting or chest discomfort that could be signs of changes in heart activity (seen on an electrocardiogram) or abnormal heart rhythm*, decreased heart rate,
• circulation problems in the arms and legs,
• rapid breathing, progressive scarring of lung tissue (interstitial lung disease)*, throat spasm, difficulty speaking, slow breathing, hiccups,
• mouth ulcers, pancreatitis*, blood in stool, tongue ulcers, mouth sores,
• liver problems, serious liver problems*, yellowing of the skin and eyes (jaundice)*,
• sunburn*, skin swelling*, abnormal hair texture, unusual skin odor, capillary rash,
• muscle rupture*, bone disorder,
• urination problems, urinary disorders, urinary retention, incontinence, increased urine production, need to urinate at night,
• sexual dysfunction, excessive vaginal bleeding, vaginal hemorrhage, female sexual dysfunction,
• swollen legs, chills, difficulty walking, thirst,
• increased liver enzyme levels, weight loss,

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

• partial loss of vision,
• jaw locking*, muscle weakness and intense muscle pain, which can be a sign of multiple acyl-CoA dehydrogenase deficiency (MADD)*,
• nocturnal urinary incontinence*,
• colon inflammation (which causes diarrhea) *,
• excessive vaginal bleeding shortly after childbirth (postpartum hemorrhage), see "Pregnancy, breastfeeding, and fertility" in section 2 for more information.

*Side effects reported after marketing.

Other side effects in children and adolescents

In clinical trials in children and adolescents, side effects were generally similar to those reported in adults (see above). The most common side effects in children and adolescents were headache, insomnia, diarrhea, and nausea.

Symptoms that may appear when treatment is interrupted

If you interrupt treatment with this medication abruptly, you may experience side effects such as dizziness, numbness, sleep disturbances, agitation, or anxiety, headaches, nausea, vomiting, and tremors (see section 3. "If you interrupt treatment with Aremis").

An increased risk of bone fractures has been observed in patients taking this type of medication.

Reporting side effects

If you experience any side effects, consult your doctor, pharmacist, or nurse, even if they are possible side effects that do not appear in this leaflet. You can also report them directly through the Spanish Medicines and Health Products Agency's pharmacovigilance system: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medication.

5. Conservation of Aremis

Keep this medication out of sight and reach of children.

Do not use this medication after the expiration date shown on the packaging after CAD. The expiration date is the last day of the month indicated.

Do not store above 30°C.

Medications should not be thrown down the drain or into the trash. Deposit the packaging and medications you no longer need at the SIGRE collection point in the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.

6. Package contents and additional information

Composition of Aremis:

• Each film-coated tablet contains sertraline hydrochloride equivalent to 100 mg of sertraline.

The other ingredients are: calcium phosphate dihydrate (E341), microcrystalline cellulose (E460), hydroxypropylcellulose (E463), sodium starch glycolate (type A), magnesium stearate (E572), titanium dioxide (E171), hypromellose (E464), macrogol 400 (E1521), macrogol 6000 (E1521), and polysorbate 80 (E433).

Appearance of the product and package contents

Aremis 100 mg is presented in film-coated tablets, white or almost white, elongated, biconvex, with the anagram "AREMIS" and scored on one side and "100" on the other.

Aremis is available in blister packs containing 30, 60, or 500 (clinical packaging) tablets.

Marketing authorization holder and manufacturer

Marketing authorization holder:

Esteve Pharmaceuticals, S.A.

Passeig de la Zona Franca, 109

08038 Barcelona (Spain)

Manufacturer:

TOWA Pharmaceutical Europe S.L.

c/ de Sant Marti, 75-97

08107 Martorelles (Spain)

Date of the last revision of this leaflet: June 2025

Detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS)http://www.aemps.gob.es/