CLANDERON 37.5 MG/325 MG FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the Patient

Clanderon 37.5 mg / 325 mg film-coated tablets EFG

tramadol hydrochloride/paracetamol

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

1. What is Clanderon and what is it used for

Clanderon is a combination of two pain relievers, tramadol and paracetamol, which work together to relieve pain.

Clanderon is indicated for the symptomatic treatment of moderate to severe pain, when your doctor considers that a combination of tramadol and paracetamol is necessary.

Clanderon should only be used by adults and adolescents over 12 years of age.

2. What you need to know before you take Clanderon

Do not take Clanderon:

• if you are allergic to tramadol hydrochloride, paracetamol or any of the other ingredients of this medicine (listed in section 6);
• if you have taken any medicine for the treatment of insomnia, powerful pain relievers (opioids), or psychotropic drugs (medicines that can alter mood and emotions) in case of acute alcohol intoxication;
• if you are taking monoamine oxidase inhibitors (MAOIs) (certain medicines used for the treatment of depression or Parkinson's disease) or if you have taken them in the last 14 days before treatment with Clanderon;
• if you have severe liver disease;
• if you have epilepsy that is not adequately controlled with your current treatment.

Warnings and precautions

Consult your doctor before starting to take Clanderon:

• if you are taking other medicines that contain paracetamol or tramadol;
• if you have liver problems or liver disease or if you notice that your eyes or skin turn yellow. This may be a sign of jaundice or problems with your bile ducts;
• if you have kidney problems;
• if you have severe breathing difficulties, for example asthma or severe lung problems;
• if you are epileptic or have had seizures or convulsions;
• if you have recently had a head injury, shock or severe headaches associated with vomiting;
• if you are dependent on any other medicine used for pain relief, for example morphine;
• if you are taking other pain relievers that contain buprenorphine, nalbuphine or pentazocine;
• if you are going to be anesthetized. Tell your doctor or dentist that you are taking tramadol/paracetamol;
• if you suffer from depression and are taking antidepressants, as some may interact with tramadol (see "Other medicines and Clanderon").

If you experience any of the following side effects, tell your doctor immediately:

If you have severe illnesses, such as severe kidney failure or sepsis (when bacteria and their toxins circulate in the blood, causing damage to organs), or if you have malnutrition, chronic alcoholism or are also taking flucloxacillin (an antibiotic). A serious disease called metabolic acidosis (an anomaly in the blood and fluids) has been reported in patients in these situations when paracetamol is used at regular doses for a prolonged period or when paracetamol is taken with flucloxacillin. The symptoms of metabolic acidosis may include: severe breathing difficulties with deep and rapid breathing, drowsiness, feeling unwell (nausea) and vomiting.

There is a weak risk that you may experience a serotonin syndrome that can occur after taking tramadol in combination with certain antidepressants or tramadol alone. Consult your doctor immediately if you experience any of the symptoms associated with this serious syndrome (see section 4 "Possible side effects").

Sleep-related breathing disorders

Clanderon may cause sleep-related breathing disorders such as central sleep apnea (pauses in breathing during sleep) and sleep-related hypoxemia (low oxygen level in blood). These symptoms may be pauses in breathing during sleep, nocturnal awakenings due to difficulty breathing, difficulty maintaining sleep or excessive daytime sleepiness. If you or someone else observes these symptoms, consult your doctor. Your doctor may consider reducing the dose.

Tramadol is transformed in the liver by an enzyme. Some people have a variation of this enzyme and this can affect each person in different ways. In some people, sufficient pain relief may not be achieved, while others are more likely to experience serious side effects. If you notice any of the following side effects, you must stop taking this medicine and consult a doctor immediately: slow or shallow breathing, confusion, drowsiness, constricted pupils, general malaise or vomiting, constipation, loss of appetite.

Tell your doctor or pharmacist if you experience any of the following symptoms while taking Clanderon:

Extreme fatigue, loss of appetite, severe abdominal pain, nausea, vomiting or low blood pressure. This may indicate that you have adrenal insufficiency (low cortisol levels). If you experience any of these symptoms, inform your doctor, he will decide if you should take a hormonal supplement.

Tolerance, dependence and addiction

This medicine contains tramadol, which is an opioid medicine. Repeated use of opioids can make the medicine less effective (you get used to it, which is known as tolerance). Repeated use of tramadol/paracetamol can also lead to dependence, abuse and addiction, which can result in a potentially fatal overdose. The risk of these side effects may increase with a higher dose and longer use.

Dependence or addiction can make you feel that you no longer control the amount of medicine you need to take or how often you need to take it.

The risk of becoming dependent or addicted varies from person to person. You may have a higher risk of becoming dependent or addicted to tramadol/paracetamol if:

• You or someone in your family has abused or been dependent on alcohol, prescription medicines or illegal drugs ("addiction").
• You are a smoker.
• You have ever had problems with your mood (depression, anxiety or a personality disorder) or have been treated by a psychiatrist for other mental illnesses.

If you notice any of the following signs while taking tramadol/paracetamol, it could be a sign that you have become dependent or addicted:

• You need to take the medicine for longer than advised by your doctor.
• You need to take more than the recommended dose.
• You use the medicine for reasons other than those prescribed, for example "to calm down" or "to sleep".
• You have repeatedly tried to stop or control the use of the medicine without success.
• When you stop taking the medicine, you feel unwell, and you feel better when you take it again ("withdrawal effect").

If you observe any of these signs, talk to your doctor so that he can indicate the best treatment option for you, including when it is appropriate to stop taking it and how to do it safely (see section 3, "If you stop taking Clanderon").

Children and adolescents

Treatment is not recommended in children under 12 years of age.

Use in children with respiratory problems

Tramadol is not recommended in children with respiratory problems, as the symptoms of tramadol toxicity can worsen in these children.

Other medicines and Clanderon

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

Important: This medicine contains paracetamol and tramadol. Tell your doctor if you are taking any other medicine that contains paracetamol or tramadol, so that you do not exceed the maximum daily dose.

Clanderon must not be takenwith monoamine oxidase inhibitors (MAOIs) (see section "Do not take Clanderon").

Clanderon is not recommended if you are being treated with:

• Carbamazepine (a medicine normally used to treat epilepsy or certain types of pain, such as severe pain attacks in the face called trigeminal neuralgia). - Buprenorphine, nalbuphine or pentazocine (opioid pain relievers). Pain relief may be reduced.
• Flucloxacillin (an antibiotic), due to a serious risk of blood and fluid anomaly (called metabolic acidosis) that requires urgent treatment (see section 2).

The risk of side effects increases:

• If you are taking triptans (for the treatment of migraines) or selective serotonin reuptake inhibitors "SSRIs" (for the treatment of depression). If you experience confusion, agitation, fever, sweating, uncoordinated movements of the limbs or eyes, uncontrolled muscle contractions or diarrhea, you should call your doctor.

• If you are taking other pain relievers such as morphine and codeine (also when used for the treatment of cough), baclofen (a muscle relaxant), some medicines to lower blood pressure, medicines for the treatment of allergies. You may feel drowsy or dizzy. If this happens, consult your doctor.

• If you are taking gabapentin or pregabalin to treat epilepsy or pain due to nerve problems (neuropathic pain).

• The concomitant use of Clanderon and sedative medicines such as benzodiazepines or related medicines increases the risk of drowsiness, breathing difficulties (respiratory depression), coma and can be potentially fatal. For this reason, concomitant use should only be considered when other treatment options are not possible. However, if your doctor prescribes this medicine with sedative medicines, you should limit the dose and duration of concomitant treatment.

Tell your doctor about all sedative medicines you are taking and follow your doctor's dosage recommendation strictly. It may be useful to inform your friends and family about the signs and symptoms indicated above. Tell your doctor if you experience any of these symptoms.

• If you are taking medicines that can cause seizures, such as certain antidepressants or antipsychotics. The risk of seizures increases if you take Clanderon at the same time as these medicines. Your doctor will tell you if Clanderon is suitable for you.

• If you are taking antidepressants, Clanderon may interact with these medicines and you may experience a serotonin syndrome (see the section 4 "Possible side effects").

• If you are taking warfarin or phenprocoumon (a medicine used to prevent blood clots). The effectiveness of these medicines may be altered, and there is a risk of bleeding. You should inform your doctor immediately of any prolonged or unexpected bleeding.

The effectiveness of Clanderon may be altered if you also take:

• metoclopramide, domperidone or ondansetron (medicines for the treatment of nausea and vomiting),
• cholestyramine (a medicine that reduces cholesterol in the blood).

Your doctor will know which medicines are safe to use with Clanderon.

Taking Clanderon with food, drinks and alcohol

Clanderon may make you feel drowsy. Alcohol may make you feel drowsy, so it is recommended not to drink alcohol while taking Clanderon.

Pregnancy, breast-feeding and fertility

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

Because Clanderon contains tramadol, it is not recommended to take this medicine during pregnancy or breast-feeding. If you become pregnant during treatment with Clanderon, consult your doctor before taking the next tablet.

Breast-feeding

Tramadol is excreted in breast milk. For this reason, you should not take Clanderon more than once during breast-feeding, or if you take Clanderon more than once, you should interrupt breast-feeding.

Based on human experience, it is not suggested that tramadol affects fertility in men and women. There are no data available on the combination of tramadol and paracetamol on fertility.

Driving and using machines

Ask your doctor if you can drive or use machines during treatment with Clanderon. It is important that before driving or using machines, you observe how this medicine affects you. Do not drive or use machines if you feel drowsy, dizzy, have blurred vision or double vision, or have difficulty concentrating. Be especially careful at the start of treatment, after a dose increase, after a change in formulation and/or when administering it concomitantly with other medicines.

Clanderon contains sodium

This medicine contains less than 23 mg of sodium (1 mmol) per tablet; this is, essentially "sodium-free".

3. How to take Clanderon

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

Before starting treatment and regularly during treatment, your doctor will explain what you can expect from the use of tramadol/paracetamol, when and for how long you should take it, when you should contact your doctor and when you should stop it (see also section 2).

You should take tramadol/paracetamol for the shortest possible time.

Treatment is not recommended in children under 12 years of age.

The dose should be adjusted to the intensity of the pain and your individual sensitivity. Normally, the lowest possible dose that produces pain relief should be used.

Unless your doctor prescribes otherwise, the recommended starting dose for adults and adolescents over 12 years of age is 2 tablets.

If necessary, you can increase the dose, as recommended by your doctor.

The shortest interval between doses must be at least 6 hours.

Do not take more than 8 tramadol/paracetamol tablets per day.

Do not take tramadol/paracetamol more frequently than indicated by your doctor.

Elderly patients

In elderly patients (over 75 years of age), the elimination of tramadol may be slow. If this is your case, your doctor may recommend prolonging the dosing intervals.

Patients with liver or kidney impairment/patients on dialysis

If you have severe liver or kidney disease, treatment with this medicine is not recommended. If you have moderate liver or kidney impairment, your doctor may prolong the dosing intervals.

Method of administration

This medicine is presented in the form of tablets for oral administration.

The tablets should be swallowed whole with sufficient liquid. They should not be broken or chewed.

If you think that the effect of tramadol/paracetamol is too strong (e.g., you feel very drowsy or have difficulty breathing) or too weak (e.g., you do not have adequate pain relief), tell your doctor.

If you take more Clanderon than you should

If you have taken more tramadol/paracetamol than you should, even if you feel well, consult your doctor or pharmacist immediately, as there is a risk of serious liver damage that may only become apparent later.

In case of overdose or accidental ingestion, consult the Toxicology Information Service, telephone: 91 562 04 20, indicating the medicine and the amount taken.

If you forget to take Clanderon

If you forget to take this medicine, it is likely that the pain will return.

Do not take a double dose to make up for forgotten doses, simply continue taking the tablets as usual.

If you stop taking Clanderon

Do not stop taking this medicine suddenly unless your doctor tells you to. If you want to stop taking your medicine, talk to your doctor first, especially if you have been taking it for a long time. Your doctor will inform you when and how to stop it, which can be done by gradually reducing the dose to reduce the likelihood of unnecessary side effects (withdrawal symptoms).

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible Adverse Effects

Like all medicines, this medicine can cause adverse effects, although not all people suffer from them.

Very Common: may affect more than 1 in 10 people

• nausea
• dizziness, drowsiness.

Common: may affect 1 in 10 people

• vomiting, digestive problems (constipation, flatulence, diarrhea), stomach pain, dry mouth,
• itching, increased sweating (hyperhidrosis),
• headache, agitation,
• confusion, sleep disorders, mood changes (anxiety, nervousness, euphoria - feeling of being "high" all the time).

Uncommon: may affect 1 in 100 people

• increased heart rate or increased blood pressure, cardiac rhythm and frequency disorders,
• tingling sensation, numbness or pinching sensation in the limbs, ringing in the ears, involuntary muscle spasms,

• depression, nightmares, hallucinations (hearing, seeing or perceiving something that does not exist in reality), memory loss,

• difficulty breathing,
• difficulty swallowing, blood in the stool,
• skin reactions (e.g. eruptions, urticarial hives).
• increased liver enzyme values,
• presence of albumin in the urine, difficulty or pain when urinating,
• chills, hot flashes, chest pain.

Rare: may affect 1 in 1,000 people

• seizures, difficulties in carrying out coordinated movements, transient loss of consciousness (syncope),
• dependence on the medicine,
• delirium,
• blurred vision, pupil contraction (miosis),
• speech disorders,
• excessive dilation of the pupils (mydriasis)

• Frequency not known: cannot be estimated from the available data
• decrease in blood sugar levels (hypoglycemia).
• hypotension.
• serotonin syndrome, which can manifest as changes in mental state (e.g. agitation, hallucinations, coma), and other effects, such as fever, increased heart rate, unstable blood pressure, involuntary muscle contractions, muscle stiffness, lack of coordination and/or gastrointestinal symptoms (e.g. nausea, vomiting, diarrhea) (see section 2 "What you need to know before taking Clanderon").

The following recognized adverse effects have been reported by people who have taken medicines that contained only tramadol or only paracetamol. However, if you experience any of these symptoms while taking Clanderon, you should tell your doctor.

• Dizzy sensation when standing up after lying down or sitting, low heart rate, fainting, changes in appetite, muscle weakness, slower or weaker breathing, changes in mood, changes in activity, changes in perception, worsening of asthma.

• The use of tramadol/paracetamol together with anticoagulants (e.g. Fenprocoumon, warfarin) may increase the risk of bleeding. You should inform your doctor immediately about any prolonged or unexpected bleeding.

• In rare cases, skin eruptions, being indicative of allergic reactions that can manifest through the sudden swelling of the face and neck, shortness of breath or a drop in blood pressure and dizziness. If this happens to you, stop the treatment and consult your doctor immediately. You should not take this medicine again.

• Frequency not known (cannot be estimated from the available data): a serious disease that can make the blood more acidic (called metabolic acidosis) in patients with severe disease who use paracetamol (see section 2).

In rare cases, using a medicine like tramadol can create dependence, making it difficult to stop taking it.

In rare cases, people who have been taking tramadol for some time may feel unwell if the treatment is stopped abruptly. They may feel agitated, anxious, nervous or trembly.

They may be hyperactive, have difficulty sleeping and have digestive and intestinal disorders.

Very few people may also have panic attacks, hallucinations, unusual perceptions such as itching, tingling sensation and numbness, and ringing in the ears (tinnitus).

If you experience any of these symptoms after stopping treatment with Clanderon, please consult your doctor.

In exceptional cases, blood tests may reveal certain anomalies, such as low platelet count, which can result in nosebleeds or bleeding gums.

In rare cases, serious skin reactions have been reported with paracetamol.

There have been reports of rare cases of respiratory depression with tramadol.

Reporting of Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that is not listed in this leaflet.

You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Conservation of Clanderon

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

Store this medicine in a safe and protected place, where other people cannot access it. It can cause serious harm and be fatal for people who have not been prescribed it.

Do not use this medicine after the expiration date that appears on the packaging, after CAD. The expiration date is the last day of the month indicated.

This medicine does not require special storage conditions.

Medicines should not be thrown away through the sewers or in the trash. Deposit the packaging and medicines you no longer need in the SIGRE Point of the pharmacy. Ask your pharmacist how to dispose of the packaging and medicines you no longer need. This way, you will help protect the environment.

6. Package Contents and Additional Information

• The active ingredients are tramadol hydrochloride and paracetamol.

• Each film-coated tablet contains 37.5 mg of tramadol hydrochloride and 325 mg of paracetamol.

• The other components (excipients) are: cellulose powder, pregelatinized corn starch, sodium carboxymethyl starch (type A) (potato), corn starch, magnesium stearate, hypromellose, titanium dioxide, talc, triethyl citrate.

Appearance of the Product and Package Contents

Clanderon 37.5 mg / 325 mg film-coated tablets EFG are white or almost white tablets.

Clanderon is available in PVC/aluminum blisters containing 20, 30, 50, 60 and 90 film-coated tablets.

Only some package sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Aristo Pharma Iberia, S.L.

C/Solana, 26

28850, Torrejón de Ardoz

Madrid, Spain

Manufacturer

Laboratorios Medicamentos Internacionales S.A. (Medinsa)

C/Solana, 26

28850, Torrejón de Ardoz

Madrid, Spain

or

ARISTO PHARMA GMBH

Wallenroder Strasse 8-10 - Berlin - 13435 - Germany

This medicine is authorized in the Member States of the European Economic Area with the following names:

PT: Tramadol / Paracetamol Aristo 37.5 mg / 325 mg film-coated tablet

DE: Tramadol/Paracetamol Aristo 37,5 mg / 325 mg Filmtabletten

ES: Clanderon 37.5 mg / 325 mg film-coated tablets EFG

IT: Tramadolo e Paracetamolo 37.5 mg / 325 mg film-coated tablets

Date of the Last Revision of this Leaflet:May 2025

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