DABIGATRAN ETEXILATE COMBIX 75 mg HARD CAPSULES

Introduction

Package Leaflet:information for the patient

Dabigatran etexilate Combix75 mg hard capsules EFG

dabigatran etexilate

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

1. What is Dabigatran etexilate Combix and what is it used for

Dabigatran etexilate Combix contains the active substance dabigatran etexilate and belongs to a group of medicines called anticoagulants. It works by blocking a substance in the body involved in the formation of blood clots.

Dabigatran etexilate is used in adults to:

• prevent the formation of blood clots in the veins after knee or hip replacement surgery.

Dabigatran etexilate is used in children to:

• treat blood clots and prevent them from forming again.

2. What you need to know before you take Dabigatran etexilate Combix

Do not take Dabigatran etexilate Combix

• if you are allergic to dabigatran etexilate or any of the other ingredients of this medicine (listed in section 6).
• if your kidney function is severely reduced.
• if you are currently bleeding.
• if you have any disease in an organ of the body that increases the risk of severe bleeding (e.g. stomach ulcer, injury or bleeding in the brain, recent brain or eye surgery).
• if you are prone to bleeding. This tendency may be congenital, of unknown cause, or caused by other medicines.
• if you are taking medicines to prevent blood clots (e.g. warfarin, rivaroxaban, apixaban or heparin), except when switching from one anticoagulant treatment to another, while having a venous or arterial catheter and being administered heparin through this catheter to keep it open or while your normal heart rhythm is being restored through a procedure called catheter ablation for atrial fibrillation.
• if your liver function is severely reduced or you have a life-threatening liver disease.
• if you are taking oral ketoconazole or itraconazole, medicines used to treat fungal infections.
• if you are taking oral cyclosporine, a medicine used to prevent organ rejection after a transplant.
• if you are taking dronedarone, a medicine used to treat irregular heartbeat.
• if you are taking a combination product of glecaprevir and pibrentasvir, an antiviral medicine used to treat hepatitis C.
• if you have had an artificial heart valve implanted that requires permanent anticoagulant treatment.

Warnings and precautions

Talk to your doctor before starting to take Dabigatran etexilate Combix. During treatment with this medicine, you may also need to talk to your doctor if you experience any symptoms or if you need to have surgery.

Tell your doctorif you have or have had any disorder or disease, especially any of the following:

• If you have an increased risk of bleeding, for example:
• • if you have recently had bleeding.
  • if you have had surgical removal of tissue (biopsy) in the last month.
  • if you have had a severe injury (e.g. a bone fracture, a head injury or any injury that required surgical treatment).
  • if you have inflammation of the esophagus or stomach.
  • if you have problems with acid reflux in the esophagus.
  • if you are taking medicines that may increase the risk of bleeding. See "Other medicines and Dabigatran etexilate Combix" below.
  • if you are using anti-inflammatory medicines such as diclofenac, ibuprofen or piroxicam.
  • if you have a heart infection (bacterial endocarditis).
  • if you know you have reduced kidney function or if you are dehydrated (symptoms include feeling thirsty and passing small amounts of dark-colored urine/concentrated urine with foam).
  • if you are over 75 years old.
  • if you are an adult patient and weigh 50 kg or less.
  • only if used in children: if the child has an infection in the brain or around it.

• If you have had a heart attack or if you have been diagnosed with diseases that increase the risk of having a heart attack.

• If you have a liver disease associated with changes in blood tests. The use of this medicine is not recommended in this case.

Be careful with Dabigatran etexilate Combix

• If you need to have surgery:

In this case, dabigatran etexilate should be temporarily stopped due to an increased risk of bleeding during and after surgery. It is very important that you take dabigatran etexilate before and after surgery exactly at the times indicated by your doctor.

• If surgery requires the placement of a catheter or injection into the spinal column (e.g. for epidural or spinal anesthesia or for pain relief):
• • It is very important that you take Dabigatran etexilate Combix before and after surgery exactly at the times indicated by your doctor.
  • Tell your doctor immediately if you experience numbness or weakness in your legs or bowel or bladder problems after the end of anesthesia, as this situation requires urgent attention.
• If you fall or injure yourself during treatment, especially if you hit your head. Seek urgent medical attention. You may need a doctor to examine you, as you may have a higher risk of bleeding.

• If you know you have a disease called antiphospholipid syndrome (an immune system disorder that increases the risk of blood clots), tell your doctor so that they can decide if it is necessary to modify the treatment.

Other medicines and Dabigatran etexilate Combix

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. In particular, you must tell your doctor before taking Dabigatran etexilate Combix if you are taking any of the following medicines:

• Medicines to reduce blood clotting (e.g. warfarin, phenprocoumon, acenocoumarol, heparin, clopidogrel, prasugrel, ticagrelor, rivaroxaban, acetylsalicylic acid)
• Medicines for the treatment of fungal infections (e.g. ketoconazole, itraconazole), except if only applied to the skin
• Medicines used to treat irregular heartbeat (e.g. amiodarone, dronedarone, quinidine, verapamil)

If you are using medicines that contain amiodarone, quinidine or verapamil, your doctor may tell you to use a reduced dose of Dabigatran etexilate Combix depending on the disease for which it was prescribed. See also section 3.

• Medicines for the prevention of organ rejection after a transplant (e.g. tacrolimus, cyclosporine)
• A combination product of glecaprevir and pibrentasvir (an antiviral medicine used to treat hepatitis C)
• Pain relievers and anti-inflammatory medicines (e.g. acetylsalicylic acid, ibuprofen, diclofenac)
• St. John's Wort, a herbal medicine for depression
• Antidepressant medicines called selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors
• Rifampicin or clarithromycin (two antibiotics)
• Antiviral medicines for HIV (e.g. ritonavir)
• Certain medicines for the treatment of epilepsy (e.g. carbamazepine, phenytoin)

Pregnancy and breastfeeding

The effects of Dabigatran etexilate Combix on pregnancy and the fetus are not known. You should not use this medicine if you are pregnant unless your doctor tells you it is safe to do so. If you are of childbearing age, you should avoid becoming pregnant during treatment with Dabigatran etexilate Combix.

Breastfeeding is not recommended during treatment with Dabigatran etexilate Combix.

Driving and using machines

Dabigatran etexilate Combix has no known effects on the ability to drive and use machines.

3. How to take Dabigatran etexilate Combix

Dabigatran etexilate Combix capsules can be used in adults and children aged 8 years or older who are able to swallow the capsules whole. There are other pharmaceutical forms suitable for the treatment of children under 8 years.

Follow the instructions for administration of this medicine exactly as indicated by your doctor. If you are unsure, consult your doctor again.

Take Dabigatran etexilate Combix as recommended for the following situations:

Prevention of blood clot formation after knee or hip replacement surgery

The recommended dose is 220 mg once a day(administered in the form of 2 capsules of 110 mg).

If your kidney function is reducedby more than half or if you are 75 years of age or older, the recommended dose is 150 mg once a day(administered in the form of 2 capsules of 75 mg).

If you are using medicines that contain amiodarone, quinidine or verapamil, the recommended dose is 150 mg once a day(administered in the form of 2 capsules of 75 mg).

If you are using medicines that contain verapamil and your kidney function is reducedby more than half, you should be indicated a reduced dose of Dabigatran etexilate Combix of 75 mgbecause your risk of bleeding may increase.

In both types of surgery, treatment should not be started if there is bleeding at the surgical site. If treatment cannot be started until the day after surgery, dosing should be started with 2 capsules once a day.

After knee replacement surgery

Treatment with Dabigatran etexilate Combix should be started 1-4 hours after surgery, taking a single capsule. After that, 2 capsules should be taken once a day for a total of 10 days.

After hip replacement surgery

Treatment with Dabigatran etexilate Combix should be started 1-4 hours after surgery, taking a single capsule. After that, 2 capsules should be taken once a day for a total of 28-35 days.

Treatment of blood clots and prevention of blood clots in children

Dabigatran etexilate Combix should be taken twice a day, one dose in the morning and one dose in the evening, approximately at the same time every day. The administration interval should be as close as possible to 12 hours.

The recommended dose depends on weight and age. Your doctor will determine the correct dose. Your doctor may adjust the dose during treatment. Continue using all other medicines unless your doctor tells you to stop using one.

Table 1 shows the single and total daily doses of Dabigatran etexilate Combix in milligrams (mg). The doses depend on the patient's weight in kilograms (kg) and age in years.

Table 1:Dosing table for Dabigatran etexilate Combix capsules

Doses that require combinations of more than one capsule

How to take Dabigatran etexilate Combix

Dabigatran etexilate Combix capsules can be used in adults and children aged 8 years or older who are able to swallow the capsules whole

Dabigatran etexilate Combix can be taken with or without food. The capsule should be swallowed whole with a glass of water to ensure release in the stomach. Do not break, chew, or open the capsule to take only its contents, as this may increase the risk of bleeding.

Changing anticoagulant treatment

Do not change your anticoagulant treatment without specific instructions from your doctor.

If you take more Dabigatran etexilate Combix than you should

Taking too much of this medicine increases the risk of bleeding. Contact your doctor immediately if you have taken too many capsules. There are specific treatment options available.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medicine and the amount ingested.

If you forget to take Dabigatran etexilate Combix

Prevention of blood clot formation after knee or hip replacement surgery Take the remaining daily doses of Dabigatran etexilate Combix at the same time the next day.

Do not take a double dose to make up for forgotten doses.

Treatment of blood clots and prevention of blood clots in children

A forgotten dose can be taken up to 6 hours before the next dose.

A forgotten dose should be omitted if the time remaining before the next dose is less than 6 hours. Do not take a double dose to make up for forgotten doses.

If you stop taking Dabigatran etexilate Combix

Take Dabigatran etexilate Combix exactly as prescribed. Do not stop your treatment with this medicine without first consulting your doctor, as the risk of developing a blood clot may be higher if you stop treatment too soon. Contact your doctor if you experience indigestion after taking Dabigatran etexilate Combix.

If you have any other questions about 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.

Dabigatran etexilate acts on blood coagulation; therefore, most adverse effects are related to signs such as bruising or bleeding. Episodes of major or severe bleeding may occur, which are the most serious adverse effects and, regardless of their location, can cause disability, be potentially life-threatening, or even cause death. In some cases, these bleedings may not be apparent.

If you experience any episode of bleeding that does not stop by itself or if you experience signs of excessive bleeding (exceptional weakness, fatigue, paleness, dizziness, headache, or unexplained swelling), consult your doctor immediately. Your doctor may decide to keep you under close observation or change your medication.

Inform your doctor immediately if you experience a severe allergic reaction that causes difficulty breathing or dizziness.

The possible adverse effects are detailed below, grouped according to their frequency of occurrence.

Prevention of blood clot formation after knee or hip arthroplasty

Frequent (may affect up to 1 in 10 people):

• Decrease in the amount of hemoglobin in the blood (the substance present in red blood cells)
• Anomalies in liver function tests

Infrequent (may affect up to 1 in 100 people):

• Bleeding may occur from the nose, stomach, or intestine, from the penis/vagina, or from the urinary tract (including blood in the urine that stains the urine pink or red), from hemorrhoids, from the rectum, under the skin, from a joint, or after an injury or surgery
• Formation of hematomas or bruising after surgery
• Detection of blood in stool in a laboratory test
• Decrease in the number of red blood cells in the blood
• Decrease in the proportion of blood cells
• Allergic reaction
• Vomiting
• Frequent loose or liquid stools
• Feeling of nausea
• Pus discharge from a wound (discharge of liquid from a surgical wound)
• Increased liver enzymes
• Yellowish discoloration of the skin or the whites of the eyes, caused by liver or blood problems

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

• Bleeding
• Bleeding may occur in the brain, at the site of a surgical incision, at the site of an injection, or at the site of a catheter entry in a vein
• Bloody pus discharge from the site of a catheter entry in a vein
• Coughing up blood or sputum with blood spots
• Decrease in the number of platelets in the blood
• Decrease in the number of red blood cells in the blood after surgery
• Severe allergic reaction that causes difficulty breathing or dizziness
• Severe allergic reaction that causes swelling of the face or throat
• Skin rash with dark red, prominent, and itchy bumps, caused by an allergic reaction
• Sudden change in skin color and physical appearance
• Itching
• Ulcer in the stomach or intestine (including ulcer in the esophagus)
• Inflammation of the esophagus and stomach
• Reflux of gastric juice into the esophagus
• Abdominal pain or stomach pain
• Indigestion
• Difficulty swallowing
• Fluid leaking from a wound
• Fluid leaking from a wound after surgery

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

• Difficulty breathing or wheezing
• Decrease in the number or even absence of white blood cells (which help fight infections)
• Hair loss

Treatment of blood clots and prevention of blood clot formation in children

Frequent (may affect up to 1 in 10 people):

• Decrease in the number of red blood cells in the blood
• Decrease in the number of platelets in the blood
• Skin rash with dark red, prominent, and itchy bumps, caused by an allergic reaction
• Sudden change in skin color and physical appearance
• Formation of hematomas
• Nosebleeds
• Reflux of gastric juice into the esophagus
• Vomiting
• Feeling of nausea
• Frequent loose or liquid stools
• Indigestion
• Hair loss
• Increased liver enzymes

Infrequent (may affect up to 1 in 100 people):

• Decrease in the number of white blood cells (which help fight infections)
• Bleeding may occur in the stomach or intestine, brain, rectum, penis/vagina, or urinary tract (including blood in the urine that stains the urine pink or red), or under the skin
• Decrease in the amount of hemoglobin in the blood (the substance present in red blood cells)
• Decrease in the proportion of blood cells
• Itching
• Coughing up blood or sputum with blood spots
• Abdominal pain or stomach pain
• Inflammation of the esophagus and stomach
• Allergic reaction
• Difficulty swallowing
• Yellowish discoloration of the skin or the whites of the eyes, caused by liver or blood problems

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

• Absence of white blood cells (which help fight infections)
• Severe allergic reaction that causes difficulty breathing or dizziness
• Severe allergic reaction that causes swelling of the face or throat
• Difficulty breathing or wheezing
• Bleeding
• Bleeding may occur in a joint or wound, in a surgical incision, at the site of an injection, or at the site of a catheter entry in a vein
• Bleeding may occur from hemorrhoids
• Ulcer in the stomach or intestine (including ulcer in the esophagus)
• Anomalies in liver function tests

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 prospectus. 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. Storage of Dabigatran Etexilate Combix

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

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

Aluminum – Aluminum (oPA/Al/PVC//Al blister): Do not store above 30°C.

Aluminum with desiccant cover – Aluminum (OPA/Al/PE//PE/Al/LDPE): No special storage conditions required.

Bottles: Store in the original package to protect from moisture.

Medicines should not be disposed of through wastewater or household waste. Deposit the packaging and unused medicines in the SIGRE Point of the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and unused medicines. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Dabigatran Etexilate Combix

• The active ingredient is dabigatran. Each hard capsule contains dabigatran etexilate mesilate equivalent to 75 mg of dabigatran etexilate

The other components are:

• Capsule content: tartaric acid, hypromellose, hydroxypropylcellulose, talc.
• Capsule coating: carrageenan, potassium chloride, titanium dioxide, hypromellose.

Product Appearance and Package Contents

Hard capsules approximately 18.0 mm in size with a white and opaque cap and a white and opaque body of size "2" filled with white to yellowish granules.

The capsules are stored in blisters composed of Aluminum with desiccant cover – Aluminum (OPA/Al/PE//PE/Al/LDPE) and Aluminum – Aluminum (oPA/Al/PVC//Al blister) or a white plastic bottle with silica gel desiccant in the cap (PP).

Package sizes:

Blister packs containing: 10, 10x1 (single-dose blister), 30, 30x1 (single-dose blister), 60, 60x1 (single-dose blister), 100, or 180 hard capsules.

Bottles containing: 100 hard capsules.

Only some package sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Laboratorios Combix, S.L.U.

C/ Badajoz 2, Edificio 2

28223 Pozuelo de Alarcón (Madrid)

Spain

Manufacturer

Laboratorios Liconsa S.A. Avenida Miralcampo 7 Poligono Industrial Miralcampo 19200, Azuqueca De Henares

Guadalajara

Spain

Date of the Last Revision of this Prospectus:

June 2024

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/)